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The Provision of Hospital and  Healthcare Facilities in Mid Ulster

Adjournment – in the Northern Ireland Assembly at 6:00 pm on 3rd March 2009.

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Photo of William Hay William Hay Speaker 6:00 pm, 3rd March 2009

The proposer of the topic will have 15 minutes in which to speak, and all other Members who speak will have approximately seven minutes.

Photo of Francie Molloy Francie Molloy Sinn Féin

Go raibh maith agat, a Cheann Comhairle. I thank the Business Committee for putting this item on the agenda for debate. The issue is very important as we try to provide healthcare facilities for rural areas of the North.

Mid Ulster is the centre of the North and has a population of approximately 95,000, 70% of whom live in rural locations. There is lack of access to public transport, many roads are in rural areas, and there is poor infrastructure due to neglect. It is unthinkable that an area such as Mid Ulster does not have a major hospital with acute services.

Yet, instead of working towards the goal of getting a major hospital for the area, the Department is trying to remove the limited services that we do have. Since Maurice Hayes was permanent secretary of the Department, the policy seems to have been to reduce services, transfer beds, say that a service is unsafe and reduce it further by closing hospital departments. Is the service now unsafe because it has been run down?

We have already had the closure of South Tyrone Hospital, the Tyrone County Hospital, Lurgan Hospital, Armagh Community Hospital, Downe Hospital, and a number of other hospitals. The maternity and major-surgery units in the Mid-Ulster Hospital have been closed, and it now has a limited accident and emergency service, a day clinic for minor injuries and limited opening hours for other services. There has been a reduction in the doctor red-eye service at Dalraida Hospital but no increase in the ambulance service that was promised when other hospitals were closed. Anyway, an ambulance is no replacement for a hospital bed or for surgery in an operating theatre.

There are no maternity services in Tyrone, the largest county in the North, or in south Derry. If one looks at a map of the North, the whole centre has been deprived of hospital and healthcare facilities, which makes the area unsafe as a place for people to have children or to live in. There is a lack of acute services to meet the needs of the people who live in the area. We will be told that we need large numbers to provide those services, but we have a mass of people in the centre of the North who have been deprived of those services.

As the distance from there to Antrim is the same as from Antrim to Mid Ulster, distance is not an issue. Even the few respite facilities for disabled children or young adults in Mid Ulster have been diluted.

The proposed closure of the accident and emergency department and remaining acute services at the Mid-Ulster Hospital will reduce it to a day clinic. It is also proposed to close Cherry Lodge children’s respite facility in Randalstown, which is the only facility in the area, and it has limited capacity. It is proposed to replace that facility, but no such replacement is in sight.

Investment is continually being made in Altnagelvin Area Hospital, Craigavon Area Hospital, the Royal Victoria Hospital (RVH) in Belfast and to a lesser extent, Antrim Area Hospital. However, with the exception of the RVH, the built size of none of those hospitals was sufficient to compensate for the closure of that number of hospitals. Neither the size nor capacity of Craigavon Area Hospital, for example, has been increased to enable it to deal with the closure of the hospitals in south Tyrone, Armagh and Lurgan.

Several further issues also come into play. Members have been told that the review of public administration (RPA) will result in savings, but the issue is that £13·5 million has already been paid out on voluntary redundancies under RPA. We have also been told that there will be a reduction in front line services and that 700 nursing jobs will be lost in the near future. How long will it be before many of the top civil servants and board directors who have been replaced return to the Health Service as consultants and advisers, as happened in the teaching profession?

Over the years, various trusts and workers in the Health Service have said that the hospitals that are being promoted, such as Antrim Area Hospital and Craigavon Area Hospital, are in the wrong place. If a decision were being made today about where to build a hospital, neither location would be selected because of an insufficient population. The population must move in from the rural areas to make those hospitals viable as far as the Department is concerned. Despite those hospitals being in the wrong place and not providing a quality service, the Department will continue to invest in them, and, therefore, the situation will get even worse.

Members have been told that, over the years, the services from the Mid-Ulster Hospital and the South Tyrone Hospital worsened, and it became, therefore, unsafe to continue to provide healthcare in either. Subsequently, patients were transferred to either Antrim Area Hospital or Craigavon Area Hospital, but do they provide a safe service? Both hospitals are overcrowded, and the services that were previously provided to local people have, therefore, been diluted.

People working in the trust have said that maternity services at Antrim Area Hospital cannot cope with the increased demand. Members know that maternity services in Craigavon Area Hospital cannot cope with the increasing number of patients, because no additional facilities were put in place. Again, local people have been deprived of services that they previously received.

Will the Minister guarantee that Antrim Area Hospital provides a safe service? In the House in March 2008, I raised the case of an elderly patient who was suffering from clostridium difficile and had been put on the Liverpool care pathway for the dying patient. The Minister of Health, Social Services and Public Safety said that he did not know what that was. I highlighted the case because local people had come to me. The patient’s family told me that they had to intervene to ensure that their mother was taken off that care pathway. Fortunately, 12 months later, that woman is alive and healthy.

On that occasion, the Minister warned me that I was scaremongering and that he hoped that I could back up my comments with material evidence. I have done so, but I have yet to receive a reply from the Minister. He has not apologised for the hospital putting a patient on a pathway for the dying long before her time. I was right, and I hope that the Minister will take the opportunity to apologise. That woman’s family are entitled to know exactly what happened and which consultant took the decision to put her on a pathway for the dying. What did the internal inquiry, which has never been made public, reveal, and what changes have been made to ensure that it does not happen again? Does Antrim Area Hospital provide a safe service?

The people of Mid Ulster deserve a better service. Members have heard about the legacy of past misman­agement and the running down of services and hospitals. We must ensure that those services and hospitals are rebuilt. In the past, the Minister’s party made it clear that were it to be allocated the Health Ministry in the future, it would do so.

Well, there is silence there at the moment, because we do not see any rebuild at the present time; we see the closure of more and more hospitals.

People in the rural part of Mid Ulster are entitled to the same quality of Health Service provision as those who live in the cities, towns and villages across the rest of the North. We want healthcare facilities in the centre. I call on all parties to set aside their political differences and to come together to ensure that we get a proper healthcare facility there. If one looks at a map of the North, there is a complete vacuum in the centre. There are no acute healthcare facilities or maternity facilities in the centre of the North. A representative of nurses and midwives appeared on television today and stated that people had to travel unsafe distances to get to hospital.

We should not stand idly by and let this continue to happen. We have witnessed the closure of a number of different hospitals — the South Tyrone Hospital, the Tyrone County Hospital, Armagh Hospital, Downe Hospital, and other facilities that have provided healthcare — yet, we do not see anything else being put in their place.

We have been promised that there will be a new hospital in the Fermanagh area. However, I am quite certain that we will come back here in the future and be told that Fermanagh does not have the mass or the need; that it is too much of an outreach area, and that a new hospital is not needed, which will save millions of pounds. If this is a savings exercise, we want to see an end to it. We want proper healthcare facilities in the Mid-Ulster Hospital.

This is not just about hospital services; it is about day-care facilities, health-centre facilities and facilities for GPs to provide proper services and care. It is about midwives and nurses in rural areas trying to provide a service against all odds, and it is about home-helps. All of those services have been reduced time and again. The main hospitals are being closed, and people are not in a situation to provide services. It is very important that we do not stand idly by and watch that happen in silence.

There is a poem by Martin Niemöller who, in 1946, made comments about those who listen in silence.

“When the Nazis came for the communists, I remained silent; I was not a communist. When they locked up the social democrats, I remained silent; I was not a social democrat. When they came for the Jews, I remained silent; I was not a Jew. When they came for me, there was no one left to speak out.”

In the hospital situation, let us say that they came for the Dungannon and South Tyrone Hospitals and closed them, and those outside the area remained silent because it did not affect them. They then came for the Omagh hospital, and divided the Omagh and Fermanagh people into different camps, and in dividing them, put the hospital where they decided, and the ordinary public remained silent. Now they have come for the Mid-Ulster Hospital, and we cannot remain silent.

We have to stop the rundown of hospitals at some stage. Let me tell Members: they are coming for Daisy Hill Hospital, Lagan Valley Hospital, the Causeway Hospital in Coleraine, the Mater Hospital, the Ulster Hospital and Whiteabbey Hospital, because the present strategy in the Department seems to be to have one hospital. It used to be that there should be six golden hospitals; now it seems that there should be one — the RVH — and all funds and resources will go there. Sometime in the future, Altnagelvin Hospital will simply become an outreach clinic for the RVH.

We have to stop the decline before it continues along its present line. I hope that the Minister will look at the North in general and say: there is a rural community there, let us look at that rural community and target it to provide a proper healthcare facility in the centre.

Let us not continue the line of maintaining and rebuilding hospitals that were built in the wrong place in the first instance. Let us go west of the Bann and build a proper acute hospital that will provide all the facilities that are required. As I have said, the distance east and west of the Bann is the same; it does not matter where you start from. I want to see an improved hospital service facility. I want to see a stop to the rundown, and I ask Members not to remain silent, but to speak out now. It does not matter who the Minister is, or what party he is from. We should be speaking out on behalf of the constituents of Mid Ulster to ensure that they have proper healthcare facilities.

Photo of Ian McCrea Ian McCrea DUP 6:30 pm, 3rd March 2009

I welcome the opportunity to speak in this important debate. However, I find it somewhat ironic that it is a Sinn Féin Member’s name on the Order Paper expressing concern about the Mid-Ulster Hospital, because it was a former Minister from his party who launched the document that has brought about those proposals. That is an unfortunate position.

I wonder whether we have witnessed a genuine road-to-Damascus political conversion, in which Sinn Féin has done an about-turn on this matter, or is it simply political opportunism. Let us never forget that the original sponsor document emanated from his party’s Minister, and the implementation of the processes in that document have brought us to where we are today. Indeed, our community has had to witness the constant drip, drip of an unfolding process that continues to undermine the services that are provided for it, and that is leading swiftly to the demise of acute-service provision at the Mid-Ulster Hospital.

It should also be noted that during the consultations emanating from the publication of the ‘Developing Better Services: Modernising Hospitals and Reforming Structures’ document, the then Sinn Féin Members — including our absentee MP for Mid Ulster, Martin McGuinness — were strangely silent. Indeed, to a hurt and concerned community, that silence was breathtaking. In the end, the Sinn Féin Members pledged their support to the Minister, and, therefore, accepted her proposals to downgrade the essential acute services that were being provided at the Mid-Ulster Hospital, thereby leaving a vast geographical area of Northern Ireland devoid of acute-hospital provision.

I welcome the Member’s conversion, and I hope that he continues his fight —

Photo of Francie Molloy Francie Molloy Sinn Féin

Irrespective of what other Members said, does the Member remember that this Member spoke out about the Mid-Ulster Hospital and the South Tyrone Hospital and disputed the loss of those services with her party? Furthermore, I traced the history of those measures not to Minister Bairbre de Brún, but long before that to a previous permanent secretary, Maurice Hayes, and to the direct rule Ministers who were in charge at the time.

Photo of Ian McCrea Ian McCrea DUP

I was coming to that point; however, given that the Member has raised it, I will deal with it now. I give the Member his dues, because it is sometimes difficult for people in all political parties to speak out against their party’s Ministers. On this matter, I accept that he has spoken out about the Mid-Ulster Hospital and the South Tyrone Hospital in Dungannon. I also accept the research to which he referred, which leads back to direct rule Ministers. However, at that time, the Assembly had an opportunity to change the policy. Unfortunately, there have been many occasions when direct rule Ministers took the people of this Province in a direction in which they did not wish to go.

Those of us who have genuinely opposed the downgrading of acute services at the Mid-Ulster Hospital over many years can rightly condemn the present proposals. However, it would be unacceptable if some Members were to play to the crowd and use the community’s fears for their own selfish ends. I accept that Sinn Féin no longer holds the ministerial portfolio for health, but the stark reality is that its fingerprints are all over the proposals.

For many years, the DUP fought with conviction against any proposals to downgrade acute services. Indeed, my father, who represented Mid Ulster for many years as an MP and as a councillor in Magherafelt, consistently led the fight to oppose the proposals. It is unfortunate that since my election to Cookstown District Council in 2001 and to this House in 2007, I find myself in the same position.

Magherafelt District Council and Cookstown District Council have continually joined together to oppose any such proposals. Unfortunately, even in 2006, when further reductions in services took place, the present situation appeared to be a fait accompli.

The Ulster Unionist Party holds that ministerial office now, and it is that party that will put the final nail in the downgrading of the Mid-Ulster Hospital, if not — as some believe — its closure. The hospital may not close today — in fact, I know that it will not close today — it may not close two years from now or ten years, but some believe that it will close. We have to give some credibility to the notion that the hospital will close.

The previous Member who spoke referred to a number of services across the constituency. We have seen the proposals for Cherry Lodge, which plays an integral part in the lives of many people in Mid Ulster. In the past 24 hours, we have seen the closure of the acute services at Tyrone County Hospital, and a few years ago, the South Tyrone Hospital in Dungannon lost its acute services. That is unacceptable. The west of the Province is crying out for acute-service provision.

Last Friday, I met some senior officials of the Northern Trust at an accident and emergency department. I also met some of the nurses who were on duty that day. They want to keep acute services at the Mid-Ulster Hospital; they want to be able to provide the service that has been provided so excellently for many years, but, unfortunately, the continual erosion of services has left them in a position where —

Photo of Sue Ramsey Sue Ramsey Sinn Féin 6:45 pm, 3rd March 2009

I thank the Member for giving way. I agree that the Health Service provisions — be they acute care or primary care — should be free at the point of delivery. There is an issue about investing for health. I am a member of the Health Committee, so I am well aware of what is happening. Does the Member accept that for years, our health sector was mismanaged, affected by bad decisions that were made by direct rule Ministers, and underfunded? Will the Member join me in calling for additional money for the Health Service from the Finance Minister — his party colleague — so that we can have a focus on acute services across the North?

Photo of Ian McCrea Ian McCrea DUP

I agree that the Health Service has been underfunded for many years. However, I am sure that the Member will accept that the Health Service received a lot more money in the current Budget than it did before. That is not to say that it has as much money as it needs. If we had an open cheque, I am sure that health would get its fair share.

Photo of William Hay William Hay Speaker

I ask the Member to draw his remarks to a close.

Photo of Ian McCrea Ian McCrea DUP

Will the Minister ensure that services are retained across the west of the Province? I raised that matter previously with the Minister at Question Time.

Photo of Billy Armstrong Billy Armstrong UUP

I speak as someone who was born in the constituency of Mid Ulster, who still lives there and who relies on the Mid-Ulster Hospital in Magherafelt. My four children were born in the Mid-Ulster Hospital, as were five of my six grandchildren, so no one needs to tell me how important the hospital is to the local people.

Nobody wants to see any hospital being closed or downgraded, but we have to live in the real world — one in which we are facing a worldwide economic downturn. Unfortunately, Mid Ulster is not immune to that.

In the last Administration here, I recall that a Sinn Féin Health Minister gave the go-ahead for the ending of acute services at the Tyrone County Hospital in Omagh. I have no doubt that many people in west Tyrone will not have forgotten that.

I have heard members from other parties criticise the Health Minister, but I have no doubt that much of their criticism is motivated by party-political considerations and that they are playing to the gallery.

Although a lack of resources is not the only factor in play on this issue, Members of other parties who are concerned about Health Service cuts should recognise that money is finite and that the Minister does not have a bottomless pit of money at his disposal. I suggest that they approach the Finance Minister to support the Ulster Unionist Party in its quest for more resources for the Health Minister.

Photo of Francie Molloy Francie Molloy Sinn Féin

I was reading a newspaper cutting outlining what the Member, before Mr McGimpsey took on the role of Minister of Health, Social Services and Public Safety, said about the closure of the Mid-Ulster Hospital and the bed waits in the Antrim Area Hospital. Will the Member explain why, all of sudden, he now accepts that the Mid-Ulster Hospital should close?

Photo of Billy Armstrong Billy Armstrong UUP

I have no problem explaining that — the Mid-Ulster Hospital is not closing.

On the positive side, according to the Northern Health and Social Care Trust’s current consultation, ‘Modernising Health and Social Care Services: The future of Health and Social Care Services in the Northern Trust’, it is anticipated that a wide range of services will be retained in the new multi-million pound facility at Magherafelt, where there will be enhanced facilities and staff training. Services will include: a nurse-led minor injuries unit; day-case surgery; outpatient services; diagnostics services; care for the elderly, including rehabilitation and assessment; palliative care and inpatient beds; and a co-located health and care centre.

In short, the hospital is not closing, but it cannot be denied that the local people will see the loss of A&E services as a major blow to the area. Experience tells us that the problem is not due solely to a lack of financial resources, although there is no doubt that funding will always be a major issue in the Health Service.

Not long ago, the Mid-Ulster Hospital’s accident and emergency unit had to be closed temporarily due to staffing problems. There has long been an issue about attracting doctors to the Mid-Ulster Hospital due to a perceived lack of opportunities, because of relatively low numbers of patients as compared with a city-based hospital. I recognise that the trust has attempted on a number of occasions to attract senior clinicians to the Mid-Ulster Hospital, but the reality is that medicine is changing and clinicians want to work in large teaching hospitals, where they can specialise in particular areas and improve their expertise. That is the reality, but it is clearly a problem for those of us who live in the west, where the population is smaller.

The concentration of acute hospital services in a number of key areas means that it is even more important than ever — particularly in the often-neglected west of the Province — that the Department for Regional Development devotes sufficient resources towards improving the road infrastructure. That will allow people to access hospitals in the likes of Craigavon, Enniskillen, Coleraine, Altnagelvin and Antrim more easily. Conor Murphy, the Minister for Regional Development and a member of Sinn Féin, can confirm that I am in regular contact with him about the dreadful state of the roads in Mid Ulster. I am sure that all Members for Mid Ulster will agree that the roads there are really dreadful and are a total disgrace because no money has been put into them this number of years.

Photo of Ian McCrea Ian McCrea DUP

Does the Member agree that the fact that the roads are in such poor condition will mean that the time that it takes for an ambulance to get from a house to Antrim Area Hospital, for example, will be increased?

Photo of Billy Armstrong Billy Armstrong UUP

We all know that if there are bad roads, vehicles cannot drive as fast, and we also all know that the Minister has put on new ambulances that may, perhaps, be able to cushion the journey over those rough roads. However, more money must be spent on our roads. I will not be letting up on that effort, and I will bring the matter to the notice of the Minister for Regional Development again.

I welcome the announcement that was made last autumn regarding the Health Minister’s huge investment in the modernising and upgrading of the ambulance fleet. That will certainly assist in getting paramedic treatment to patients, and that money was very well spent. We must achieve a first-class Health Service for the people of mid Ulster; that is what I want to do, and I know that the Minister shares that aim.

Photo of Patsy McGlone Patsy McGlone Social Democratic and Labour Party

Go raibh maith agat, a Cheann Comhairle. Probably the only part of my speech that will share commonality with Mr Armstrong’s is that I speak as someone who not only represents Mid Ulster but is from the area, and who has had extended family treated successfully, and others not successfully — that is no reflection whatsoever on the intensity of care available — in Mid-Ulster Hospital.

I place on record my comments about the accident and emergency departments at Mid-Ulster Hospital and Antrim Area Hospital. Despite the critical pressures that staff are under and the vulnerabilities that they face, they perform like true heroes.

It is not often that Mr Armstrong and I disagree on issues. However, there is a need to inject a strong flavour of reality into the situation. It was said earlier that acute services at Mid-Ulster Hospital are not to close. For those of us with family who have suffered difficult circumstances, quick access and proximity to an A&E department is paramount. Whether people come from Pomeroy, Ardboe or up in the mountains in The Six Towns outside Draperstown, it is paramount that they can receive urgent care. It does not matter how good the road is, access to Craigavon, Antrim or Enniskillen is second-rate for people who live in those areas. By the time that they would reach any of those destinations to receive the necessary treatment, or by the time an ambulance would reach them — I will talk more about that later — their situation could have moved into the critical, or possibly fatal, zone.

Photo of Ian McCrea Ian McCrea DUP

I am sure that, like me, the Member read an article in one of the local papers a couple of weeks ago in which a mother referred to the fact that her son had attempted suicide. Had it not been for the staff at Mid-Ulster Hospital’s accident and emergency department, she felt that he would not have survived. He needed urgent treatment, and if he had had to travel any further, there was every chance that his life could not have been saved. Given what the Member has just said, does that not put into stark reality the need for retaining acute services at Mid-Ulster Hospital?

Photo of William Hay William Hay Speaker

The Member has an extra minute.

Photo of Patsy McGlone Patsy McGlone Social Democratic and Labour Party

I thank the Member for his comments. I read about the case, and that is one of the sadder examples in which — although fortunate for the person involved — access to medical treatment at the A&E department at Mid-Ulster Hospital in Magherafelt was available.

I will highlight a few stark realities. The A&E facility at the hospital has been reduced and downgraded. It now closes at 11.00 pm, and I have been in there with people at 11.00 pm when the doors close. It is quite simple: the patient must travel to Antrim Area Hospital or to some other hospital. Staff at Mid-Ulster Hospital are under strict instructions not to admit or treat people who arrive after 11.00 pm.

Another stark reality is that if that facility is shut, the existing waiting times of three to seven hours at Antrim Area Hospital’s A&E department will become 12 to 15 hours before a person is treated. That harsh reality must be placed on record. If acute services at Mid-Ulster Hospital closes, people will, potentially, have to wait for 12 to 15 hours. Another fact is that Antrim Area Hospital regularly communicates with Mid-Ulster Hospital to establish whether it has any beds, instead of what we had been led to believe, which was that people would be moved to Antrim Area Hospital to be treated there. That is an unacceptable situation.

We have been told that services are being modernised by moving facilities and trying to concentrate them in Antrim Area Hospital, when, clearly, its A&E department cannot cope. It has neither the beds nor the resources, and staff are under serious pressure.

I will move on to another aspect of healthcare in the area, which is the doctor-on-call service. Someone from the area around Pomeroy, Ardboe or Kildress might need a doctor, and that doctor could be in Ballycastle or Coleraine. In fact, the present proposal is that in order to get treatment from a doctor on call during those hours, that person would have to travel to Coleraine. That is a grossly unacceptable situation for those of us who live west of the Bann and who have seen acute hospital services stripped and denuded from County Tyrone.

I will move on to the Ambulance Service. Again, it has excellent staff who are doing their best with limited resources. An extra ambulance was supposed to have been provided for use in Mid Ulster. I am very reliably informed that that ambulance could be as far away as Newtownabbey when it is required in Mid Ulster.

I welcome the upgrade to the ambulance fleet. I hope that it comes through and that it benefits my constituency. However, observers have told me that it is not an infrequent occurrence for ambulances in the existing fleet to break down. One person recently told me that a breakdown lorry travelling through Moneymore with an ambulance on tow is not an infrequent sight. That may be an unfortunate reality, but it is a reality nonetheless.

We are told that there are no doctors for A&E, and that, consequently, services must be centralised at Antrim Area Hospital. I may be approaching the situation from the perspective of an ordinary 5’8”, but why can a contract not be developed that co-ordinates the services of doctors and consultants between Antrim and Magherafelt, in order to provide the service that people west of the Bann need and to which they are entitled?

I am also reliably informed that in other parts of the world the practice is to decentralise services outwards, rather than centralise them in large hospitals. Doing so ensures that the medical services needed by people in more rural areas are more accessible to those people.

Antrim A&E is already under severe pressure. Maybe some money could be saved by not producing glossy brochures that tell us everything in the garden is rosy, because it simply is not. There are intolerable pressures in Antrim A&E, and people are suffering. If we want to deliver a service, we must address those bed pressures, and doctors must have at their disposal all the services and resources that they need.

Photo of William Hay William Hay Speaker 7:00 pm, 3rd March 2009

The Member must bring his remarks to a close.

Photo of Patsy McGlone Patsy McGlone Social Democratic and Labour Party

Sure, just one wee minute, Mr Speaker.

In conclusion, is it acceptable to the Assembly that someone dies, not on a trolley — on which people are lying at present — but in an ambulance, because not even a trolley is available? I do not believe that that is acceptable to the Assembly. God forbid, but I hope that we avert such a situation.

Photo of Michael McGimpsey Michael McGimpsey UUP

I have listened with interest to the points made by Members. I certainly share their interest and concern about the provision of hospital and healthcare facilities in Mid Ulster. I would like to meet the people who “reliably inform” Patsy McGlone and other Members, because I do not recognise some of the scare stories that he is producing. Scaring is not the way to take forward a debate on the future.

Photo of Michael McGimpsey Michael McGimpsey UUP

No, I will not give way. The Member has just sat down.

We are governed by a document and a strategy called ‘Developing Better Services’ that was actually developed by Sinn Féin, Mr Molloy’s party. That strategy allows for moving the hospital and Health Service estates into the provision of modern, up-to-date healthcare for the Northern Ireland population.

The reality is that medicine is changing. It has changed dramatically in the past 20 years. No longer does a general surgeon on a ward fix a broken leg, take out an appendix, remove tonsils and carry out a cardiac operation on the way past. All of those operations are specialised, and because that is the case, we have specialist teams. We have it that way because patients do better. The outcomes from the Health Service for patients have dramatically improved and increased in the past 20 years. That is why we are tailoring the hospitals to suit the situation.

Billy Armstrong made the point that there is a very serious revenue consequence with which I am dealing in the Health Service. We want to run a Health Service that is comparable to that in England, but we are currently £300 million short, which will rise to £600 million. In fact, if I had accepted the draft Budget that Mr Ian McCrea and his party were so keen for me to accept, we would have been a long way short even of that. I did not accept that draft Budget, and the Department received extra money. At the time, I said that that was as good as it gets. However, the reality is that that is not enough. That is the other element with which we are dealing.

I noticed that Francie Molloy has an ongoing vendetta against Antrim Area Hospital. It is a very good hospital, and has dedicated staff who provide a first-class service. The hospital overwhelmingly hits the 95% target of treatment for accident and emergency patients within the four-hour target time. Mostly, the hospital achieves much better than that. There were some breaches over the winter period as a result of the onset of winter flu — the worst for 10 years — which not only increased the throughput of patients, but meant that we lost some staff.

That being said, the staff in the accident and emergency department of Antrim Area Hospital are very good. The department has an enormous throughput. The fact is that it is that sort of accident and emergency department in which specialist doctors want to work. Each night, the accident and emergency department in the Mid-Ulster Hospital in Magherafelt may deal with one patient who has suffered a heart attack. The accident and emergency department in the Antrim Area Hospital handles approximately seven such cases each night. That is what the head of accident and emergency services told me. That means that the staff keep a very high level of skill. It is about maintaining those levels of skill.

The Mid-Ulster Hospital in Magherafelt cannot maintain the sort of levels of specialism that are required to deliver what Members appear to think can be delivered in a local hospital. However, the fact is that we are increasingly specialising. We are not, as Francie Molloy suggested, coming down to one hospital. That is nonsense. There are nine acute hospitals in the system: six major acute hospitals, including the Royal Victoria Hospital, which is the regional acute hospital, and three smaller acute hospitals — the Daisy Hill Hospital, the Causeway Hospital and Erne Hospital. The Causeway Hospital was built 10 years ago. For the benefit of Mr Molloy, we are about to spend £260 million on a new hospital in Enniskillen. If that does not determine our intentions as far as the Erne Hospital is concerned, I am not sure what would.

What I heard was a disappointing litany of scares, half-truths and rumours from reliably informed sources. However, some sources are not that reliably informed. Mid-Ulster Hospital has over 500 staff, which includes approximately 250 nurses and 32 doctors. There are no plans to reduce that workforce by any appreciable amount as we deliver the new hospital that is planned for Mid Ulster. That new hospital will receive investment of approximately £25 million. At the same time, there will be investment in the Antrim Area Hospital of approximately £84 million, and a number of health and care centres will also be built, including one in Magherafelt.

We are trying to change the way that we do things. There is not a retreat from Mid Ulster — the hospital is not closing. The Tyrone County Hospital in Omagh is not closing either. Omagh is getting a new hospital at a cost of £190 million. If Members cannot hear and understand those messages, I despair. Antrim Area Hospital is a major acute hospital. If memory serves me correctly, it has approximately 450 beds. It also has a large number of staff who deliver a first-class service.

Francie Molloy talked about the Liverpool pathway for death, but there is no such thing. There is a Liverpool care pathway. That is in place because every year in Northern Ireland —

Photo of Michael McGimpsey Michael McGimpsey UUP

No; I will not. The Member should allow me to speak. I have listened to him. I would have given way if it had been a serious contribution. [Interruption.]

Photo of Michael McGimpsey Michael McGimpsey UUP

Every year, approximately 15,000 people die in Northern Ireland.

Most of them would like to die at home, but around 70% die in hospital. Of course, there must be protocols, and procedures must be in place to provide that end-of-life service. Therefore, whenever I talk about cradle-to-the-grave care, I mean it literally. It starts with maternity care and carries on all the way through to the end of life, and that end-of-life service is provided by the Liverpool care pathway.

Indeed, the Regulation of Quality Improvement Authority investigated the Liverpool care pathway, which was devised by the Marie Curie Palliative Care Institute and which is in universal use in the UK. That end-of-life service focuses on providing comfort, respect and dignity for the patient. The incident to which Mr Molloy referred was investigated, and recommendations were made, all of which were implemented. The report cannot be published because of data protection. That is the situation. [Interruption.]

If Members shout at me from a sedentary position, I do my best not to respond. [Interruption.]

The Health Service is changing, as is the way in which services are delivered. The Health Service has to change. Let me give another example: there has been a lack of investment in the Health Service over the past 30 years because of the need to fund a terrorist —

Photo of Francie Molloy Francie Molloy Sinn Féin

If the Minister will not reply to comments that are made from a sedentary position, perhaps he will reply if I stand up —

Photo of William Hay William Hay Speaker

Order. It is quite obvious that the Minister has no intention of giving way, so the Member should not persist in interrupting.

Photo of Michael McGimpsey Michael McGimpsey UUP

As I said, when contributions are serious, I am happy to give way, and I normally do so. However, I will not give way in this instance.

After 30 years of funding a terrorist war, there are huge capital infrastructure deficits in Northern Ireland, not least of which are in the health sector. We need more than £7 billion, which is a huge sum of money. The allocation is less than half that, which means that we are a long way short of the amount that we need to provide the necessary investment, therefore meaning that I have to prioritise again. When one does not have enough money, one has to prioritise. One of the priority areas in the 10-year capital programme will be the Mid-Ulster Hospital, among others, and it will be part of the investment that I talked about. Billy Armstrong listed what we see as the future services in the Mid-Ulster Hospital under ‘Developing Better Services’ plan, which was introduced by a Sinn Féin Minister and supported by Sinn Féin.

Francie Molloy talked about hospital closures, but I have not closed a single hospital. I resent those types of spurious, silly accusations. Investment is coming forward and will continue to do so. It would happen faster if there were more money in the kitty, but the fact is that there is not. As I see it, the Mid-Ulster Hospital has a very secure future, delivering a slightly different type of service for Magherafelt and the surrounding area. That service will be absolutely essential for the future, and it will work in combination with the network of hospitals.

Let me focus on the key elements of accident and emergency and acute services. The Ambulance Service has a target response time of eight minutes, and the key is that each ambulance, whether it be an emergency A&E ambulance or an RRV, has a skilled paramedic on board. It is essential to get that paramedic to the patient as quickly as possible. Ambulances are not meant to rush out out, scoop up a patient and then rush them back to the hospital; ambulances take the A&E service to the patient. That is what the A&E ambulances and the RRVs do, and the target is to respond to 75% of life-threatening cases within eight minutes. The service is very close to meeting that target.

In addition, there is a four-hour waiting target for A&E units, and Antrim Area Hospital has a very good record in that regard, too. Antrim Area Hospital provides the main A&E unit for the area, but it also has support from other places.

Comments were made about County Tyrone, but health services in Northern Ireland are not delivered by county. The county line is an old regional boundary line that dates back to Tudor times, but we deliver by trust area and in accordance with trust boundaries. Of course, Magherafelt falls within the Northern Health and Social Care Trust area. The Northern Trust has two acute hospitals, as do the Western Health and Social Care Trust and the Southern Health and Social Care Trust. Those are the trusts that people in the area can access, but normally the blue-light ambulance will go to Antrim Area Hospital.

I have been to the accident and emergency department at Antrim Area Hospital on more than one occasion. It is a first-class accident and emergency service, which is provided by first-class staff, and I wish that Members would occasionally acknowledge that and acknowledge the work that is being done in our hospitals and throughout the Health Service. The Health Service is changing. It is getting stronger, it is getting better, and it is getting better for everyone, including the people of Mid Ulster.

Adjourned at 7.15 pm.