Hospital Waiting Lists

– in the Northern Ireland Assembly at 3:00 pm on 17 September 2002.

Alert me about debates like this

Photo of Mr Donovan McClelland Mr Donovan McClelland Social Democratic and Labour Party 3:00, 17 September 2002

I wish to advise Members on how I propose to conduct the debate, which has been allocated two hours by the Business Committee. Two amendments have been selected and published on the Marshalled List. The mover of the motion will have 10 minutes to propose and seven minutes to do the winding-up speech. The proposer of each amendment will have seven minutes to propose and five minutes to do the winding-up. The amendments will be proposed in the order in which they appear on the Marshalled List. When the debate has concluded, I shall put the Question that each amendment be made in turn. If amendment No 1 is made, I shall put the Question on amendment No 2. If that is clear, I shall proceed.

Photo of Ian Paisley Jnr Ian Paisley Jnr DUP

I beg to move

That this Assembly notes with concern the most recent statistics on hospital waiting lists and calls on the Minister of Health, Social Services and Public Safety to put in place a policy that urgently addresses the needs of patients by reducing the number of patients and length of time spent on these waiting lists.

On 5 September 2002 the Minister of Health, Social Services and Public Safety issued a press release claiming that she "gets tough on waiting lists". If her record in recent years is anything to go by, I would hate to see the results of a softly-softly approach to waiting lists, which appear to be totally out of control.

We are used to hearing the Minister make all manner of promises about healthcare — especially on the waiting lists crisis — and failing to deliver. Every quarter, before the publication of waiting list statistics, we hold our breath in anticipation of the ever-increasing numbers of patients on lists. Last March the Minister pledged to reduce the number of people waiting for hospital treatment to 48,000. That promise has never been fulfilled. Today more than 59,000 people are on the waiting list, which represents an increase of almost 9% since June 2001.

The Northern Health and Social Services Board has a massive waiting list; it is the highest outside Belfast. More than 9,000 people are queuing for the treatment that they deserve. Like many representatives, I am bombarded by queries from constituents and the families of patients about what is being done. It has become embarrassing to try to explain to them that I and other Members have voted more money than ever before to the Department of Health, Social Services and Public Safety. I will vote even more money to it this year, yet it will make no impact whatsoever on the surgical needs of my constituents’ loved ones. It is embarrassing, because this place is getting the allocations wrong.

If the figures are staggering, consider how much more staggering they are in the light of the 28% increase in the excess waiting list, that is to say, the number of people waiting to get onto the priority list. Tens of thousands of people are waiting for urgent treatment — they are waiting and waiting and waiting. Given the track record of the Minister’s current policy, they will go on waiting.

Trends in waiting lists make an interesting source of study. In 1997 waiting lists decreased steadily. Since the Minister took over, they have risen consistently in every quarter except one. What concerns me most is that the Minister and her minions have no ambition to reduce the waiting lists. The press release of 5 September, which was issued together with the trends, states that her target is to "hold" the waiting lists at these unsatisfactory levels. By the words of her own press release the Minister is condemned.

This year’s waiting list is unacceptable, yet the Minister will tolerate it for another 12 months with the weak ambition to "hold" the figures at that level.

Photo of Ian Paisley Ian Paisley Leader of the Democratic Unionist Party

I thank the Member for giving way. Wards in certain hospitals are closing because of infections. I was asked to visit Belfast City Hospital, and on the exit stairs I counted around 500 cigarette butts and saw tin cans and all sorts of rubbish. The wards open onto those exit stairs, which are an absolute disgrace. How can hygiene be maintained in a hospital where such conditions exist?

Photo of Ian Paisley Jnr Ian Paisley Jnr DUP

I thank the Member for his observation; it shows that money is being targeted incorrectly.

The Minister has adopted the bureaucratic speak of "acceptable numbers" on waiting lists that are thoroughly unacceptable. I will discuss the trends later. The scandal of waiting lists is somehow robbed of humanity when we speak only about stark statistics. It is only when we meet constituents day to day and hear about their personal trauma that we realise just how harrowing and appalling the situation is.

I wish to mention two constituency cases. The first is a letter from Mrs W of Ballymoney, who wrote:

"I require breast surgery and went to see my GP in January 1998. I was referred to Coleraine Hospital on 1st February 1998 and seen by the specialist there on the 13th February.

I was seen again on 7th July 1999 and was told then that I would be put on the waiting list. The only contact I have had since then from the Ulster Hospital specialist has been a letter in January 2001 asking if I still want to be kept on the waiting list. On 20th June 2002 I was told that I was still on the waiting list."

That is an appalling example of what it means to be a statistic on a waiting list in my constituency. Yet it is being repeated, and I am sure that Members across the House, representing the four corners of Northern Ireland, would agree.

The second example is from a gentleman from Broughshane, who has written to the Minister’s office about his concerns. In his letter to me he states:

"Due to multiple injuries received in a road traffic accident on 4th July 2001, I was transported by ambulance to the casualty department of Antrim Area Hospital. After a cursory examination it was deemed my injuries were not of sufficient serious nature and I was discharged. It was only by persisting with a complaint that I had difficulty breathing that, after a long wait, x-rays were taken. These showed that I had a punctured lung with my broken ribs. A chest drain was inserted and I was admitted."

One of his injuries persists, and he has told me:

"On 8th August I was referred for an opinion from an orthopaedic specialist. My consultant reviewed me again in November 2001. Having waited expectantly for an appointment date, and believing that the NHS was reasonably efficient, I was growing increasingly impatient when I continued to receive nothing, even by way of recognition that I was on a waiting list.

I cannot express adequately how shocked and horrified I was to find that the orthopaedic specialist had not received either of my referrals from my consultant. How can it be possible that two referrals within a few months of each other can fail to reach their destination? What sort of crass, bureaucratic inefficiency does it take to lose, not one, but two referrals?"

Let us be clear about one thing; it is no longer a question of money — the resources are there. More of our Budget goes to health than at any time before. In the words of Brian Patterson, the British Medical Association Northern Ireland representative:

"It is not enough to just pour money into the NHS. It must be targeted to where it is most needed."

If the Minister were called Barbara Brown — and I ask Members to consider setting aside all of the political divisions in the House for a moment — and spoke with an English accent and was here on behalf of the Labour Party or Conservative Party as a direct rule Minister, people would not get near Stormont Castle without tripping over Sinn Féiners calling for her to go because of the way in which the system has been managed. We should draw back and look at the situation from that perspective. We would not let an English Minister run the Health Service in this way, or pump up the waiting lists. Why then are we allowing a person from Northern Ireland, a devolved Minister, to do it? We ought not to; we ought to reject her. The silence of some parties on the issue has been deafening.

The Minister’s policy is a disgrace; it has failed. She has turned a trend of decline in waiting lists in 1997 to a consistent increase. However, there is not a squeak from her party about her incompetence or that of her policy. The problems we face are a symptom of the political process. In any other Administration where a Minister had made such a significant mess of a portfolio they would, at best, be reshuffled elsewhere: the Cabinet or the Executive would see to it that such action was taken. This Executive lack the courage, and Sinn Féin the self-respect, to remove an incompetent Minister who has made a mess of a bad situation.

My party can, and will, be accused of many things, but at least our Ministers, all four of them to date, have been quality Ministers doing an efficient job. If they were not up to it, the party, let alone the nominating officer, would see to it that changes took place. Sinn Féin does not have the guts to change the Minister, even though she should have gone a long time ago.

If the Assembly continues with the Government’s health policy, the result will be a disaster. The Minister’s pledges and words count for little. Her glossy reports, of which there are dozens, do little but delay, procrastinate and confuse the public. I have those reports in front of me, and I will refer to them later. The House must demand that matters are put right or the Minster should be put out.

There are two amendments to the motion. I studied the Alliance Party’s amendment, and then I checked the statistics that have been provided. I believe that the Alliance Party’s amendment has been accommodated, because in the appendix to those statistics are the inpatient waiting lists by speciality. Perhaps they should be broadened, but that is for another day. I appeal to the Alliance Party to withdraw its amendment for that reason.

With regard to the amendment that stands in the name of Mr Hamilton and Mrs Courtney, I do not doubt their sincerity. However, that amendment just expands upon what I have already said. Let us keep the focus on a single issue. Let us distil it to the real point, which is that the Government’s policy has failed. Let us place the blame where it ought to be placed.

Photo of Kieran McCarthy Kieran McCarthy Alliance 3:15, 17 September 2002

I beg to move amendment No 1: At the end add:

"and to ensure that future statistics include waiting times for various ailments."

Every member of society is appalled at the continuing increase in waiting lists for healthcare. All Members must express concern at that rise and emphasise that those statistics represent thousands of people who are suffering physically and psychologically. Waiting lists tell us little about the services that are delivered by the National Health Service, because they tell us little about the care that patients receive while they are on them.

Waiting lists can distort clinical priorities. Doctors have always considered them almost meaningless, as they almost place the same importance on minor surgery as on life-threatening illness. There is much more suffering for one person waiting for a cancer operation than there is for 10 people waiting for treatment for a dermatological or other less life-threatening ailment.

Waiting lists are meaningless to people. However, waiting times have a meaning, as people know how long they will have to wait for their needs to be met. They give patients a time and date to have in their sights, and they do away with uncertainty. Waiting times are a common-sense alternative, and they give the National Health Service a meaningful measure of its progress on improving the service delivered to patients. Waiting times are particularly crucial for more serious procedures such as heart and liver operations, cancer therapy, kidney transplants, brain surgery and so on, as they make the difference between life and death.

Last year the Scottish Executive announced that waiting times, rather than waiting lists, were to be the litmus test of progress in the Health Service. I cannot see why we should not do the same. That would show how much waiting time is due to major surgery on gravely ill patients being cancelled at the last minute for various reasons, causing great alarm to the patients and their relatives. All concerned must ensure that that extra burden on waiting lists is halted at once.

Photo of Mr Tom Hamilton Mr Tom Hamilton UUP

I beg to move amendment No 2: In line 2 delete all after "waiting lists" and insert:

"and, recognising the problems of bureaucracy, lack of resources, wastage of present resources and total lack of decision-making within the healthcare system, calls for the implementation of an effective and co-ordinated strategic plan between the Department of Health, Social Services and Public Safety and the Health Boards and Trusts to help reduce the number of patients and length of time spent on these waiting lists."

I seek support for the amendment from all parties in the House. The reason for that is simple: I want to see real, effective action taken by the Minister. The Minister has told people repeatedly in Northern Ireland that she has put plans and measures in place to deal with the problem. However, this debate is evidence that her initiatives have, unfortunately, failed.

I congratulate Ian Paisley Jnr on tabling the motion. It is important that the House accept the amendment proposed by the SDLP and my party, because it will help to add more weight to the original motion and to expose the bureaucracy of the system. People want improvements on the ground. The amendment will help to make the Health Minister more accountable to the House and put more pressure on her to implement effective plans.

Two years ago, the Minister told us that her framework for action on waiting lists would help to solve the problems of recent years. It is obvious to everyone that her plans have not worked. It must be asked whether the Minister has the authority and vision to make a real difference to the problem of waiting lists. In a press release issued on 12 September 2000, the Minister said:

"Yesterday I issued a comprehensive framework for action. I am confident that the action flowing from that framework will immediately begin to address the problem, and will bring down waiting lists in the longer term."

Can the Minister be as confident now that the frameworks are having the impact that she intended? Is it not time that she admitted that her plans have been unsuccessful? Only yesterday, my Colleague Robert Coulter drew attention to delayed discharges and bed blocking in the Causeway Health Trust and to the link between bed blocking and waiting lists.

Through my membership of the Health Committee, I sincerely understand the Minister’s problems. It is because of those problems that the House has been patient for the past few years and has given the Minister time to tackle the issues. We were told that things would not improve overnight. I agree — no one expected them to. However, the Minister has had more than enough time to make a serious start on improving waiting list statistics.

It was important that the amendment contain a specific phrase on the relationship between the Department, health boards and trusts. There is a growing public perception that the Minister lacks the authority to put effective measures in place. According to reliable health professionals, there seems to be a disjointed and unco-ordinated approach to that problem within the health system.

The Minister often tells us how the Health Service has suffered from underfunding over the past few decades. I do not doubt that there is some merit in that argument, but, enough time and tolerance has been given to the Minister since she took up her post. It is about time that action was witnessed, so that people can see the benefits of a locally elected institution.

I was interested to read the recent comments of Dr Brian Patterson of the British Medical Association, who said that it was not enough to pour money into the National Health Service and that money needed to be targeted to where it was most needed, within the context of a coherent plan. That has been the argument of the Ulster Unionist Party. That is why it has proposed the introduction of an independent health auditor within the health system. Currently, auditors appointed by the Department of Health, Social Services and Public Safety audit the accounts of health bodies in Northern Ireland.

We support the establishment of a robust independent audit of health services, with the Comptroller and Auditor General being appointed the auditor of all health bodies. That must be dealt with as part of the forthcoming audit and accountability legislation in order to best address the combined needs of Northern Ireland’s Health Service and local taxpayers. It is no good throwing taxpayers’ money into a massive black hole. We need to know that we are getting value for money and the maximum benefits possible. Money must be directed in the most effective way possible.

I hope that the House will accept the amendment and that the Minister will admit to the failure of the present framework for action on waiting lists. That is not simply my view, but that of health pressure groups, such as the British Medical Association. Real, effective measures and immediate action are needed, not more consultations.

Photo of Dr Joe Hendron Dr Joe Hendron Social Democratic and Labour Party 3:30, 17 September 2002

Mr Hamilton made a point about the Comptroller and Auditor General, and that issue has been raised with the Minister previously. As I understand it, the Comptroller and Auditor General for Northern Ireland has responsibility for all Departments, with the exception of the Department of Health, Social Services and Public Safety. I am not sure whether that historical arrangement has changed, but the Comptroller and Auditor General should have responsibility for the Department of Health, Social Services and Public Safety just as he does for every other Department.

I welcome this opportunity to put the spotlight on the intractable problem of waiting lists. I acknowledge that this is a complex issue, for which there is no easy fix. I thank Mr Paisley for tabling the motion on this important issue and those who tabled the two amendments, which have encouraged serious and worthwhile debate.

The latest waiting list figures of almost 60,000 continue that depressingly familiar upward trend in quarterly statistics. The lists have gone up by an average rate of almost 10% since 1996. Our waiting lists are the highest per capita in the UK and are 60% higher than they are in England. Over 5,000 patients have been waiting for admission to hospital for longer than is acceptable under charter standards. Not surprisingly, those statistics play an important role in shaping a generally negative public perception of the Health Service in the Northern Ireland. There is an increasingly vocal public demand for those seemingly endless increases in waiting lists to be arrested as a matter of urgency.

We are frequently urged to look beyond the headline figures and consider the overall increase in the number of people being treated. Although some 7,000 more patients were treated in 2001 than in 1999, that will be cold comfort for the tens of thousands waiting anxiously for treatment, not knowing when they will receive it. It is completely unacceptable that patients with life-threatening illnesses sometimes have to wait years for treatments — that adds to their stress and increases the risk to their health. Regrettably, the wait will be too long for some. The many people who are waiting for cardiac bypass surgery can pay approximately £14,000 for private treatment. I do not oppose that — patients are entitled to opt for private treatment, if they can afford it.

Photo of Dr Joe Hendron Dr Joe Hendron Social Democratic and Labour Party

I will give way shortly.

I object to a person having to use his or her life savings to pay for treatment. It is wrong that someone who may have only a few years left to live should have to pay that amount. Last week, in my capacity as a doctor, I dealt with someone in that situation.

Photo of Robert McCartney Robert McCartney UKUP

Does the Member appreciate that, even with £14,000, it takes three months to have a bypass operation in the Royal Victoria Hospital? One must travel to Dublin.

Photo of Dr Joe Hendron Dr Joe Hendron Social Democratic and Labour Party

I understand that to be the case, although the wait would be no more than three months. Not everyone can afford that; something is wrong.

The Committee for Health, Social Services and Public Safety has for some time monitored the alarming increase in waiting lists and has frequently questioned senior officials about the obstacles to reducing them and the steps taken to increase capacity in the system. The Committee has written to the Minister on several occasions expressing serious disquiet at the escalating numbers who are waiting for hospital treatment. Like many others, the Committee has demanded to know what practical steps are being taken to tackle the problem. There is no doubt that historical Health Service underfunding in Northern Ireland has contributed directly to the crisis. For example, cuts in health resources in 1995-96 led to a 30% reduction in elective surgery that year. The waiting lists for elective procedures have been a major problem in Northern Ireland for several years. The Minister’s proposals in the recent document on elective surgery will be a positive step when they are implemented.

The problem has been compounded by a decrease of 18% in bed capacity over the past 10 years; however, inpatient surgery increased by 10% during that period. As a result, many hospitals are working to maximum capacity.

The Committee has the most profound respect for front-line doctors and nurses. We have visited every hospital in Northern Ireland and have seen how hard they and all other hospital staff work in accident and emergency departments and elsewhere. I pay tribute to their commitment, resilience and dedication, and I am sure that every Member would show them great respect and thank them.

The advent of devolution, however, provided a proper focus on health, which has been — deservedly — the Executive’s main priority ever since. That has meant a welcome injection of additional resources to reduce waiting lists.

The consensus was that extra funding was required to support an increase in service capacity to meet the demand for elective procedures. An additional £5 million was allocated for that purpose by the Minister in 2000 to support her three-year programme of action to tackle waiting lists. That sum was consolidated in 2001-02, together with an additional £3 million for new actions to deal further with the problem. Some £2 million has been set aside for waiting list initiatives this year, and that has been targeted at protected elective admissions.

Those significant funding increases led to a guarded optimism that tangible improvements would begin to flow from the initiatives in the Minister’s ‘Framework for Action on Waiting Lists’. I am sure that the Minister will speak positively; however, judging by the figures, the framework for action has signally failed. The Department’s priorities for action have consistently included targets for increased capacity, improved access to services and addressing staff shortages. The plan for 2001-02 included a plan to reduce waiting list figures to 48,000 by 2002. However, given the latest figures, the less challenging target of keeping the 2002-03 waiting lists at the level of 2001-02 may seem overambitious.

Photo of Mr Donovan McClelland Mr Donovan McClelland Social Democratic and Labour Party

Dr Hendron, I did not impose a time limit because of the number of Members who wish to speak, but I would be grateful if you would draw your remarks to a close.

Photo of Dr Joe Hendron Dr Joe Hendron Social Democratic and Labour Party

I shall indeed, Mr Deputy Speaker. I warmly welcome the recent appointment of the regional co-ordinator, Ms Jill Anderson, to provide a focus on waiting lists. She will provide a central steer to trusts’ senior managers, who were appointed to develop better management approaches in assessing activity.

The problem is complex. It is very much in the Minister’s interests to reduce the waiting lists, and she wants to do that. However, all the structures in Northern Ireland need urgent examination. More must be done to attract trained nurses and doctors into orthopaedics. One of the problems in orthopaedics is that there is not so much a need for surgeons as for appropriately trained theatre nurses. That is a key point.

I have spoken for long enough.

Photo of Paul Berry Paul Berry DUP

I commend my Colleague Ian Paisley Jnr for tabling such an important motion. Unfortunately, because the issue of waiting lists has been raised so often, we have run out of words to describe the deplorable situation that exists. The words "crisis", "meltdown" and "Third-World service" have been used before, and it is evident that, regardless of promises to deal with waiting lists, those lists get worse every day.

In ‘Framework for Action on Waiting Lists’ we read of commitment to reduce the numbers waiting. When the framework was published, a further £5 million was allocated in 2000-01 to deal with the problem. The usual press release trumpeted the great things that would be done. However, many of us would like to know how that money, and the other moneys that were given to deal with waiting lists, was spent. An audit should be carried out to determine where the money was siphoned off to and how much was really spent on tackling waiting lists.

The framework was a gigantic hoax. One of its great suggestions was that boards should describe the situation in their area and what they had done to alleviate it — which, regrettably, were facts that were already known. Further, they were to appoint a manager and submit quarterly returns to the Department. That is all tremendous stuff, but the end result has been that bureaucracy has increased year on year.

Many words such as "targets", "process" and "protocols" and grand phrases such as "strategic case mix planning" and "slot systems" have been used. There was an action plan, followed by board action plans, followed by trust action plans, followed by managers appointed by each board. There has been much activity and paperwork, but waiting lists have still increased. I find it deplorable that the situation is getting worse, but, most of all, our constituents, who are suffering as a result, find it deplorable and disgraceful.

I had discussions with representatives from the Chartered Society of Physiotherapy, and, although debates such as this are important, it is also important that we submit ideas to the Department. The phrase "winter pressures" seems to be fading from the collective consciousness as Ministers and managers realise that waiting lists and bed blocking are ever-present problems. Even in a good winter, bed blocking is one of the biggest burdens on the Health Service. However, with good management the situation can improve. For example, physiotherapists in other UK regions have been quick to establish their position as key players in the battles against waiting lists and delayed discharges. A growing number of highly experienced physiotherapists now work in the front line of healthcare. Many of them in England, Scotland and Wales are extended-scope practitioners. Their role includes assessing patients; making clinical diagnoses; referring patients to other healthcare professionals; and treating and discharging patients without their having to see a doctor.

Photo of Robert McCartney Robert McCartney UKUP

Is the Member aware that the acute bed blocking is caused, to a great degree, by the failure of the trusts to pay reasonable fees to nursing homes that could relieve the pressure at a fraction of the cost?

Photo of Paul Berry Paul Berry DUP

I agree wholeheartedly with Mr McCartney’s comments. The Health Committee raised that issue with the Minister. We asked her to provide temporary funding to enable nursing homes to care for elderly patients until they are fit to be discharged into the community.

Research has shown that more than 70% of patients referred to orthopaedic clinics do not need to see a consultant. In Sheffield, the introduction of an orthopaedic screening service, led by two physiotherapists working as extended-scope practitioners, has resulted in patients waiting an average of 32 working days for an initial appointment, compared to 11 months for a hospital appointment. The problem in Northern Ireland is that, although a national service agreement instructing trusts to make provision for extended-scope practitioner roles for physiotherapists was introduced in 1996, to date no trusts have fully implemented it. Like the Chartered Society of Physiotherapy, I believe that developing more opportunities for physiotherapists to work as extended-scope practitioners would provide more timely care for patients, reduce waiting lists and enable the Health Service to work more effectively.

To develop those roles, the Department of Health, Social Services and Public Safety should firmly direct all trusts in Northern Ireland to implement fully and wholeheartedly the national service agreement on grading for the professions allied to medical practice.

In the Southern Board area, over £2 million has been wasted as a result of non-attendance at hospital appointments. The elderly, for example, may forget about their appointments. More than £10 million has been wasted in all the board areas in Northern Ireland in that way. A system must be implemented to remind people of their hospital appointments closer to the time so that such a situation can be avoided. The information system on appointments must be investigated so that the people get a better service. I support the motion.

Photo of Sue Ramsey Sue Ramsey Sinn Féin 3:45, 17 September 2002

Go raibh maith agat, a LeasCheann Comhairle. As a member of the Committee for Health, Social Services and Public Safety, I am aware of the needs of patients, staff, the elderly, children and the disabled. I am also aware of the community’s concerns about waiting lists as well as the strategy that the Minister of Health, Social Services and Public Safety has implemented to tackle the problem. However, another member of the Committee for Health, Social Services and Public Safety is unaware of that strategy.

I accept that waiting lists are a concern for everybody and that they must be addressed as other Members have said. However, I cannot accept the amendment that has been tabled by two of my Committee Colleagues because it is disrespectful to those who work in the Health Service.

I assume that the accusation in the amendment that there is a

"total lack of decision-making within the healthcare system" is a cheap jibe at the Minister. I am glad that she is here today and will be able to refute that accusation. I should also like to applaud the Minister for her commitment to tackling waiting lists. She has successfully gained funding to put 1,000 extra community care packages in place, which will undoubtedly free beds, and the last Member who spoke reminded us of the problem of bed blocking and how the elderly are kept in hospitals. That must be considered.

Incidences of elective surgery have increased, and the Committee was informed of that last week. That must also be applauded because, as the Chairperson said, we cannot tackle waiting lists in isolation without considering the Health Service as a whole.

I cannot support the amendment. Thousands of healthcare workers have decision-making responsibilities, and I object strongly to its wording on their behalf. People who work in the Health Service make decisions daily, whether they are doctors, nurses, or other hospital staff. They have increased the activity and efficiency of the Health Service over the past 10 years, despite serious underfunding. Statistics show that activity in hospitals has increased while funding has decreased. The accusation that there is a total lack of decision-making in the Health Service is objectionable and an insult to medical workers.

We must take a more serious approach that looks at what has led to the increase in waiting lists, and the Assembly must act as a whole to tackle them. The Chairperson rightly pointed out — and someone of his calibre who has had years of experience in the Health Service will know — that waiting lists cannot be considered in isolation, because they are a complex problem.

One Member said that while waiting lists remain a concern, we can see from the June figures a slight increase, mostly as a result of the new fertility services that were previously unavailable on the Health Service. I can see some Members screwing their faces up at that. The welcome introduction of fertility treatment has caused a slight increase in waiting lists.

Tom Hamilton spoke about developing a strategy to examine where the money goes in the Health Service. The needs and effectiveness study that pointed that up seems to have backfired on the Office of the First Minister and the Deputy First Minister, as many people have stated that money cannot continually be thrown at the Health Service. The system must be overhauled. Bodies such as the National Health Service Confederation, the British Medical Association and the Health Committee have all stated that the Health Service is underfunded, and now the Office of the First Minister and the Deputy First Minister has published a study that proves it.

Some Members spoke about staffing and the problem of cancelled appointments. At last week’s Health Committee I asked for the figures. Cancelled appointments and people not bothering to attend account for 25% of the total. There is also a shortage of staff, and it will take 10 or more years to fill the quota.

I accept that consultants work extremely hard; however, when annual leave is taken no one is trained to take their place. The acute services review ‘Developing Better Services’ calls for a single strategic regional authority with a workforce planning remit, which is the sort of change needed, and I commend the Minister on that. Boards and trusts must not take decisions outside their remit while not considering the hospitals or the acute sector as a whole.

Recently, the Health Committee was advised of the 100 additional beds to be provided for the Mater, Craigavon Area and Antrim Area Hospitals. I commend the Minister on that provision. Proposals are in place in the acute services review to reform management structures; the movers of the motion would do well to study them.

I thank Paul Berry for raising the matter of winter pressures, which place extra burdens on our hospital services. However, Ian Paisley Jnr should ask his Minister to grit the roads and footpaths properly this winter to ensure that the pressures on hospital services do not continue.

Photo of Prof Monica McWilliams Prof Monica McWilliams NIWC

The statistics for waiting lists are stark. The Department of Health, Social Services and Public Safety’s press release of 12 June 2001 stated that there was a hope that waiting lists would be down by 25% to 39,000. That figure rose six months later to 57,000, and, as the Committee Chairperson said, they stand now at over 60,000.

I have no difficulty with Mr McCarthy’s amendment, which calls for waiting times to be included in future statistics, but we already have accurate information on waiting times. I have been looking through the minutes of the Eastern Health and Social Services Board, which detail its plan. It will be interesting to hear from the Minister that these figures are the returns from some months ago and that there may be improvements since these plans have been introduced.

Last week in my constituency I was told of an elective surgery admission that was cancelled four times over four months. The admission was an urgent referral for a large bowel investigation. The patient had to wait four months for a barium enema, which resulted in an unacceptable delay in the diagnosis of bowel cancer and a consequent delay in treatment. In the case of bowel cancer, any delay is very serious, as a life could be saved by prompt treatment. Only yesterday, I mentioned a horrific case, where a woman had been prepped four times for a bowel cancer operation. Between June and 23 August, the woman had been sent home to fast every Wednesday night in preparation for an operation the next day. She had still not had her operation by 23 August.

These cases are the tip of the iceberg. It is a terrible message to send out that, even in the case of cancer, which is a priority in the Health Service strategy, intensive care beds are not available. A consultant wrote to me saying that he had had to cancel his list of patients waiting for breast cancer operations. The Eastern Health and Social Services Board stated that it hopes to bring forward 180 patients for breast surgery operations with the extra money for waiting lists. This is a serious situation, which is traumatic for people on the waiting lists who have been diagnosed with cancer but do not know when their operations will be carried out. If an operation can be done promptly, a life may be saved. The longer cancer is left, the less likely it is that that life will be saved.

The Eastern Health and Social Services Board attempted to address the matter and to enhance its elective day-care work by reserving a number of beds that were used for emergency admissions for that surgery. I hope to hear that that strategy is working in the Mater Hospital and the Lagan Valley Hospital. The board then had to decide whether to opt for extra activity by the current consultants, for a locum surgeon to carry out more operations, or for additional permanent surgeons. I was taken aback to find that some of the consultants were demanding £500 for each extra operation. That serious matter should be addressed.

The Eastern Health and Social Services Board decided on different solutions for different hospitals. It is good to see that it has provided a permanent surgeon in the Belfast City Hospital, which seems to have the highest waiting list figures. There are 5,460 on the list, with an overflow list of 1,375. Those are huge figures, and I do not know what impact one surgeon might make on those. Nevertheless, it is an attempt to reduce the figures.

It is good to see that the Northern Ireland Chest, Heart and Stroke Association’s (NICHSA) regional services improvement co-ordinator, Jillian Anderson, has developed the waiting list handbook and the common management protocols. The fact that different trusts are doing different things is problematic. We need to know what Jillian Anderson has recommended to date. The centrally co-ordinated waiting list and the common management protocols must be prioritised to enable the transfer of patients. It will be good to see whether these protocols are beginning to make a difference.

We have heard from the NICHSA’s chief executive, Andrew Dougal, on several occasions about the extensive waiting list for cardiac surgery. The Eastern Health and Social Services Board tells us that the figures for 2002-03 show that there are 268 people still on the list, despite the fact that 33 of those people were transferred outside Northern Ireland and that 44 of those 268 people have been waiting more than 12 months. Other Members have stressed that these extensive waiting lists mean that a long time passes between diagnosis and convalescence; we should set a target of no more than 12 months for that period.

The key is found in what I have said about management protocols, and most importantly, about co-ordination. This is not the first time that I have raised this matter in the House — it is probably the tenth time. The Member for North Down, Bob McCartney, mentioned community care. There is a demographical problem. The elderly are living longer, and nursing homes have closed, so we must find alternatives. I am told that 50 of the Causeway Hospital’s 250 beds are taken up by delayed discharges — that is a fifth of the hospital’s beds. Such figures clearly represent a crisis, and we must address that problem.

Between 65% and 80% of the 1,000 community care packages that the Minister released across all four health and social services boards went to the elderly.

The problem is clear: the elderly are in great need of these packages, but to distribute 1,000 of them was not enough. If the aim expressed today is to move patients out of hospital so that others can come in, and to increase intensive care capacity for those who require operations urgently, the number of community care packages must be increased.

I agree with Ms Ramsey’s comments about agreeing priorities in the Health Committee. It is with dismay that I note that politics are being played in respect of health issues, but I can understand that. Mr Berry and Iris Robinson were in a difficult position because they felt that they had to deviate from the wording of the Committee’s letter about increased funding, which referred to funding as "a priority" and not "the priority". The Assembly must give the clear message that funding is "the priority".

Photo of Robert McCartney Robert McCartney UKUP 4:00, 17 September 2002

Six months ago, I stated in the House that the waiting lists in Northern Ireland were not only the worst in the United Kingdom but the worst in Europe. Since then they have got even worse. Two points must be made about the Minister responsible. First, I agree with Ms Ramsey that health is under-resourced — there is no doubt about that; however, I do not agree that the Minister has made the best use of the available resources, or that she has administered them in the most competent and effective way.

We must look deeper at the cause of the present dilemma in the Health Service. The growth of waiting lists and the general lack of morale in the Health Service are the product of the form of Government endorsed by those who signed the Belfast Agreement. The underlying failure of the entire system is demonstrated. The pro-agreement parties, not just Sinn Féin — it was not the biggest party — but the SDLP and the Ulster Unionist Party, signed an agreement that made no provision for filling the black hole of capital underinvestment and the under-resourcing of aspects of life here.

(Madam Deputy Speaker [Ms Morrice] in the Chair)

The core problem would exist regardless of whether the Minister of Health, Social Services and Public Safety were from Sinn Féin, the SDLP or the Ulster Unionist Party. The difficulty is that not only was there a failure to negotiate sufficient resources but there was a failure in the institutions. The undemocratic d’Hondt system means that no Minister is really accountable to the Executive, the Health Committee, or even the Assembly. Ministers can be wholly incompetent or ineffective, but only the parties that appointed them can remove them — and that is unlikely in the present state of affairs. The pro-agreement parties were so anxious to get power that they sold out the basic interests of the population in Northern Ireland that is in need of healthcare, whether Unionist, Nationalist or of any other denomination.

The pro-agreement parties in the Executive, including the SDLP and the Ulster Unionists, failed to pass on the extra cash that the Chancellor of the Exchequer gave out over the past couple of years as a share of national increases in health spending. They preferred to spend it on their own priorities — more staff, more offices, more bureaucracy and more Departments like the "Department of the Centre", whose two Ministers have more than 400 staff and advisers.

The Minister of Health, Social Services and Public Safety is not without blame, although there are some extenuating circumstances as regards resources. She has failed to administer her Department and to spend the available money efficiently. For example, there was the decision to close the Jubilee Maternity Hospital and the resultant massive overloading of the Royal Maternity Hospital, the failure to begin the promised new maternity hospital, and the perverse and ideological decision to scrap GP fundholding in favour of a centralised bureaucratic system that is still not properly in place and will probably never work. The GPs — respectable, dedicated doctors in the British Medical Association — are in revolt because the system is not working.

The Minister is also guilty of having a bizarre proclivity for launching inquiries at the drop of a hat, thereby wasting the precious administrative resources of her Department and the limited time she has as a Minister to make and implement decisions. Mr Berry has given Members a catalogue of committees and initiatives, all of which have produced absolutely nothing, except that the Minister’s eyes have been taken off the main object, which is the healthcare of the community.

The failure of the Health Minister is just one prominent example of the failure of pro-agreement parties to deliver the joined-up government they promised in the referendum. If it was not so sad, something could be made of the fact that all those folk who promised the people of Northern Ireland more efficient, accountable and effective government have failed to deliver it, and the system has failed to deliver it.

We can talk from time to time, whether it is about health, the environment, roads, sewerage or whatever, of the failure of the respective Minister to deliver, but we must look at the basic system. Unless we have principled, democratic, efficient, accountable government, we get 10 independent warlords without any collective responsibility.

Madam Deputy Speaker, every other Member has been given seven minutes to speak, and you are demonstrating impatience when I am not anywhere near that.

Photo of Ms Jane Morrice Ms Jane Morrice NIWC

The signs from the Chair were not impatience due to the time. I am aware that the Deputy Speaker has agreed that Members should speak for seven minutes, and I am prepared to go along with that. The subject of the motion is hospital waiting lists, and you were straying off the subject. That was why I was questioning you.

Photo of Robert McCartney Robert McCartney UKUP

With the greatest respect, Madam Deputy Speaker, if the basic system of government that produces these waiting lists, inefficiencies and difficulties is not relevant to the waiting lists, it is difficult to see what is. Of course, there are many Members in the House who cannot see the wood for the trees, and who cannot see that the things that are debated in a superficial way are the product of deep-seated constitutional failures to deliver effective government. That is the relevance.

I was going to say that I always find it amusing, if not tragic, to see that when one Minister is under the gun, every Member in the House attacks him or her. There is no question of collective responsibility. Today it happens to be the turn of the Health Minister. Let us blame the Health Minister for what she is culpable of, and remember that most of our problems are directly relevant to the system of government that the major parties that signed the agreement are responsible for.

Photo of Ms Jane Morrice Ms Jane Morrice NIWC

Order. [Interruption.] Order, order. [Interruption.] Order. Given the number of Members who still wish to contribute to the debate, and the time that has been made available, I must ask Members to restrict their speeches to five minutes.

Photo of Jim Shannon Jim Shannon DUP

I support Mr Paisley Jnr’s motion and wish to comment on waiting lists. Last week the press announced that they had been banned from entering the Ulster Hospital to ask patients and staff their opinions on the service that is being provided and to give an accurate portrait of what is really going on in the Health Service. Many people approached me and said that they thought that it was an absolute disgrace that the press were unable to ask patients and staff just what is going on so that they can get a fair idea of their problems. The hospital might have tried to withhold the information about long waiting times and people sitting on trolleys for more than eight hours at a time, but no one can hide that kind of dissatisfaction.

The statistics themselves speak volumes before one even begins to talk to those waiting for hip replacements or scans that could diagnose life-threatening conditions. It has been reported that some 140,000 people in the Province are "in the queue waiting to join the queue" for operations and treatment. People are waiting inordinate lengths of time to undergo relatively minor surgery that would have them operating on full power without the need for other forms of care. Patients such as those waiting for hip replacements are prime examples of that scenario. They usually need care packages while waiting for their surgery, but, on the whole, they would recover fully and be active and mobile members of the community were they to receive the surgery that they needed when they needed it. That would also save the system money.

The Health Service is full of people who need surgery, only to have it postponed. Therefore there is congestion, with people suffering pain and distress because they have been waiting so long. That drains resources from other parts of the NHS, such as community care and general practitioners. The waiting list system is a vicious circle, which the Minister and her Department must address. In last week’s papers, it was incredible to see the plethora of advertisements selling insurance, private health policies and operations at private clinics on the basis that the Health Service is so bad that it is failing to do its job. One of the captions read, "Worried about NHS waiting times? Phone this number".

I should not say that the country is worried about NHS waiting times. However, waiting times are becoming extremely frightening for those on the waiting lists, especially the elderly, who are now parting with their life savings to rid themselves of the very pain and suffering that they expect the Health Service to try to alleviate. What sort of society do we live in if the elderly have to wait to part with hard-earned cash so that they need not be burdened by pain and suffering at their time of life, when they should be using their savings to enjoy their retirement and to pursue activities that they could not when they were working? The elderly, and everyone else in this country, have to be told that the Minister and her Department will do something other than simply offer platitudes about how seriously they regard the situation or, at the end of this debate, sum up by saying that they agree with what has been said.

What is to happen? Is it not about time that the Minister stopped blaming the Conservative Government for what they did to the Health Service and showed us what she will do about the situation? The problem has reached somewhere beyond crisis point. Around 10% of the population are waiting to see a doctor, never mind have an operation or take their treatment further. The situation is indefensible, and something must be done about it, not in the next financial year but now, when thousands more have joined that same queue waiting for operations.

Several hospitals around the Province were closed down around five or six years ago so that the pooling of resources would benefit the country. The direct result, especially in the Ulster Hospital in Dundonald, was a bigger workload and not enough staff or hospital beds to cope with the larger catchment area that was created by closures elsewhere. Those same hospital buildings, which only five years ago had seen patients getting treatment and the proper level of care that they deserve, are for the most part lying empty.

Another reason that lists are so long is that patients are being sent home early to free beds and reduce the lists, only for them to return with complications that take longer to cure. As a result, they require more time in a hospital bed than the original surgery would have resulted in had the patient been allowed the appropriate post-operative rest time to begin with.

There is no doubt that we have the worst waiting lists in Europe. We are certainly outstripping other areas of the United Kingdom. The breach of charter standards has been going on for a long time, with many patients waiting more than two years for hip replacements when the maximum should be 12 months. Can we imagine how many people are living in pain daily? We see figures on a page that tell us that there is a two-year waiting list for hip replacements, or a year or two for cardiac or orthopaedic surgery.

I urge Members to support the motion, which my Colleague, Ian Paisley Jnr, tabled. It is opportune and applicable, and people wish to see the waiting lists reduced now.

Photo of Billy Armstrong Billy Armstrong UUP 4:15, 17 September 2002

I welcome the opportunity to speak about the consistently high waiting lists, which are causing concern to many people throughout Northern Ireland. Our health system is cursed with the worst waiting lists in the United Kingdom and Europe. Given the size of the population, we are now the poor man of Europe as far as health provision is concerned.

The most recent statistics show that waiting lists continue to grow at an alarming rate. The rise in the number of people waiting for hospital treatment, whether inpatient or outpatient, started in 1999, around the time that the Minister of Health, Social Services and Public Safety took office. In a recent press statement, the Minister said that hospital trusts were being put on notice to deliver on waiting list targets. Surely she should take responsibility for this disgraceful situation that she has presided over as Minister.

Every Member knows of the long-standing effects of gross underinvestment in the Health Service during direct rule. The Health Service has been under the leadership of the Minister for three years now, but the situation has far from improved; indeed, it has spiralled out of control. What is the Minister going to do to reduce the number of patients on long waiting lists? How is she going to reduce the bureaucracy in the Department of Health, Social Services and Public Safety? Her past decisions have done nothing to alleviate wastage and reduce waiting lists.

The number of people waiting for inpatient services grew by nearly 9% in the past year alone. The number of people waiting for more than the recommended time increased by 22% in the past 12 months. The number of people with serious health conditions waiting for treatment increased by one fifth in one year. One of my constituents, who was due to have an operation for a cancer-related illness, was told a few days beforehand that it had been postponed. I had to intervene to have the appointment reinstated. The general public is disillusioned with the health system here. Over the past years, many have seen hospital services decline, not improve.

Last year the Minister made a pledge to reduce waiting lists to 48,000, and she was given an extra £224 million to help her to keep that promise, which has since been broken. The waiting list now stands at a disgraceful 59,000. It is not only inpatient waiting lists that have increased. Outpatient figures have soared to over 140,000 persons, which is another shameful statistic. Each statistic represents an individual suffering, often facing anxiety and unable to get on with his life because he has to wait for an operation.

The waiting list crisis is summed up by the recent comments of the vice-chairman of the British Medical Association’s Northern Ireland council. Dr Brian Patterson said that doctors were

"impeded by bureaucracy, lack of resources and a total lack of decision-making within the healthcare system".

As elected representatives, we cannot afford to ignore the views of the representative bodies of doctors, nurses and other health professionals. The Minister has shown a marked lack of leadership on the issue of waiting lists. No amount of consultation documents can take the place of firm decision-making. The crisis is such, as illustrated by the highest waiting lists in Europe, that the Minister of Health, Social Services and Public Safety should abdicate from her position, as she has failed in her duties.

The Minister told us in March that there would be a reduction in waiting lists, which has not happened. The public have grown tired of broken promises and failed initiatives. We need more beds, more doctors and more nurses in our hospitals.

Photo of Ms Jane Morrice Ms Jane Morrice NIWC

The Member will draw his remarks to a close.

Photo of Billy Armstrong Billy Armstrong UUP

There must be a way of monitoring how taxpayers’ money is spent and there must be a measure of accountability in the health system. The people of Northern Ireland should not be made to wait any longer.

Photo of Mr John Kelly Mr John Kelly Sinn Féin

Go raibh maith agat, a LeasCheann Comhairle. Members have heard much about waiting lists, not only today but over several weeks. It is worth looking back. On 13 March 2002, the Department told the Health Committee that

"Waiting lists for elective procedures have been a problem in Northern Ireland for a number of years. Cuts in resources for health in 1995/96 led to a 30% reduction in elective procedures that year. There has been a subsequent downward spiral, in spite of substantial non-recurring funds directed into elective surgery."

That was in 1995.

"Over the last 10 years bed capacity has decreased by 18%, while inpatient surgery has increased by 10%; 2001 saw a 9% increase in general medical emergencies, which had a knock-on effect on non-urgent electives."

The report goes on — statistic after statistic. Members could argue all afternoon about statistics.

I listened to Bob McCartney — I see he has left the Chamber — and for the first time he acknowledged that the responsibility for the waiting lists was not all down to the Health Minister. Sinn Féin been saying that since the Minister was appointed. For some Members, the Department of Health, Social Services and Public Safety is not a health issue, but a political issue. They manifestly continue to treat health as a political football, and not as something that affects their constituents. They use it as a political weapon against the Health Minister because she is a Shinner — a member of Sinn Féin. That is the basis of their attack on the Health Department, just as it was on Martin McGuinness’s Department. That is the fundamental reason why some Members are being destructive, rather than constructive, in relation to health and education.

It is interesting to note the factors about waiting lists. According to the Office of Health Economics:

"Consultants working in both the public and private sectors have a vested interest in maintaining lists to ensure that some patients will choose to be treated privately."

There are vested interests in the medical profession at GP level. The British Medical Association has been mentioned by several Members as the sounding board or benchmark against which a good or bad Health Service can be judged. I ask the British Medical Association and Brian Patterson what constructive input they have made towards reducing waiting lists. What co-operation have they given to the Department to reduce waiting lists? It goes back to the vested interest and to the impact of vested interests on the Health Service.

Since health is being treated as a political football, Members are entitled to ask what influence those who made it so have used on their friends in the trusts and boards to block the system, cause difficulties and use the same kind of politics that they use in the Assembly. The Minister cannot be accused of being solely responsible for the regrettable state of the waiting lists. All Members regret it.

No one can say that the Minister is clapping her hands because there are waiting lists. Are Members suggesting that she encourages waiting lists and is not taking sufficient action to reduce them? Did the Minister not appoint Jill Anderson — whom no one could accuse of being a Shinner — to attempt to reduce waiting lists? That was a positive action by the Department and the Minister to address the waiting lists in a serious, coherent and cogent way.

Unfortunately, Bob McCartney blamed the Good Friday Agreement for the failure of the Health Service. However, the failure is in the reluctance of a major section of the Assembly to accept Sinn Féin Ministers, and their continual attempts to reduce their effectiveness by back-door tactics and by making areas such as health into political footballs rather than something for the good of the community.

Photo of Mr Sam Foster Mr Sam Foster UUP

I welcome the opportunity to speak on this important issue, which must be one of the Assembly’s priorities. I support the amendment tabled by my Colleague Tom Hamilton and the SDLP’s Annie Courtney. Although it would be incorrect to say that all is well in the Western Health and Social Services Board, where I live, I must acknowledge the board’s recent initiatives to try to reduce the waiting lists. The board has the lowest percentage of ill people on waiting lists in Northern Ireland, and the new day care unit in the Erne Hospital in Enniskillen has contributed to that reduction. Such a move makes the Erne Hospital a valuable asset in the Fermanagh area, and its services to the community could never be dispensed with.

I concur with many Members’ comments that this issue is one of the Minister’s main priorities and, therefore, that one would expect to see an improvement. However, instead of progress, the waiting lists now have approximately 60,000 people on them. It is easy to quote numbers and statistics, but we must remember that each figure represents one patient. Sometimes we lose sight of that. Each of those patients is suffering unnecessarily because of inefficiency and disorganisation in the Department of Health, Social Services and Public Safety. It is worrying to note that we have the longest waiting lists in the United Kingdom, and, more worryingly, in Europe.

The Minister has said that this is one of her main priorities. Two years ago, she established the ‘Framework for Action on Waiting Lists’. Although that led to improvements in other services — 200 people had cardiac surgery outside Northern Ireland in the past year — the Minister’s plan failed to address the underlying problem of longer waiting lists. Will she now have the honesty to admit the failure of that policy? More importantly, will she set in place a coherent, strategic, effective plan that will make a real difference to people’s lives?

An overwhelming majority of people believe that the present structure of the Health Service only complicates matters. There is an overburdened bureaucratic structure instead of an effective decision-making process that is accountable. There are great expectations and greater demands on the health services, but there are also too many areas of administration to contend with. That becomes time-consuming and blocks progress to get a job completed. I acknowledge that this is a complex problem, but enough time has passed for us to see some improvement in the statistics.

An additional £5 million was allocated in 2000, and £2 million was allocated for waiting list initiatives this year. I totally support the call by the Ulster Unionist Party’s health representatives for an independent health auditor. It is possible that the health system is under-resourced, but not as much as some people, including the Minister, would like to make out. Too much taxpayers’ money is being wasted, and we need an autonomous body to help to regulate the money that is channelled into health. I will be interested in the Minister’s comments on that.

Photo of Mr Sam Foster Mr Sam Foster UUP

No, I do not have the time. People are weary of hearing excuses for hospital waiting lists not being reduced. The Minister has been in office long enough to implement effective policies. We do not need more PR spin; we need action so that people can see improvements. Good health is vital, and society demands it now.

With reference to John Kelly’s remarks, does he accept that many of the problems in the Health Service are a residue of the terrible injuries inflicted on people over 30 years of trouble and strife?

Photo of Ms Jane Morrice Ms Jane Morrice NIWC

I call Mr Hussey, and I ask him to restrict his speech to four minutes.

Photo of Derek Hussey Derek Hussey UUP

I congratulate Mr Paisley Jnr on tabling the motion, but he will understand that I am supporting the amendment. I am struck by the similarity of this motion and that proposed by Mr McGrady on 18 September 2001, which stated:

"that this Assembly views with concern the ever-increasing waiting lists for medical and hospital treatment in our local health services, and requires immediate action to remedy this unacceptable and growing problem."

We must ask what action has been taken in the past year, and whether the unacceptable and growing problem has been remedied. The answer to the second part of that question must be an emphatic "No". I await the Minister’s answer to the first part. As a layman, I cannot see what action has been taken by the Department to stop the growth of hospital waiting lists and cut them back.

In December 1999 there were nearly 46,500 people on the waiting list in Northern Ireland. That figure has risen to just under 60,000 in 2002. It is true that the total number of people waiting at any given time does not tell the whole story, as Mr Shannon said. The length of time spent on the waiting list is probably more important. The situation in that respect is extremely bleak.

We do not need a repeat of the 2001 motion. We must concentrate on action to improve the services. That is why I support the amendment.

Nearly 9,000 people in Northern Ireland are categorised as excess waiters, defined as those who have been waiting more than 12 months for cardiac treatment or more than 18 months for other specialities. The National Health Service Patient’s Charter is being routinely breached in this part of the United Kingdom.

Behind the statistics and jargon lies human pain and suffering. I have a big, strong friend at home who is suffering from a hernia. He is being gradually incapacitated by that medical condition, which is not being dealt with by the Health Service.

The problem is not only the number of people on the waiting list, but also the length of time that they must wait. The situation is exacerbated by the ageing population; staff shortages; lack of trained doctors and nurses; fewer hospital beds; delayed discharges caused by the lack of available community care packages; and, in some cases, growing disillusionment among those who are under so much pressure in the Health Service.

The picture that other Members have painted is bleak. I await with interest the Minister’s description of her Department’s strategy for reducing waiting lists and times. I assume that there is one.

I note that her expectations have been radically downsized. At one time she promised large reductions in the waiting lists. However, her Department’s press release of 5 September 2002 states:

"Our target this year is to hold waiting lists at their present levels".

I do not want the buck to be passed. In previous debates the Minister has blamed the Tories, the Chancellor of the Exchequer, the Barnett formula, the Brits in general and other Members of the Executive Committee, especially the Finance Minister. Her latest press release points the finger at the chief executives of the health trusts.

Given the priority that health has been given in budgetary allocations, and the extra money that has been put into the Department in recent years, the buck must stop with the Minister. I note that her attire today is sombre, in contrast to the colourful dress she wore yesterday. She still stands indicted at the scaffold. The onus is on her to account to the Assembly and the people of Northern Ireland for the crisis in the Health Service —

Photo of Ms Jane Morrice Ms Jane Morrice NIWC 4:30, 17 September 2002

Order. The Member will draw his remarks to a close.

Photo of Derek Hussey Derek Hussey UUP

— represented by the waiting list she presides over.

Photo of Bairbre de Brún Bairbre de Brún Sinn Féin

Go raibh maith agat, a Cheann Comhairle. Tá mé buíoch de na Comhaltaí ar fad a labhair sa díospóireacht inniu. Dhírigh an díospóireacht ar cheist ar cúis mhór imní í do go leor daoine. D’éist mé go fíorchúramach leis na pointí agus chuir mé an-suim iontu. Tiocfaidh mé ar ais chucu i gceann tamaill.

Aontaím nach féidir glacadh leis go mbeadh ar dhaoine breoite fanacht ar feadh tréimhsí fada le cóireáil. Aontaím go bhfuil tuilleadh infheistíochta de dhíth inár n-ospidéil. Aontaím go gcaithfimid a chinntiú go bhfaighimid an luach is fearr ar ár n-airgead ó na hacmhainní a chuirtear isteach sna seirbhísí sláinte agus sóisialta.

Tharraing Comhaltaí aird fosta ar chúrsaí taobh amuigh dár n-ospidéil. Ní lú sin de chúis imní domh. Tá go leor daoine ag fanacht sa bhaile leis an tacaíocht atá de dhíth orthu lena neamhspleáchas agus cáilíocht a saoil a choinneáil. Is daoine scothaosta go leor acu seo. Mura bhfaighidh siad cúnamh pras oiriúnach beidh ar chuid acu dul isteach san ospidéal. Beidh moill ann ag cur daoine ar ais chun an phobail mura mbíonn na seirbhísí ann le tacaíocht a thabhairt dóibh.

I am grateful to the many Members who contributed to the debate, which focuses on an issue that is of deep concern to many people in our community. I have listened carefully, and with great interest, to the points that have been made, and I will address them.

I agree that it is unacceptable for sick people to have to wait long periods for treatment. I agree that our hospitals need more investment and that we must ensure that we get the best value for money from the resources being put into health and social services.

Members have also drawn attention to the situation beyond our hospitals, and that is of equal concern to me. Large numbers of people — many of whom are elderly — are waiting at home for the support they need to maintain their independence and quality of life. Without prompt and appropriate assistance some will end up in hospital, and there will be a delay in returning people to the community after hospital care because services may not be in place to support them.

We must view health and social services as a continuum of care. We cannot think in terms of one sector’s pre-eminence. All four sectors — acute, community, primary care and public health — have to work together, and a shortcoming in one becomes a drag on the others.

Waiting lists must be viewed in context. Over the past five years, hospital activity has increased by 10%. During the same period there has been a 27% increase in the number of community care packages. That pressure might have been manageable in a service that had the investment it needed. However, since the early 1980s, the equivalent of £190 million — in today’s terms — was taken out of health and personal social service’s baseline budget. It was only this year that significant additional resources became available for reinvestment.

It is a fact that I inherited a service in which the number of hospital beds had been drastically reduced to the point where we have too few beds to cope with demand. Many hospitals are working at over 90% occupancy, and that is not tenable in the long term.

As Paul Berry said, our community services are also underfunded, leading to inappropriate admissions to hospital and delayed discharges. I am addressing those issues urgently together with my Colleagues in the Executive. However, as I have said, we started with a very low baseline, and it will take some time to put things right.

Demand for hospital services is increasing all the time. The number of GP referrals increased by over 4% between 1997-98 and 2001-02. One factor is, undoubtedly, our ageing population; another is the rapid advances in medicine, which offer new therapies for previously untreatable conditions. More people are being referred for treatment than ever before. However, there is no single cause for the increase in referrals.

One of my first actions as Minister was to set out a long-term plan for dealing with waiting lists. The issue has been one of my key priorities ever since. The plan, which involved getting the extra resources that I needed so that hospital and community capacity could be built up, improving the management of the system and putting best practice into effect, is the only way that the problem will be overcome. Currently, that plan is being implemented.

To address the issue of capacity, I have already announced plans for significant expansion in hospital capacity at the Mater, Antrim and Craigavon hospitals — over 100 extra beds. I have also announced plans for a new day procedure unit for the Erne Hospital and for new theatres at Musgrave Park. When those new developments come on-stream, they will be a major factor in getting more people treated more quickly. The number of renal dialysis stations will also be increased this year to meet growing demand.

The units at the Mater Hospital, for example, will involve the creation of a 14-bed elective unit, which is estimated to deliver some 1,500 cases a year. The Lagan Valley Hospital proposal will deliver about 600 cases a year, initially targeting patients seeking routine elective surgery in general and vascular surgery. Alongside those schemes, significant investment is also going into equipment that will have a direct impact on the length of time that patients have to wait. For example, the new linear accelerators going into Belvoir Park Hospital will increase throughput and reduce waiting times. New diagnostic imaging equipment at Musgrave Park Hospital will boost the regional orthopaedic service.

Alongside that expansion of hospital capacity, it is important to improve the way that existing capacity is used. At present, a significant programme of work is under way to tackle that. In April, I appointed a regional service improvement leader to drive the waiting list agenda and to ensure improved access to services. That individual has a great deal of experience in that area of work within the National Health Service, and she is already making a difference.

Improvements are being made in the way that waiting lists are managed. I have made it clear that I expect the service to deliver on waiting lists. For example, at the end of September, chief executives of boards and trusts are being brought together to examine the key initiatives on validation and waiting list management. Staff have been appointed to support, lead and contribute to all aspects of local action on patient access improvement initiatives. Plans are in place for trusts to allocate staff to make the management of waiting lists in hospitals more efficient.

It is important that the service be encouraged to learn from what works well elsewhere. To that end, I have asked boards and trusts to develop several protected elective facilities. Those facilities will not be affected by day-to-day pressures on the service, which will mean that more people will get their treatment on time instead of — as often happens at present — operations having to be postponed because of the pressure caused by emergency admissions. Plans for those facilities are now at an advanced stage, and their effect will be seen in the months and years to come. That is a prime example of people here already making a difference and showing that the things that they have put in place make a difference. Other trusts throughout the North are taking those lessons on board and are driving forward similar plans in their areas.

Members have referred to the recent statistics for the June quarter, on which the debate is based. I want to make several important points about those figures. First, it is worth pointing out that the increase in the number of patients waiting for inpatient treatment was the lowest quarterly increase since 1998, despite the fact that compared with the same quarter in 2001, the service treated over 1,000 more patients. Secondly, the increase was accounted for mostly by the gynaecology speciality. It contributed almost 75% of the overall inpatient increase, primarily because patients waiting for in vitro fertilisation treatment were included on the inpatient waiting list for the first time. Thirdly, the great majority of patients are still being treated promptly throughout the service. No less than 74% of inpatients treated between April and June this year had been waiting for less than three months. Of inpatients admitted for treatment during the June quarter, 94·8% had been waiting for less than 12 months.

The present position needs to be seen against that background. I have made the point before, in the Assembly and elsewhere, that there are no instant solutions to the problem. What is needed is increased investment, more hospital capacity, more capacity in community services, extra specialist and nursing staff, and more effective and efficient management of the service.

There is strong evidence of progress in that area, but it takes time for the initiatives to build.

It is also important to restate that hospital waiting lists cannot be viewed in isolation. Primary and community care services have a significant role to play in keeping those people out of hospital who do not need to be there and in getting patients discharged as early as possible.

I welcome Paul Berry’s appreciation of the need to invest in a wide range of services in the community as well as in acute hospitals in order to address waiting lists. Such developments will cost money, and I look forward to Members throughout the Chamber supporting me in addressing the financing of services in forthcoming debates on funding.

Tom Hamilton suggested that there was an unco-ordinated approach to waiting lists. That is simply not the case. All boards are working to a common approach, and trusts are working to the template that I set out in the framework for action.

Monica McWilliams mentioned consultants asking for more money for extra sessions. I have made it clear to boards that I expect the new protected elective facilities to be provided on a normal contractual basis, and staff are now being recruited. In advance of the new arrangements, there have been some discussions with clinicians about temporary initiatives. In some cases, staff may have to work through their holidays. I expect boards to consider carefully any proposals to ensure that all costs can be justified, taking appropriate account of agreed rates for such activity.

Sue Ramsey and others mentioned people not attending appointments and who are designated as "DNA" (do not attend). The outpatient rate for non-attendance is 13%. The inpatient rates are suspected to be much lower, but there is no firm evidence of that. All boards are very aware of the problem of people not keeping appointments. Measures are being considered to ensure that reminders are issued and that checks are made that people still need appointments. The possibility of rerunning a publicity campaign is also being considered.

Monica McWilliams quoted the Eastern Health and Social Services Board minutes concerning people waiting more than 12 months for cardiac surgery. The minutes state that, of 52 people waiting more than 12 months in March 2002, 42 had refused an offer of treatment elsewhere, eight had had treatment but were not yet off the list and two had received a date for future treatment elsewhere. However, I accept that people on waiting lists will not always choose to be treated elsewhere.

Ms McWilliams said that the 1,000 community care packages will not be sufficient. I assure her that there is a bid for future rises in funding to increase the number of people who we want to help in community settings.

I agree with Joe Hendron’s point that waiting times, rather than overall numbers, are important. Indeed, one of the key issues that Jillian Anderson is addressing is the more effective management of waiting lists. I expect that her work will lead to reductions in waiting times. The management of waiting lists, which was mentioned, will be a key performance management objective for the service this year.

Billy Armstrong mentioned the ownership of waiting lists. I have developed an approach that has three components: targeting waiting list money for specific activity; a co-ordinated initiative to review and tighten the management of waiting lists in each trust; and, in collaboration with the Executive, putting additional resources into increasing capacity in community services and several key hospitals.

I, of course, am working to target waiting list money in collaboration with my Executive Colleagues. I look to the service to deliver on the co-ordinated initiative to review and tighten the management of waiting lists. I am working closely with the boards and trusts to ensure that each component is well targeted and closely monitored.

I recognise Members’ desire to reduce waiting lists. I too want shorter waiting times for procedures and treatment that will improve people’s lives. I am very much aware of the effect that waiting times have on the individual waiting for treatment. Two years ago, when I issued the ‘Framework for Action on Waiting Lists’, I said that only management action focused on the long term, coupled with new investment in the service, would improve the waiting lists. That remains my position. It is disingenuous not to recognise that a plan, a policy and a clearly thought out approach exist. Waiting lists are a key priority for me and my Department. I have already taken significant action to build a solid foundation to tackle the waiting list problem. I have secured additional resources for the service this year, although that investment can be only a beginning; much more will be needed to build the necessary capacity for a modern service. I look to Members, especially those who have taken part in the debate, to support the endeavour to get the necessary resources.

I have set in motion a long-term programme of work to ensure that health and social services make the best use of the resources allocated and to strive to improve performance in the key areas that make a difference. We must recognise — as Members have today — that until we get resourcing of health and social services right over a sustained period, the improvements that the public want, and which I have been working to achieve, will simply not be deliverable.

A foundation has been laid, but it cannot bring results overnight. However, we are making a difference. Our approach, which I have again explained in detail today, can, and will, bring dividends and ensure that we tackle the problem and that we deal with its effect on those who want easy access to health and social services.

Photo of Mrs Annie Courtney Mrs Annie Courtney Social Democratic and Labour Party 4:45, 17 September 2002

I welcome the opportunity to speak to the amendment moved by Mr Tom Hamilton. I also congratulate Mr Paisley on bringing this timely debate to the House. Neither Mr Hamilton nor I wish to dilute the debate. We hope that Mr Paisley will accept our amendment, the purpose of which was to strengthen and put in place resources and strategies to make the Department more effective and more accountable to the Assembly.

I worked in the Health Service for more than 20 years. Sue Ramsey, a member of the Health Committee, claims that the amendment contains a cheap jibe at the Minister and that people are trying to get at her. The only people who have made a political football of this debate are Sue Ramsey and her Colleague. It is disgraceful that she has accused Tom Hamilton and me of wording the amendment in such a way as to cause offence to staff. Her remark should be withdrawn.

Photo of Mrs Annie Courtney Mrs Annie Courtney Social Democratic and Labour Party

No, not at the moment.

I worked in the Health Service for over 20 years; I was a theatre sister for most of that time. I stood at the operating table night after night, not because of waiting lists, but because of the bombings, shootings and killings on the street. The following day health workers had to suffer the indignity of listening to people who supported such actions. Night after night, we came out to help voluntarily and then went to work the next day. We received no extra money for it, for there was none. I strongly resent the attitude of the two Sinn Féin Members to our amendment, and I hope that the House shares that view.

Mr John Kelly asked what GPs are doing. The GPs at the coalface have suffered throughout. They are the people who have had to try to get patients into hospital. Dr Brian Patterson pointed out that any waiting list meant that someone was waiting for surgery.

There is evidence that the Executive and the Assembly are committed to the Health Service, but we do need to know how the extra £687 million — almost a third of the Executive budget — was spent. We have a responsibility to ensure good management and accountability for the use of resources. Some trusts were able to manage their budgets, while others were allowed to run up large deficits — perhaps to the detriment of their colleagues. They were given an extra £18 million by the Department of Health, Social Services and Public Safety. How was that money spent, and what was the origin of the deficits? The Minister must address those issues and respond.

Also, we must see the progress of the Executive. The Department produced. ‘Framework for Action on Waiting Lists’ in Autumn 2000. We have not yet seen that report.

I warmly welcome the appointment of the regional co-ordinator, who will focus specifically on waiting lists and times. The Committee for Health wants to assess the effectiveness of the resources used in tackling waiting lists and to see precisely where the money has been spent. I agree with Mr Hamilton that an audit trail is necessary. It is almost impossible to obtain answers. The money goes into the Health Service, and no one is too sure where it comes out. For that reason, we need answers and an audit trail. Thus, I hope that the mover of the motion will accept our amendment in the spirit in which it is intended. It is not meant to dilute what he said. I welcome his comments and all the constructive comments that have been made today.

It is also necessary to find extra skills and training to assist staff. As I said earlier, I worked for so long in the Health Service that I resent some of the remarks made today. Yes, it is possible that in the past there was wastage in the Health Service. It is also possible that the Health Service was taken for granted.

Photo of Ms Jane Morrice Ms Jane Morrice NIWC

Will the Member draw her remarks to a close.

Photo of Mrs Annie Courtney Mrs Annie Courtney Social Democratic and Labour Party

Madam Deputy Speaker, I understood that we had seven minutes to wind up.

Photo of Ms Jane Morrice Ms Jane Morrice NIWC

It is my understanding that the Deputy Speaker made it clear that the mover of each amendment would have seven minutes to propose and five minutes to wind up. Those were the instructions. I shall give the Member leave to finish her last line.

Photo of Mrs Annie Courtney Mrs Annie Courtney Social Democratic and Labour Party

Thank you for that, Madam Deputy Speaker.

I also welcome the commitment of the Minister to address the issues in an effective and coherent manner. With regard to amendment No 1, we find that it is too vague to be of any assistance in tackling waiting lists. It will impose extra bureaucracy on the Department and trusts.

Photo of Mr John Kelly Mr John Kelly Sinn Féin

On a point of order, Madam Deputy Speaker. Is it not in order that if a Member is named in a contribution to debate, that Member has the right to reply? The Member refused to give way.

Photo of Ms Jane Morrice Ms Jane Morrice NIWC

Order. The naming of a Member, as the Member is well aware, happens often on the Floor of this Chamber. Certainly, it is absolutely the choice of the Member who is on his or her feet whether to give way.

Photo of David Ford David Ford Alliance

I welcome this debate, and I support amendment No 1, which strengthens the original motion put down by Mr Paisley Jnr. We support that motion from the Benches, although we do not necessarily support all of the words used by the mover.

I also welcome the Minister’s recognition of the continuum of care, which extends from primary care to community care, and of which acute services are only a part. I assure the Minister that, like Paul Berry, I will, wearing my retired social worker’s hat, continue to remind her of those facts.

The point of our amendment, which was dismissed so fleetingly by Mrs Courtney, is to focus the Assembly’s attention on the relevant statistics. The number of people on waiting lists is irrelevant; the issue is how quickly they receive treatment. That is why the Scottish Executive have adopted the concept of waiting times rather than waiting numbers as the basis on which statistics in Scotland are compiled, which is a more meaningful way of expressing concerns.

Individuals do not care whether there are 40,000, 50,000 or 60,000 people on a waiting list. They want to know how quickly people are treated. In particular, a statistic that includes various specialities and varying degrees of seriousness of ailments is meaningless. Serious, worrying, life-threatening illnesses are mixed with many other matters. The Minister should give urgent attention to determining a better way of presenting statistics.

At the moment, rather than concentrating on life-threatening illnesses that are of greater concern to the community, the statistics provide consultants with a perverse incentive to treat minor ailments that can be dealt with quickly and cheaply, thus removing one person from the waiting list. That is why we sought to strengthen the motion by referring to "waiting times", not "waiting numbers". I trust that if the proposer of the motion cannot accept amendment No 2, he can at least accept amendment No 1.

Although the Minister was unhappy with all criticism of her Department, which is her right, Mr Paisley Jnr’s motion is a moderate, reasoned and sensible method of addressing the issue, just as one would expect from him at times such as these. It is a pity, however, that the words that he used when proposing the motion were anything but moderate, sensible and reasoned.

I am concerned by amendment No 2, which seems to propose merely to tack on at the beginning of the motion a "let’s bung in all we can to make it sound nasty" few words. For anyone who is taking the issue seriously to suggest that there is a total lack of decision-making, when we have heard that people have been appointed to deal with the matter, is rather over the top, and for two Back-Benchers from the parties of the First Minister, the Deputy First Minister and the Minister of Finance and Personnel to propose an amendment that refers to the lack of resources, which is a problem for the Minister of Health, Social Services and Public Safety, as opposed to the Executive, is a slightly thin argument. Members on these Benches, therefore, have no intention of supporting amendment No 2, which merely adds political diatribe without recognising the problems that we face.

Mr Hussey said that the Minister of Health, Social Services and Public Safety previously blamed the Chancellor, the Barnett formula, the British Government and the Brits in general. Fundamentally, many causes exist, and it is illogical for Ulster Unionist and SDLP Members to pretend that it is the fault of the Minister alone.

The Minister must accept her responsibility, and her Executive Colleagues, who are also concerned with the allocation of resources, should accept their responsibilities as well. That is why the motion, with the addition of amendment No 1 to make the statistics more meaningful, puts realistic pressure on the Executive, whereas amendment No 2 would detract from that entirely.

Photo of Ian Paisley Jnr Ian Paisley Jnr DUP 5:00, 17 September 2002

Whatever David Ford is on, he should perhaps find a dark corner, lie down, keep taking the tablets and, it is to be hoped, it will all be over by the morning. If there is a doctor in the House, perhaps he could help him with his problems. I notice that Dr Hendron is not volunteering his services. The manner in which Mr Ford supported my motion was rather dubious but, if he keeps taking the tablets, it should all be over soon.

Mr Hamilton said that he supported the Comptroller and Auditor General’s view on what he should do. It is disappointing that that is not mentioned in the amendment; if it were, the Assembly could have supported it collectively.

However, I am drawn by the comments of Mrs Courtney and Dr Hendron. Dr Hendron is correct to say that the framework for waiting lists has failed. That has failed along with the other glossy reports that the Minister has published: ‘Building the Way Forward to Primary Care: A Consultation Paper’ — that has failed; the report of the acute hospitals review group, on which we have had incomplete answers, has failed; ‘Investing in Health’ has also failed; and ‘Developing Better Services’ has failed. In fact, the Minister has all the reports but none of the answers. That was proved in the Minister’s address — again we got no answers. If the situation was hopeless before the debate, it is even more hopeless now, because we have heard the same rigmarole and the same tired excuses from the Minister, and that is disappointing.

Mrs Courtney rightly targeted the Member for West Belfast, Ms Ramsey, and the Member for Mid Ulster, John Kelly, for what they said. Ms Ramsey set up a straw man by claiming that the debate is an insult to those working in the Health Service. That is absolute rubbish. In fact, if the debate had not occurred, those who put in the hours in the Health Service would be insulted that we do not care enough to debate the crisis.

Photo of Ian Paisley Jnr Ian Paisley Jnr DUP

No — I am winding up, and the Member is obviously getting wound up.

Photo of Ian Paisley Jnr Ian Paisley Jnr DUP

Ms Ramsey said that she wished to commend the Minister. If she and her party wished to commend the Minister, why did they not table an amendment that commended her for her work on the waiting lists? They are silent on that; they do not wish to commend the Minister because they dodge the issue every time. Indeed, I see that they are getting rather erratic. That is probably because, as John Kelly said, they are Shinners.

I put it to the House earlier that if Bairbre de Brún were called Barbara Brown, if she had an English accent, or if she were a direct rule minister, we would be tripping over Shinners at Stormont Castle demanding her departure because she was a disaster. I noted that Sinn Féin dodged answering that tonight. When we search our hearts, we know that the Minister has given us no hope or comfort that we can take back to our constituents, be they in West Belfast or North Antrim. The Minister has sold them out, and that is the stark reality for us all.

John Kelly’s speech was a pièce de résistance. He said that is was the doctors’ fault and specifically that it was Dr Brian Patterson’s fault. Dr Patterson does more in one day than Mr Kelly will ever do in a year to help ailing people. He also went on to insinuate that it was the nurses’ fault. The only thing that he did not say was that it was the patients’ fault for being sick in the first place. It was ridiculous. All I can say to Sinn Féin is this: keep digging, because you are making a mighty big grave for yourselves.

There are fewer nurses working in Northern Ireland tonight than there were under Margaret Thatcher. That is the indictment on this Minister of Health, Social Services and Public Safety

Photo of Ian Paisley Jnr Ian Paisley Jnr DUP

Ms McWilliams says that Maggie Thatcher started it. It is a pity that the Minister will not improve the situation; all we hear is previous Governments being blamed when this Government do not make any improvements.

I feel drawn back to John Kelly’s comments because they were so imaginative. He slagged off the doctors. Dr Terry Magowan, a GP in Ballymena, was quoted in the ‘Belfast Telegraph’ on 13 September 2002. I will read this slowly so that John Kelly can understand. Dr Magowan said that, since the end of fundholding, his practice had more than 200 minor surgery procedures disallowed each year:

"Although our funding through the General Medical Services budget was only for 60 procedures, we were able to achieve funding for more than 200 additional procedures through the fundholding budget."

That is another failure by the Health Service. Even when it ends one service, the problem of waiting lists is not addressed. The Minister has lost her grip.

The situation should be put in a European context. Northern Ireland does not stand alone in this crisis, although we have the longest waiting lists in Europe. It would be different if we had long waiting lists and everywhere else had even longer lists. There are 15 countries in the European Union; 11 of them maintain national waiting list totals. Taking population sizes into account, all of them have shorter waiting lists than Northern Ireland. The four countries that do not monitor the national trends do measure how long patients have to wait for treatment. Northern Ireland comes at the bottom of the pile. Portugal’s queue is 10,000 people longer than Northern Ireland’s, but its population is approximately six times higher.

Photo of Ms Jane Morrice Ms Jane Morrice NIWC

The Member will draw his remarks to a close.

Photo of Ian Paisley Jnr Ian Paisley Jnr DUP

I have reservations on some points, but I will support amendment No 2 and will not vote against amendment No 1.

Question,

Several Members:

Aye.

Photo of Ms Jane Morrice Ms Jane Morrice NIWC

I shall repeat the Question, so that I am completely clear.

Question,

Several Members:

Aye.

Photo of Ms Jane Morrice Ms Jane Morrice NIWC

The "Ayes" — [Interruption].

Several Members:

No.

Photo of Prof Monica McWilliams Prof Monica McWilliams NIWC

On a point of order, Madam Deputy Speaker. The first time the Question was put it was very clear that there were no "Noes". Surely we should have taken that and moved on to the Main Question?

Photo of Ms Jane Morrice Ms Jane Morrice NIWC

Thank you for that point of order. In the Chair, I was unclear as to exactly what the position was when the "Ayes" and "Noes" were made. It was not clear to me, and therefore I repeated the Question. I shall put the Question a third time so that I can be totally clear as to what the position is on amendment No 1.

Question,

Question,

Main Question, as amended, put and agreed to.

Resolved:

That this Assembly notes with concern the most recent statistics on hospital waiting lists and, recognising the problems of bureaucracy, lack of resources, wastage of present resources and total lack of decision-making within the healthcare system, calls for the implementation of an effective and co-ordinated strategic plan between the Department of Health, Social Services and Public Safety, the Health Boards and Trusts to help reduce the number of patients and length of time spent on these waiting lists.

Adjourned at 5.14 pm.