Non-Acute Hospital Provision in Armagh City

Adjournment – in the Northern Ireland Assembly at 3:30 pm on 12th May 2009.

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Photo of Francie Molloy Francie Molloy Sinn Féin 3:30 pm, 12th May 2009

I remind Members that the proposer of the topic will have 15 minutes in which to speak. All other Members who are called to speak will have approximately nine minutes.

Photo of Dominic Bradley Dominic Bradley Social Democratic and Labour Party

Go raibh maith agat, a LeasCheann Comhairle. Tá an-áthas orm labhairt ar an ábhar seo inniu.

I thank the Business Committee for the opportunity to debate the provision of non-acute health services in Armagh.

As Members are no doubt aware, the re-establishment of devolution was a source of hope for many, including the people of Newry and Armagh. Those people elected us to the Assembly because they believed that local politicians would be better stewards of their interests than direct rule Ministers. Little did they know that devolution would threaten Armagh city with the closure of three hospitals. The people of the constituency are now asking us, their elected representatives, to step up to the plate and deliver on the promises that we made to them.

We are all aware that Northern Ireland Departments are charged with finding 3% efficiency savings over the three years of the comprehensive spending review. However, we did not expect those savings to impact on front line services to the extent that they have done, especially in Armagh, where the efficiency savings appear to have been directed. Efficiency savings of 3% should not mean the closure of three hospitals that serve the three most vulnerable groups in the community: St Luke’s Hospital for the severely mentally ill; Longstone Hospital for those with severe learning disabilities; and Mullinure Hospital for the frail and elderly.

The closure of 50% of acute and specialist psychiatric beds is the most extensive closure in all the trusts in Northern Ireland. It seems to have been decided that Armagh will take the hit, because the proposals are dominated by the Southern Health and Social Care Trust’s determination to make inpatient services fit into the new Bluestone mental-health unit at Craigavon Area Hospital rather than by an assessment of the population’s current and future needs.

As we all know, Armagh is particularly dependent on public-sector jobs, which account for 37% of employment in the area. The proposals could lead to the loss of around 200 jobs there. The only consolation that the trust can offer us is that no compulsory redundancies will be made. That would be a consolation if we were short-sighted enough to accept it, but we are not. Jobs lost through any form of redundancy are jobs lost; they are lost not only to those who hold them at present but to the local economy, our children and our grandchildren. Armagh does not have a strong industrial base, because of its location and lack of infrastructure. The area also does not have a well-developed retail sector. As I said, it depends heavily on the public sector for its survival. As elected represent­atives, we cannot stand idly by and watch proposals that will devastate Armagh be implemented.

Those who put those proposals forward cannot, any more than we can, be oblivious to their social, economic and political impact. Armagh is united on the issue across the community with all political parties and 16,000 signatures rejecting the proposals with one voice.

In the consultation, the trust proposed closing the Mullinure Hospital rehabilitation unit for elderly patients, which has 36 beds. It said that the demand for non-acute beds had declined, that the current three-site provision was unsuitable, that Mullinure Hospital had the lowest occupancy rate of the three sites and that it did not have the full range of services. The trust said that there were also concerns about the future availability of clinical cover during out-of-hours periods, and that there were delays in ambulance transfers from the hospital.

In response to the consultation, it was pointed out to the trust that it had failed to take into account the impact of the proposals on elderly relatives, carers and friends of patients, and that it had not developed measures to mitigate those effects. It was also pointed out that Mullinure Hospital had the shortest stay of the three sites, and that out-of-hours services could be provided by GP out-of-hours arrangements. In addition, it became clear through Assembly questions that the trust had overstated the ambulance issue. When those rebuttals were put into the mix, it was clear that, using the trust’s own criteria, the preferred option should have been the continuation of the three-site model.

Furthermore, the trust failed to consider an additional model of retaining a dementia rehabilitation and assessment unit at Mullinure Hospital and transferring the dementia assessment and treatment unit from St Luke’s Hospital to Mullinure. That model was rejected because the trust said that it would not address the serious concern regarding the difficulty of sustaining in-hours medical cover. That issue was never mentioned in the consultation, but has now become a driving factor in the process. It looks very much as though the trust was caught on the hop by the new Mullinure model proposal and had to find some reason to reject it.

In all this, the trust has not placed sufficient emphasis on accessibility of services. We saw earlier that the trust dropped its proposal to close a residential home on the basis of accessibility. The trust is committed, in its own words, to removing barriers to service. The closure of Mullinure Hospital will create a barrier to service access for many people in the Armagh district.

I appeal to the Minister to reconsider the issue of Mullinure Hospital. The Minister has been invited to visit the Armagh hospitals. I ask him to come to see for himself the situation on the ground and the level of care that is provided. I ask him to talk to relatives, who are very satisfied with the high standards of treatment that their loved ones are given. Mullinure Hospital is a new facility. In Armagh, it is a jewel that should not be sold off for short-term gains. It should be polished and shine in the crown of health services in Armagh for years to come.

Turning to the case of St Luke’s Hospital and Longstone Hospital, the proposals ignore or dismiss the in-patient needs of any part of the mental-health, learning-disability or dementia services that cannot be accommodated in Craigavon Area Hospital. The proposals have been supported by a highly subjective and, in my view, superficial and biased centralisation option appraisal that is focused primarily on short-term efficiency savings of 3%. They do not sufficiently address mid-term and long-term service needs.

They are not future-proofed to meet the Bamford Review recommendations to develop a range of specialist psychiatric facilities for the most vulnerable patient groups. There is no mention of dementia or of challenging behaviour in line with recommendations 35, 51 and 53 of the Bamford Review. Where is the nursing and medical support for psychiatry, low-security or challenging behaviour? Where is the accommodation for learning disability, low-secure and challenging behaviour to be sited? Where are the step-down beds for forensic psychiatry to be sited?

Those issues are detailed in recommendations 81, 82, 100 and 146 of the Bamford report on forensic services, but they are nowhere to be seen in the trust’s proposals. If the trust is required to provide, and has the capacity to provide, for all those facilities on the Armagh site, why is the trust proposing further extensive newbuilds on the already overcrowded, traffic-congested site at Craigavon?

Given the trust’s projections of a significant increase in the elderly population — 44·4% growth by 2017 — one would have to ask why the trust is closing villas one and two in St Luke’s Hospital, which is all of the statutory provision for that vulnerable and increasing patient group. Would it not be more prudent for the trust to maintain some statutory provision and expertise for this patient group, whose needs frequently cannot be met by the private sector? Has the trust considered the reorganisation and optimum reallocation of vacant facilities on the Armagh site as a viable alternative to the Bluestone one-site option?

The closure of 50% of acute and specialist psychiatric beds is the most extensive closure in all the trusts. It has been justified as being essential to meet efficiency savings and to improve services. However, I believe that there are valid, less extreme alternatives for mental health and learning disability to meet the 3% efficiency savings contribution, while still maintaining essential adequate acute and specialist beds and fulfilling the recommendations of the Bamford Review by resettling any truly long-stay patients, but also providing for the low-security and challenging-behaviour patient groups.

It would be sensible to retain the two-site option, with the Bluestone unit at Craigavon Area Hospital and the Armagh site. It was rated as the best option in the board’s previous strategic review. The reallocation of the paediatric intensive care unit, the acute admission ward and the addiction unit to the best vacant facilities at the Armagh site would avoid the significant expense of newbuilds in Craigavon.

There are further benefits to the two-site option. It would fulfil Bamford’s recommendation for all patient groups, including low-security and challenging-behaviour patient groups, severely mentally handicapped patients, the elderly, and people with severe learning disabilities. It would also avoid the further expense of a newbuild on the already overcrowded and congested Craigavon site, maintain capacity and flexibility for future service needs, including mentally-ill patients who are diverted from the criminal justice system, and maintain the expertise and employment in the statutory sector in Armagh, rather than using a growing expensive diversion to a remote private sector.

The Southern Trust’s proposals for Mullinure, St Luke’s and Longstone Hospitals are not the best option for Armagh. They are not the best option for patients or staff, nor are they the best option for the future of employment in Armagh.

I ask the Minister to reconsider the proposals, with a view to coming forward with an acceptable plan based on the outlines that I have given today. I believe that they make sense for patients, for staff and for employment in Armagh. I know that the Minister cannot be here today, but I am assured that he will consider carefully the contributions made by each public representative here today. I trust that he will do that and, in doing so, reject the trust’s proposals and come forward with a much more acceptable solution for Armagh.

A LeasCheann Comhairle, gabhaim buíochas leat as seans a thabhairt domh labhairt ar an ábhar seo inniu. Go raibh céad míle maith agat.

Photo of William Irwin William Irwin DUP

I thank Dominic Bradley for securing the Adjournment debate, which highlights the concerns of Health Service employees, patients and their families in the Armagh area. The Southern Health and Social Care Trust recently decided to press ahead with plans to reorganise and reduce services in the city, much to the disappointment of staff, patients and the wider community.

As was said in the debate last week on the axing of nursing posts, the power to change minds rests with the Minister. A decision by Minister McGimpsey to endorse the trust’s proposals on services in the Armagh area would have a massively detrimental effect on its health services. I have spoken to many staff and service users who feel strongly that the trust is going down the wrong path to meet the requirements of the compre­hensive spending review. Minister McGimpsey said that the review would not mean cuts; rather, he would find savings through efficiencies. Despite that pledge, the trust is flying in the face of the Minister’s assurances by proposing to close wards and reallocate services.

Indeed, in a detailed response to the Southern Health and Social Care Trust’s consultation on the proposed reorganisation, Armagh City and District Council, of which I am a member, questioned the trust’s supposed patient-first ethos. That is because the trust’s proposals do not have the patient at heart. Why reduce and remove services that have consistently been performing well in the Armagh district? Why force the most vulnerable to travel further and to be inconven­ienced when there are highly respected services at the Mullinure, Longstone and St Luke’s sites?

UNISON held a rally in Armagh on 19 April that, unfortunately, I could not attend. It is clear from those who did and from the thousands of people who signed our council petition that Minister McGimpsey has a big decision to make. I noted UNISON’s call for the Department of Health to be exempt from the compre­hensive spending review; however, that is not a realistic or acceptable solution. All Departments must make efficiency savings, and exempting the Department of Health would be a mistake. Even the Minister agrees that there are efficiency savings to be made in the Health Service.

I also voice my concerns about the detailed response that was tabled by our local council and about how that submission was received and treated by the trust. When we met a few weeks ago to hear the trust’s verdict on the consultation, I left feeling strongly that our concerns and responses had not been adequately considered. Armagh City and District Council tabled options, including the provision of non-acute in-beds at Mullinure Hospital, but the trust simply moved the goalposts, without allowing any further comment from the council.

I call on the Minister to give a commitment that the detailed and collective response submitted by the elected representatives of the Armagh district be given adequate consideration and that the trust discuss the alternative positions that are outlined in our response. The Minister holds the key to the future of healthcare in Armagh city and district. The version of future service provision presented by the trust is very much at odds with the views of staff, patients and the wider public.

Minister McGimpsey must lean on his pledge to find efficiencies, and leave alone the hard-working and highly respected services that operate to a high standard in Armagh city. He must also instruct the trust to reconsider its options, taking into account fully the views of the area’s civic leaders and allow a full and frank debate on the proposals.

Photo of Cathal Boylan Cathal Boylan Sinn Féin

Go raibh maith agat, a LeasCheann Comhairle. Ba mhaith liom tacaíocht a thabhairt don díospóireacht.

I welcome the Adjournment debate and thank Dominic Bradley for securing it. However, I am disappointed, not so much that the Minister is not here, but that the debate has proceeded. Someone should be here to respond to debates such as this.

Photo of Cathal Boylan Cathal Boylan Sinn Féin

I will in a minute.

I also want to put on record that the Executive agreed that the 3% efficiency savings were not to be taken out of front line services, and Members have already referred to that. Every Minister agreed efficiency savings, but they were not to be targeted at front line services.

Photo of Dominic Bradley Dominic Bradley Social Democratic and Labour Party

I thank the Member for giving way. He expressed disappointment that today’s debate was going ahead without the Minister’s presence. I am sure that we are all disappointed that the Minister is not here. I am not here to lambaste the Minister; I am here to try to convince him to change his mind.

This debate was tabled on two previous occasions, and this is the latest opportunity that we have had to debate the issue in the Chamber. Were we to wait any longer, there would be no guarantee that the Minister would be present next time, so it is better to air the matter today.

Photo of Cathal Boylan Cathal Boylan Sinn Féin

I thank the Member for his intervention. I take his point, but I would have liked to have heard what the Minister had to say.

I appreciate the opportunity to speak about what could be one of the most important issues that will affect Armagh city and district for many years, if the Southern Health and Social Care Trust’s proposals are approved by the Minister.

On Thursday 26 March 2009, I attended a board meeting at St Luke’s Hospital, where I was given the chance to speak on behalf of the staff and patients of all three facilities in the area. Little did I realise that when I entered that meeting, I would witness two different sets of emotions. In the morning, I saw tears of joy and happiness because of the proposals to save facilities in one area. However, there were tears of sadness and disappointment in the afternoon because of the proposed closure and reduction of services in Armagh city. That was particularly poignant because I reside in that part of the constituency and I have a close affiliation with many of the people who are involved.

The trust proposes to close 36 non-acute beds at Mullinure Hospital and 47 inpatient mental-health beds at St Luke’s Hospital. In total, it is estimated that approximately 176 beds will be lost across three hospitals. The trust has also proposed to resettle 60 long-stay mental-health patients and 33 long-stay learning-disability patients from Longstone Hospital into the community.

Mullinure Hospital has been open since 1989. It provides a day hospital, a minor-injuries unit and 36 non-acute beds that cater for frail, elderly people in Armagh and the wider area, many of whom are 70, 80 or 90 years of age. Two main functions of the Mullinure Hospital are to rehabilitate patients after acute hospital care and prepare them for a return home to the community, and to provide palliative end-of-life care.

St Luke’s Hospital has been open for 184 years. It is the second-oldest hospital in Ireland. It has 47 mental-health inpatient beds. It is proposed that those will move to the Bluestone unit at Craigavon Area Hospital, which is already under severe pressure. The Bamford Review recommended the closure of larger institutions in favour of smaller community units, so does the proposal not contradict and defeat those recomm­endations? After gaining approval for a new 42-bed hospital on the St Luke’s Hospital site, why has the trust decided to shelve those plans?

If patients from Longstone Hospital are to be resettled into the community as proposed, that must take place in Armagh, given the vulnerability of many of the patients. Quality and consistency of care has to be at the core of such matters. Consideration must be given to the staff who would have to adapt to different working conditions and surrounds if those proposals were implemented.

For many years, it has clearly been recognised that employment in Armagh city has never been heavy-industry based or orientated towards major retailing, private investment or entrepreneurialism. Rather, there has been a reliance on the public sector, niche shops, small indigenous businesses and tourism to generate employment and drive the local economy.

Public-sector jobs account for between 35% and 40% of the total job provision in Armagh, and the health sector provides 18% of those jobs. One can see how important those jobs are to the local economy. If the proposals are implemented, it is conceivable that up to 300 jobs could be lost. That could signal the demise of the public sector in the area and expedite the move away from the city of many other jobs in education or administration. Under the new council structures in 2011, Armagh could lose out on all fronts.

Healthcare, including mental-health care, care for elderly people, respite care and care for people with learning needs or disabilities, has been provided in Armagh for many years. During the conflict, healthcare providers in Armagh made no distinction between people; each and every patient was cared for equally. Over the years, an excellent, dedicated, professional and highly skilled pool of workers has provided high-quality healthcare. As a result of drastic cuts, those highly skilled jobs and members of staff could be lost permanently to the community and to Armagh.

Members and representatives of staff from the three hospitals and from Armagh City and District Council submitted evidence during the consultation process, including new suggestions for the trust to consider. However, they believe that the trust has not seriously considered those suggestions. Furthermore, they believe that, before the consultation period, the trust offered those who will be affected most by the proposals little opportunity to make a positive contribution.

As I said, I am disappointed that the Minister is not here. Nevertheless, would it not be more practical for the Southern Health and Social Care Trust to evaluate all the facilities, public and private, in its area to ascertain whether there are pressures on other aspects of the healthcare that it provides? If so, would it not be feasible to transfer or relocate those services to the three hospitals, not only to alleviate pressure but to create and sustain jobs in Armagh city and the surrounding area? Go raibh maith agat.

Photo of Danny Kennedy Danny Kennedy UUP

I thank Mr Dominic Bradley for securing this important debate. As a Member who represents the Newry and Armagh constituency, I recognise that this debate is an important contribution to facing up to the ongoing concerns about hospital provision in Armagh city. At the outset, I pay tribute to all health staff and workers, who, over many years — indeed, generations — have provided care and attention to a great many people in the complex of St Luke’s, Longstone and Mullinure hospitals.

I know that the local health trust’s recent decision has caused much angst among Health Service workers, patients and people in the Armagh area. The Minister of Health, Social Services and Public Safety is considering those decisions, and I know that he fully understands all the issues involved, some of which are complex and difficult. Nevertheless, those difficulties must be faced up to. I also know that although the Minister is not present in the Chamber he will take a keen interest in the Hansard report, which I hope he will have an early opportunity to study. Moreover, I hope that he will have an early opportunity to come to the Mullinure Hospital — indeed, the entire complex — if he has not been there already. In addition, I hope that a meeting can be arranged between the Members who represent the constituency and the Minister to discuss matters further.

Local party councillors and I have taken the opportunity to meet the Health Minister to discuss those matters.

The future of non-acute hospital provision in Armagh is important, but it is also important to place the debate in context and look at the processes of change that will affect overall decisions. Members will be aware of the recommendations of the Bamford Review, which all parties endorsed and signed up to, and for which they have enthusiasm. The difficulty for us is that the implementation of the Bamford Review will, of necessity, mean change. However, that change must be well managed, and, if that is to happen, we must ensure that non-acute health provision is retained in Armagh.

As local representatives, we are concerned at the impact of job losses in the public sector and the adverse impact that that would have on Armagh. We will seek to retain as many public-sector jobs as possible, be they in health, education, local government or Government agencies. That has to be a priority for Members who represent Newry and Armagh and the representatives of the wider community.

Regardless of whether we like it or not, the economy in Armagh, rightly or wrongly, is built on and relies heavily on public-sector jobs. Therefore we need to see how those jobs can be protected and if possible enhanced. I, with other Members of the House, have encouraged, welcomed and participated in the Armagh United campaign, which was formed and organised by the local council to protect public-sector jobs. I want that campaign to succeed. If it is to succeed, I believe that we, as political and party representatives, have a responsibility to work together and put aside personal interests and party advantage. Playing to the gallery and political grandstanding will not serve our constituents well. Instead, we must work together and build consensus to see how we can go forward.

We need to work with the local council and the health authorities, the Administration and the relevant Departments for the future development of the complex that comprises Longstone Hospital, Mullinure Hospital and St Luke’s Hospital.

There is an urgent need to create an effective estates strategy that will examine the management of sites and consider what public-sector services they should provide. I look forward to ongoing representations on the issue being made to the Health Minister. I understand the importance of the issue and I encourage Armagh United and the local council in their campaign. Furthermore, I appeal to local representatives to stay united on the issue, not to use it for party advantage and — considering that all of their parties are signed up to the recommen­dations of the Bamford Review — to be realistic in their anticipated outcomes.

Photo of Dominic Bradley Dominic Bradley Social Democratic and Labour Party 4:45 pm, 12th May 2009

Does the Member agree that the trust’s proposals contain a misinterpretation of the Bamford Review term “long stay” to include specialist, low secure/challenging behaviour bed provision and that the Bamford recommendations 35, 51 and 53 require provision for patients with challenging behaviour and those with dementia. Furthermore, does he agree that recommendations 47, 48 and 99 require provision for patients with challenging behaviour/low secure requirements and severely mentally-ill patients, and that those have been ignored by the trust’s proposals?

Photo of Danny Kennedy Danny Kennedy UUP

I certainly accept that, when making any final decision on those issues, the Minister will have to consider the full implementation of the recommendations of the Bamford Review and what that really entails, including whether the recommendations are being properly applied in this case. There are clear concerns that must be addressed.

At the public rally in Armagh, members of the UNISON trade union spoke with various representatives about the Ulster Unionist Party amendment on the 3% efficiencies target affecting health services. It is with some regret that I mention that, apparently, some Members gave commitments that they would support that amendment but then reneged on them. Let us not divide on all those issues. I caution members to stay united. Armagh is united, as it should be, and its representative must be united in the face of very difficult and challenging decisions.

Photo of Mickey Brady Mickey Brady Sinn Féin

Go raibh maith agat, a LeasCheann Comhairle. I, too, thank Mr Bradley for securing this Adjournment debate. I accept that he is not here to lambaste the Minister, but rather to convince him of his point of view. The Minister might be easier to convince if he was present in the Chamber, but, unfortunately, he cannot be here.

Sinn Féin believes that people have the right to social, economic, gender and cultural equality. Creating the conditions for establishing an equal society means recognising that many diverse groups need enhanced protection within the state. Many of the issues that must be addressed when promoting social inclusion relate to the provision of, and access to, quality services. People in all walks of life must have equal access to equal services.

In its publication ‘Changing for the Better’, the Southern Health and Social Care Trust made a number of proposals. The trust stated that it had consulted widely with older people, including focus groups. It was informed that, in future, those people would not want to be cared for in a residential care setting, preferring instead to maintain their independence and remain at home. Apparently that has been achieved through the development of rehabilitation and support services and the increased availability of respite choices and 24/7 home care.

Having spoken to staff in Mullinure, St Luke’s and Longstone hospitals, it seems clear that staff were not consulted to any great degree. Their input and views on all those issues would have been very important. The trust is proposing to centralise mental-health inpatient care to the new £12 million state-of-the-art facility at the Craigavon Area Hospital site. Given the increasing numbers of people who present with mental-health problems, it appears that the trust is putting all its eggs in one basket. Statistically, 43% of people who claim employment and support allowance — formerly known as incapacity benefit — present with mental-health and behavioural problems, so those problems are very much on the increase.

The trust proposes to continue to reduce the numbers of people with learning disability in long-stay hospital care. That would lead to the closure of three wards in Longstone Hospital over the next two years and 33 people with learning disabilities being resettled into new supported-living accommodation in the area. That is fine in principle, but what happens if there is no supported-living accommodation in the area? It is those 33 people who will bear the brunt.

The closure of St Luke’s Hospital would have a detrimental effect on patient care. There would also be serious implications for the public, as well as a severe impact on staff in ancillary services, who may lose their jobs. Up to 280 to 330 jobs will be affected by the trust’s proposals, which will have serious repercussions for Armagh and the surrounding district.

The Bamford Review has already been mentioned, but the Bain Report advocated the decentralisation of public-sector jobs. The strategy to relocate elsewhere is wrong, particularly in the context of the RPA. Armagh city and district needs those jobs and relies on them for its economic well-being.

It needs increased job opportunities, not job losses. Job losses will affect many families in the area.

Above all, staff feel that patients, and their care, must come first. In talking to staff on all those sites — experienced staff who have been in post for many years — it is apparent that the trust has not addressed their views and considerations adequately. Those people are on the front line, and it is essential that their views are considered. In talking to staff, I have found that they have a realistic and pragmatic approach, and they realise that certain things need to change. However, they feel that their interests, and those of the patients, have been sacrificed on the altar of efficiency cuts. We were all told that front line services would not suffer in the efficiency cuts.

Before any decision is made, I ask the Minister to consider all aspects of the situation. The views and input of all the relevant parties must be addressed fully.

I apologise for Minister Murphy’s being unable to be here; he has ministerial business. Nevertheless, he will lend all his support to the matter, and, like the rest of us, he will endeavour to do all that he can to maintain those hospitals on site.

Adjourned at 4.56 pm.