Specialist Neurology Beds

Private Members’ Business – in the Northern Ireland Assembly at 3:30 pm on 29th November 2010.

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Photo of Francie Molloy Francie Molloy Sinn Féin 3:30 pm, 29th November 2010

The Business Committee has agreed to allow up to one hour and 30 minutes for the debate. The proposer will have 10 minutes in which to propose the motion and 10 minutes in which to make a winding-up speech. All other Members who are called to speak will have five minutes.

Photo of George Robinson George Robinson DUP

I beg to move

That this Assembly notes with concern the cut in specialist neurology beds at the Royal Victoria Hospital; acknowledges that the Belfast neurology unit is a facility for all of Northern Ireland; and calls on the Minister of Health, Social Services and Public Safety to ensure that the beds are reinstated so that patients with neurological conditions have equal access to specialist treatment.

First, I pay tribute to and welcome to the Public Gallery the representatives of various charities that work with people affected by neurological conditions and their families. Their work is invaluable and it must be acknowledged and praised. In proposing the motion, I am in no way minimising the excellent work done by other agencies in our Health Service. I salute them all.

Without any consultation with other trusts, the Belfast Health and Social Care Trust has reduced the number of specialist neurology beds from 23 to 15, which represents a cut of around 35%. That cut has had a devastating impact on a specialist service that was already struggling to cope with inadequate facilities. There are some 35,000 patients with a significant neurological disability in Northern Ireland, but there are only 17 neurologists in post to look after them. I would like Members to listen carefully to the approximate figures that I am about to quote. There are 4,000 patients with multiple sclerosis (MS), 4,000 patients with Parkinson’s disease, 100-plus patients with motor neurone disease, and 600 patients at risk of having Huntington’s disease. In Northern Ireland each year, there are 8,500 stroke victims, who may suffer neurological damage, and 17,000 patients with epilepsy. That is not an exhaustive list of the neurological conditions that Northern Ireland neurologists deal with, but it gives an idea of the numbers of patients who are affected by the loss of specialist beds from the neurology unit. Members must remember that that specialist unit is for the whole of Northern Ireland and is not just a facility for the Belfast area. The Minister has not recognised this in some of his answers to my written questions.

Photo of Thomas Buchanan Thomas Buchanan DUP

Does the Member agree that the Minister’s written response to my concerns about the cut in the number of neurology beds, which he said is a matter for the Belfast Trust and not for his Department, represents the Minister passing the buck? He is taking no interest in that huge issue, which will affect patients across Northern Ireland. That is totally irresponsible of the Health Minister, and, with the Member, I call on him to reinstate those beds as soon as possible.

Photo of Francie Molloy Francie Molloy Sinn Féin

The Member has an extra minute.

Photo of George Robinson George Robinson DUP

I agree entirely with my colleague. The loss of beds affects the whole of Northern Ireland, not just Belfast.

Many conditions that neurologists deal with are obscure. I have a personal interest in epilepsy and, when possible, have helped Epilepsy Action closely over the past few years. As I stated earlier, 17,000 people in Northern Ireland have epilepsy, and there are three epilepsy specialist neurologists for Northern Ireland. That equates to roughly 5,600 patients for each specialist neurologist. Those numbers relate to epilepsy only. All the other neurological conditions suffer the same minimal service provision. Given that the beds that are dedicated to neurology have been cut by one third, the service will not be adequate and will leave neurology patients without proper diagnosis and treatment.

A facility that provides Province-wide specialist services with so few beds does not meet the expectations of patients and will leave some of them with a quality of life that is lower than should be expected. It also hinders the valued staff in doing their specialised and dedicated job. I pay special tribute to the excellent work that those people do. The unit may be in the Belfast Trust area, but it serves all of Northern Ireland. As the facility at the Royal Victoria Hospital (RVH) is Northern Ireland-wide, I sincerely hope that the Minister can intervene to provide such a specialised service. More than 40% of people with disabilities have a neurological symptom, and 10% of all attendances with a GP are for a neurological symptom. Those figures show the importance of neurology provision. That is the reality, and the loss of beds will impact adversely on patient outcomes. That is not acceptable.

I hope that all Members appreciate the need to support neurology services in Northern Ireland and their huge benefit to individuals and families and will, therefore, support this very worthwhile motion on a cross-party basis.

Photo of Mickey Brady Mickey Brady Sinn Féin

Go raibh maith agat, a LeasCheann Comhairle. I support the motion. In 2009, the Minister of Health, Social Services and Public Safety said that his Department was developing a strategy for physical and sensory disability services. He also said that there may be an opportunity to co-ordinate services regionally to provide the basis upon which to develop patient-centred services. In April 2010, he announced a £50,000 funding boost for neuro-physiotherapy services to set up a regional network to improve services for those who suffer from conditions such as multiple sclerosis. The Minister said that those were welcoming and meaningful statistics in the development of a network that will result in better services for people with neurological disease.

Almost 45,000 people in the North live with a neurological condition, and the Neurological Alliance has outlined its concern that a 30% reduction in the number of acute regional neurology beds should have been taken in consultation with stakeholders. It also stated that a greater proportion of patients will be exposed to overcrowded six-bedded wards on ward 4E at the RVH. The essential numbers of critical care beds are not in place, and people who require emergency admission will be unable to access specialist neurological care when needed. The reduction in the number of beds will increase waiting times for planned admissions.

As was alluded, in answer to a number of Assembly questions, the Minister has stated repeatedly that the delivery of services at the RVH is a matter for the Belfast Health and Social Care Trust, as the service provider. He has also said that the trust is engaged in a programme of modernisation in the neurology service. The programme includes a review of current neurology services, patient pathway models and bed utilisation. If the RVH is a regional centre, perhaps the Minister can tell us whether it is getting additional money to provide that service. If the decision has been taken that the RVH will provide a regional service, other areas should have been included in that decision.

When the Minister was asked by the Chairperson of the Health Committee whether hospitals and service users outside the Belfast Health and Social Care Trust were consulted about the decision to reduce the number of beds that are available in the acute neurological unit at the RVH, he did not give a direct answer. The RVH is the centre for neurological services for the whole of the North, so it does not seem unreasonable that other stakeholders should have been consulted, but there is no real evidence that that happened. Here in the North, we have some of the highest levels of neurological conditions, such as multiple sclerosis, in the world. For instance, up to 25 years ago, it was documented by the Mayo Clinic in America that my constituency of Newry and Armagh has some of the highest statistics for people suffering from multiple sclerosis and other neurological conditions.

It is essential that we have a neurological service that is effective and has the capacity to deal with the number of patients who require its services. Reducing the number of specialist neurology beds does not seem to be the answer, and the Minister needs to address that issue urgently.

I am sure that all Members have received lobbying letters from people who suffer from conditions such as brain tumours and who are worried that the cutbacks will affect the treatment that they receive. Those people suffer from serious conditions, and they really do not need the stress and trauma that the cutbacks will impose upon them. I support the motion.

Photo of Samuel Gardiner Samuel Gardiner UUP

Neurology is an important aspect of medicine, and it is responsible for one in five hospital admissions. It is also why between 10% and 15% of people consult their GP in the first place. In addition, around 16,000 people attend neurology outpatient clinics. I understand that new outpatients experience a waiting time of 13 weeks and that inpatients experience a similar waiting time. Waiting times are, of course, a direct result of the number of staff who are available, and that is a direct consequence of the amount of finance that is available. I pay tribute to the staff who deal with patients with such complaints.

The financial reality underpinning all this is that the Belfast Trust’s budget has been reduced by £112 million over the three-year comprehensive spending review period. In short, the trust has had to find 11% efficiencies in a staged process over three years under the comprehensive spending review, yet a nursing bed in hospitals costs between £25,000 and £40,000, according to how dependent the patient is. I understand that, to meet the need in the facility for the whole of Northern Ireland, there are 8·5 full-time-equivalent neurologists in Belfast, supported by others. In addition, there are two consultant neurologists at Altnagelvin Area Hospital, one at Antrim Area Hospital, two at Craigavon Area Hospital and two at the Ulster Hospital. They work in close co-operation across the region.

We are back in familiar territory with this latest debate. There is a demand for service improvements at a time of budget cuts. To be fair, that is a difficult problem, because there is a limit to the staff numbers and operational efficiencies that can realistically be achieved.

At a certain point, the amount of funding available will impact directly on waiting times. Other factors that govern the operation of a hospital unit are the sheer geography of where beds are located and the infection control regulations in that hospital. I understand that significant advances have been made in handling outpatients through far faster turnaround times. Efficiencies have also been made through flexible bed management for inpatients. There will, therefore, be limits on future efficiency gains.

In conclusion, enormous pressure has been put on the Health Minister to cut his budget. Therefore, perhaps the movers of the motion, who are members of the same party as the Finance Minister, should consider their motion the next time they hear about health cuts.

Photo of Tommy Gallagher Tommy Gallagher Social Democratic and Labour Party 3:45 pm, 29th November 2010

I support the motion. I reiterate my party’s position on this matter, which is to call on the Minister to reverse the decision to cut the number of beds, because that is the only sensible decision to be taken. Before the decision was made to cut the number of beds from 23 to 16, which is a 30% reduction, many patients were already facing difficulties and delays in assessment, treatment or diagnosis. Strangely, despite that, and despite the fact that the service is a regional one for all the people of Northern Ireland, the decision was taken without consulting any other trusts, clinicians or the public. The Belfast Trust is guilty of a serious failure in that regard. It failed to consult on a key service. It also tried to tell the Committee that its decision was for the best and that it would improve the service and make it slicker. Clearly, the trust has acted in a high-handed manner, which is worrying for patients, carers and families.

Photo of Alex Easton Alex Easton DUP

Will the Member give way?

Photo of Tommy Gallagher Tommy Gallagher Social Democratic and Labour Party

I am afraid of losing time, so I will just keep going.

It is also worrying for us as elected representatives, because we are answerable and accountable to people.

Given the decision to cut the number of beds by 30%, let us consider the situation as regards neurology patients at the Royal Victoria Hospital just over a week ago. Not only were the 16 neurology beds full, nine neurosurgical beds were occupied by neurology patients, and two further neurology patients were in ward 7. Twenty-seven beds were, therefore, being used for neurology patients. I also understand that at least half a dozen other patients were waiting urgently for treatment but could not be accommodated. Therefore, quite clearly, the decision has to be reversed.

Some Members will be aware that the trust tried to advise the Health Committee that everything to do with the service was all right and that Committee members had nothing to worry about. The trust said that this was modernisation. We were also told by one of the witnesses that it would improve the flow of patients by reducing the length of bed stays. Perhaps the Minister will comment on the logic behind the claim that the flow of patients will improve if the number of beds are reduced. That does not stand up, and it raises questions.

There are also questions about how the decision was reached. I have already said that there was no consultation. In addition, the Belfast Trust told the Committee that one reason for the decision was that it was doing some work with the NHS Institute for Innovation and Improvement. At the next Committee meeting, there was a letter from the chief executive of the trust saying that it was working with this institute but that the work was ongoing. Will the Minister explain how the trust took the decision when the work with the institute was incomplete?

Ulster Unionist Party Member Sam Gardiner referred to financial difficulties, but the clinicians in the Belfast Trust were told that it was based on finance. Those of us who are members of the Health Committee will recall that we were told that it was due to modernisation. It cannot be both, so there is a simple question to be answered: which is it? Which version do we believe?

There is only one thing to do —

Photo of Francie Molloy Francie Molloy Sinn Féin

Bring your remarks to a close.

Photo of Tommy Gallagher Tommy Gallagher Social Democratic and Labour Party

— and that is to reverse the decision. I call on the Minister, further to this debate today, to do just that.

Photo of Chris Lyttle Chris Lyttle Alliance

I support the motion, and I pay tribute to the staff who are working in the unit and to the people with this condition. In Northern Ireland, 48,000 people, all of whom use this excellent facility at the Royal Hospital, suffer from a neurological condition, including those with brain injuries; stroke victims; people with dementia; MS and ME sufferers; those with Parkinson’s disease, Huntington’s disease, motor neurone disease and epilepsy; and those with the rare condition trigeminal neuralgia.

It stands to reason that a reduction in beds will bring concern for patients and for the capacity of the service. That concern is shared by consultants who work at the unit also. Consultants have raised concerns with the Belfast Health and Social Care Trust about the potential impact of the cut on an already-stretched facility. As other Members have said, the fact that these reductions were carried out without any consultation with the experts working in the department is of deep concern.

We are all interested in our Health Service delivering efficiency, but concern must be expressed when services are cut in this way. It appears to me that we are placing excessive emphasis on what trusts do in GB rather than focusing on the best outcomes for our patients locally. There is real concern among patients and families about the lack of privacy, dignity, safety and infection control that may arise as a result of this cut and that emergency admissions will be unable to access specialist neurological care when urgently needed.

I welcome the fact that £50,000, which was used to set up a regional network that includes neuro-psychotherapists and nurse specialists who are experts in dealing with these long-term conditions, was invested in the services during the early part of this year. However, if patients cannot get a bed on admission, how can they access this improved level of care?

I have noted the submission of Ms Donnelly to the Health Committee, as stated, in which she promoted that the beds that were closed were not in the main neurology ward and that some had been re-designated as stroke beds. She also promoted the financial savings as a result of this so-called modernisation. However, we must never allow this to put primary patient care at risk.

Photo of Alex Easton Alex Easton DUP

I am in favour of the motion, and I thank my party colleagues for tabling it. The mind boggles as to why these specialist beds have been withdrawn. In April, the Minister gave a token gesture of £50,000 towards developing neurological services and the set up of a regional network to improve services for patients suffering from conditions such as multiple sclerosis.

In March 2009, the Minister committed himself to improving services for people with neurological conditions. He told the House that his Department was developing a strategy for physical and sensory disability services. He said that this strategy would consider neurological disabilities, including neuromuscular disabilities.

In reply to a question from the Member for North Belfast Alban Maginness on any possible reduction in the number of beds in the RVH, the Minister said:

The Trust is currently engaged in a programme of modernisation within the neurology service and this includes a review of bed utilisation. As a result, the Trust has reduced the number of neurology beds from 23 to 16 in October 2010, thereby bringing the neurology service into line with comparable peers in other parts of the UK.”

The Minister admitted not having intervened in that issue and stated that he had:

“not personally had any discussions with the Belfast Trust about the reduction in the number of neurological beds.”

Will the Minister inform the House whether there have been any discussions with the trust on that issue since 21 October? I ask the House to tell me, through the Deputy Speaker and the Minister, what price we can put on a person’s care and well-being when deciding whether to make cuts in bed numbers.

Photo of Jonathan Craig Jonathan Craig DUP

Cuts in neurological beds amount to approximately £200,000 a year in savings, yet the Belfast Health and Social Care Trust employs 798 people on salaries of between £50,000 and £100,000, with a total wage bill of between £40 million and £80 million a year. Surely the trust could have found savings of £200,000 in such a colossal wage bill, which is, after all, for middle management. It is also disgraceful that the trust did not consult other the boards, because it has plenty of middle managers to do so.

Photo of Francie Molloy Francie Molloy Sinn Féin

The Member has an extra minute.

Photo of Alex Easton Alex Easton DUP

I thank the Member for his intervention. The Committee for Health, Social Services and Public Safety is debating management structures and pay bands at the moment. It has discovered that there are huge numbers of managers, and it needs to undertake further investigation.

One who is in need of neurological surgery needs specialist care and treatment. I am concerned about the effect that removing beds will have on patients, and I am not confident that the trust can justify the cuts. The trust admitted to the Committee that it has no other choice but to reduce bed numbers, yet it also told the Committee that it puts patients first.

I was not convinced by the reasons put forward by the representatives of the trust at the Committee’s meeting on 14 October 2010. They continually played on the word “modernisation,” yet admitted that the decision to remove seven of the 23 beds was down to money. Therefore, there seems to be confusion about what it was down to. I understand that we are living in difficult times, but I am worried about unjustified cuts.

Staff are employed in the management of the Health Service who are not healthcare workers but who, as my colleague Mr Craig mentioned, earn between £50,000 and £100,000 a year. The savings produced by cutting the number of beds was put at approximately £210,000 a year, and I must ask whether patients and their need for constant care, treatment and support or the salary of a member of the management team is more important. The management is responsible for cutting the number of beds, and the mind boggles at the level and cost of management in the Health Service in Northern Ireland. I support the motion.

Photo of Paul Girvan Paul Girvan DUP

I, too, support the motion. There is no point in going over all the facts and figures. Everyone seems to be aware of the issue and the impact that the reduction from 23 to 16 beds will have. That is probably most true of the consultants who wrote to the trust outlining their fears that the closure of beds will stretch further an already stretched service.

The lack of consultation has been highlighted. The decision was made that, on 1 October, there would be a dramatic one third reduction in the number of beds, and there was little or no consultation with anyone outside the Belfast Trust.

Photo of Alex Easton Alex Easton DUP

Does the Member agree that when the Committee for Health, Social Services and Public Safety took evidence from the trust, there seemed to be a serious disagreement between the neurological consultant and the management of the trust and that it was clear that the specialist was upset at the cuts?

Photo of Paul Girvan Paul Girvan DUP 4:00 pm, 29th November 2010

I thank the Member for his intervention. At that meeting of 14 October, it was evident that there was a definite disagreement about the way in which the cuts had been brought forward.

We have to support bringing back the beds, because, according to the calculations of the Royal College of Physicians and the Association of British Neurologists, neurology beds are drastically under-resourced. Jonathan Craig mentioned that savings could be made, and there are areas in which savings must be made. However, neurology is not an area in which to seek cuts or try to tinker around the edges. At the end of the day, the issue is one of closing beds that are already being provided in a hospital.

We invest money in treating people in a specialist unit where they will receive first-rate care. However, we understand from what other Members said that some neurology patients are now being treated in general wards. Tommy Gallagher said that a number of patients are in ward 7, which, I understand, is a general ward. I am not suggesting that they do not receive proper treatment there, but the specialist treatment that they would receive in a neurology unit would be of the appropriate standard to deal with their conditions.

Given that the Belfast Trust was providing neurology services not only within its own area but to the whole Province, we have no alternative but to ask the Minister to revisit the decision. The Belfast Trust should have engaged with every other trust on the matter, and the Health Department should have taken the lead on how it moved forward. The Minister cannot wash his hands of the fact that he and the Department should have been giving direction. At the end of the day, he will be the one to suffer for not doing that. I support the motion.

Photo of John McCallister John McCallister UUP

I thought that Mr Girvan was going to widen the debate and say that the entire health budget was “drastically under-resourced” — I think that he used that phrase. Had he done so, I would have concurred with him. I am sure that the Minister will give us the figures to show that our Health Service is more than £600 million behind the equivalent services in the rest of the country.

Neurological conditions have a huge impact on those who suffer from them, their families and their carers. I pay tribute to all the groups that represent such individuals and families and provide the support that many of them need. They have a tremendous impact on the lives of sufferers and their families.

Members and colleagues from the Health Committee spoke about the delivery of services and the Belfast Trust’s decision to cut beds. I agree with the observation that Mr Easton made during his intervention. Neither the Belfast Trust’s handling of the decision nor its performance in front of the Health Committee provided any comfort or confidence that alternative service arrangements were in hand. The people within the team who presented evidence sent out different messages. That was worrying, and it is probably the main reason why the debate is taking place today. We want to find out the facts behind that presentation to the Health Committee.

There were concerns about the reduction in beds from 23 to 18, and then a further two beds were moved to stroke services. The trust made the case that the reduction would not limit care. I urge the Minister to stay in close contact with the trust to make sure that the reduction does not have any detrimental impact on care, on those who depend on the service, or on their families.

I am quite confident that the Minister will do that as this new system goes forward, to make sure that the necessary support and services are put in place and kept there. After all, we have to focus on the outcomes. What provides the best outcomes for the patients for whom we seek to provide care? The outcomes should be the best. We want to see no reduction in the quality of outcome for each patient.

Photo of Michael McGimpsey Michael McGimpsey UUP

I welcome the opportunity to talk about regional services for those suffering from neurological conditions. I will begin by explaining what is meant by the term “neurological conditions”. They are the most common causes of serious disabilities and have a major but often unrecognised impact on health and social services. Neurological conditions can include Parkinson’s disease, Huntington’s disease, multiple sclerosis, muscular dystrophy, motor neurone disease, spina bifida, stroke, brain injury, epilepsy, cerebral palsy, and so on. It is a long list that covers some very challenging conditions.

The specialist neurology unit at the Royal Victoria Hospital is a key part of a network of the neurology services for Northern Ireland. The unit sits at the centre of a service that extends out to other hospitals across the Province. It is a service providing diagnosis, care and support for a wide range of conditions. Last year, over 31,000 people were seen at neurology outpatient services and 1,303 patients were admitted for specialist neurology work as day-case patients or inpatients. People with a neurological condition may also be treated by general physicians or care-of-the-elderly physicians, either on an outpatient or an inpatient basis. In addition, there is an important role for the patient’s GP and others, including allied health professionals such as physiotherapists.

The reason why we are here today is to discuss the recent reduction in beds in the specialist neurology service in the Royal Victoria Hospital. The delivery of services at the Royal is, of course, a matter for the Belfast Health and Social Care Trust, since it is the service provider. It is responsible for providing the regional service, and that is why it is the trust’s responsibility. Had it decided to reduce the service, that would have been a different matter, and I will elaborate on that now, but the trust is confident that it will continue to provide the service that it is responsible for.

Photo of Jim Wells Jim Wells DUP

If the Belfast Trust was providing a regional service and carrying out a reconfiguration — let us not call it a reduction, but a major change to how that service is delivered — why did it not consult the other four trusts that depend on that? I have met the chief executive of three of those trusts and they were not consulted in any shape or form about the major change to that service.

Photo of Michael McGimpsey Michael McGimpsey UUP

The trust is responsible for providing a regional service. It will continue to provide the regional service at the same level as it had been providing it. Had it decided that it was going to reduce that service, it would have been required to go to the other trust, but the other trust will receive exactly the same service. That is its assurance.

The trust has advised me that the reduction came about following a programme of modernisation within the neurology service. The key aim of that work is to provide safe, high-quality, effective care in a more efficient, responsive and flexible way. The trust assessed the provision of services at the Royal. A key element was looking at comparable neurological units in other parts of the UK so as to benchmark the services here with practice elsewhere.

Members will be aware that they have pressed me constantly over three and a half years to be more efficient. Although the unit in the Royal offers high quality clinical care, it appears that patients stay longer than in other areas of the UK. Also, patients who elsewhere may be managed on an outpatient or day-case basis may be more likely to be admitted in Belfast. The aim must be to improve the local services with a view to reducing the length of time that patients spend in hospital. That has meant looking at pathways of care for patients to ensure that there is quick and appropriate diagnosis and effective treatment so that patients stay in hospital only for as long as necessary.

An important element in that is the use of a ward sister to clinically co-ordinate the admission and discharge of patients. She will accurately schedule inpatient activity with the neurological service to ensure that there are no delays either pre- or post-assessment. That will improve the movement of patients within the hospital and provide the most timely interventions and treatment. The trust will also ensure the provision of services on a day-case basis and outpatient basis in preference to inpatient stays, where appropriate.

I have been absolutely assured by the trust that the reduction in beds will not impact on patient care. In fact, I have been advised that, since the change, not all beds are full, because services are provided to patients on an outpatient basis. That is despite Mr Gallagher’s understanding, and I would be interested to know what that understanding is. If he will communicate it to me, or even write to me, I will be happy to investigate his allegations about waiting times, and so on.

It is essential that we stop focusing on beds and rather start focusing on ensuring that patients have the right care at the right time in the right place. People must not stay in hospital unless they absolutely have to. What is more, on the one hand, I am being asked to make efficiencies, yet, on the other hand, when I start to make those efficiencies, the work is criticised. I assure the House that if patients need to be admitted to hospital, I will ensure that trusts have the right number of beds in the unit to allow that to happen. However, our focus should, rightly, be on helping people to manage and cope with their conditions without the need to go to hospital.

The decision to reduce beds was not, as some have suggested, an arbitrary cut. The decision was, in fact, carefully planned and managed to provide an improved service to the patient. Nobody wants to be in hospital a minute longer than is necessary, and some of the improvements will help to ensure shorter stays.

Photo of Michael McGimpsey Michael McGimpsey UUP

I repeat that people can be admitted on the morning of a procedure rather than the night before. People can be discharged more quickly, thereby ensuring a shorter stay. Some people may be able to have tests and procedures done as an outpatient rather than have to stay in hospital for them.

I have been specifically asked to take measures to reinstate a number of neurology beds. With the steps to improve current services, there should be no need to reinstate beds at this time. However, if there is pressure on beds and more are needed, I will ensure that additional capacity is provided. I believe that the service is well placed to meet the pressures that it faces in providing its vital role for the whole of the Province.

I accept that some medical staff and clinicians were unhappy with the decision. The trust assures me that it is continuing to consult staff on the matter and will take on board their concerns. There has also been speculation about the effect of the changes in the specialist input unit for stroke services.

Mr Gallagher wanted to intervene.

Photo of Tommy Gallagher Tommy Gallagher Social Democratic and Labour Party

I have almost forgotten why. The Minister has moved on a bit from the point on which I wished to intervene. He said that, essentially, the Belfast Trust improved the service and that it is now a better service. However, can he explain why, at the Committee, senior clinicians from the trust disagreed with those who tried to tell us that it is a better service? The senior clinicians are the people who work on the ground.

We need to get the full picture of the work that the Belfast Trust did to arrive at this point. There is great doubt over the agreement, given the differences of opinion between the administrative side and senior consultants.

Photo of Michael McGimpsey Michael McGimpsey UUP

I know that Jim Morrow had something to say in Committee and that he expressed his concerns. Discussions have been ongoing in the unit.

The Member wants to know how the decision was arrived at. I have just explained it to him. I said that it was arrived at by running through things such as benchmarking against comparable units in the rest of the UK to determine what services could be provided on an outpatient basis so that there could be shorter stays and fewer inpatient procedures. However, the Member talked about a concern that he has and his understanding of the issue, and I am keen to hear from him. If he writes to me, I will investigate the matter for him.

I assure the House that the reduction in beds should have no impact on stroke care. Indeed, four hyper-acute stroke beds are being opened in the Royal Victoria Hospital.

We need to remember that stroke services are, and will continue to be, provided in stroke units at 12 hospitals across Northern Ireland. Jim Morrow’s concern related to stroke services in Belfast at weekends, but the City, the Ulster and the Mater hospitals each have a stroke unit. I believe that Dr Morrow was on duty in the Royal that weekend. He is a serious clinician, and he has concerns. I have asked the Belfast Trust to ensure that those concerns are addressed.

It is important to note that the majority of people who suffer a stroke are likely to be cared for by a care-of-the-elderly physician. A small proportion may benefit from thrombolytic or clot-busting therapy and receive specialist input from a neurologist. The current hyper-acute service is offered across the Belfast Trust on an age-related basis to patients who meet the relevant criteria. I want to be clear that the trust has confirmed that there has been, and there will be, no change in that service.

I remind Members that, in recent times, I pushed through other significant developments that will assist people with neurological conditions. One example is the acquired brain injury action plan, which was published in July and outlines a care pathway for people with mild brain injury and those with moderate-to-severe brain injury.

As Members are aware, I announced an investment of £50,000 in a neurological practitioners’ network earlier this year. Alex Easton referred to that as a “token gesture”. Mr Easton should reflect on that every time he gets up to vote for cuts to the Health Service, which he has done on a number of occasions. I invested £50,000 to develop, encompass and co-ordinate different elements of neurology such as education, support and therapy. Those are all essential to ensuring the best possible outcomes. The aim is that a network will involve healthcare professionals from all neurological services working together to improve communication, support and access. The network will be well placed to explore the different models of service delivery.

I have also commissioned the Health and Social Care Board to carry out a full evaluation of the effectiveness of the implementation of the 30 recommendations of the 2002 ‘Review of Adult Neurology Services in Northern Ireland’. In parallel with that evaluation, departmental officials are reviewing the continued appropriateness of the recommendations in light of guidance from the rest of the UK.

I understand Members’ concerns in this area. I took a hard look at the question of when is a cut a cut and when is it an efficiency or a modernisation. We are looking at a service that is modernising. We have made great strides in the treatment of strokes, for example, and this is part and parcel of that. As I said to the House, if it appears that we have a shortage of beds, I will make sure that the unit has the bed capacity.

Mr Brady said that we do not need the stress of cutbacks. I do not understand why he keeps voting for them. He votes for cutbacks to the Health Service. He votes for £700 million of efficiencies to be taken out of the Health Service. Where does he believe the efficiencies will come from when he talks about not needing the stress of cutbacks?

Mr Craig spoke about the cost of management in Northern Ireland. The cost of management in Northern Ireland is extremely low. From memory, I think that it is around 3·5% of the budget. For the benefit of Mr Craig, I remind him that I am the only Minister to introduce the review of public administration. We reduced the number of trusts from 19 to six, which means that the number of chief executives and boards have also reduced from 19 to six. I reduced the number of health boards from four to one. I took step after step to reduce numbers, and I believe that we made huge progress.

The progress that I would like to be made now is for people such as Mr Craig, Mr Easton and Mr Brady to be prepared to stand up for the health and social care service and to vote for the funds that are required to keep it going. Believe me: it fills me with dread when I think about where we will be in three or four years’ time a result of cheese-paring and proposals to slash the Health Service budget once again.

I remind Members that they voted through a Budget here six months ago that took well over £100 million out of the Health Service. That was in addition to other cuts, and it was done in-year. Where do you think that money comes from? The pain goes into the Health Service, to patients, and to the delivery of services. There are no easy answers to this issue, other than to be prepared to stand up for your Health Service.

Photo of Jim Wells Jim Wells DUP 4:15 pm, 29th November 2010

In these debates, it is normal for the Member doing the summation to go through the various arguments made by honourable Members on the issue. That is what I had intended to do until I opened my post this morning and read a copy of a letter dated 29 September 2010, which was addressed to Dr Tony Stephens, who is the medical director of the Belfast Trust. The letter is signed by nine neurological consultants based in Belfast, including the leading neurological consultants in Northern Ireland.

The only people who seem to be in favour of the decisions are the Belfast Trust, ably assisted by the Minister. Patients are totally opposed to it, as are groups that represent people with conditions such as epilepsy, motor neurone disease and multiple sclerosis. However, most significantly, those who are at the coalface and who are leading consultants with several hundred years combined experience of this particular issue are totally opposed to it.

We got a glimpse of that at the Committee’s public hearing on the issue. It was a unique experience to see leading officials from the Belfast Trust being contradicted by someone who knows exactly what he is talking about. I wish to put on the record a few of the comments made in the letter, which, I think, are explosive. The consultants said:

“Despite our opposition and advice that this will lead to delayed diagnoses and treatment, translating into worse patient outcomes, the Belfast Trust decided to downgrade the number of available beds within the unit from 23 to 15, a cut of 35%. Regrettably, the Trust only decided to enter into consultation with us after already deciding to cut these beds.”

Therefore, we have a situation in which the four health trusts that feed into the Belfast Trust, because it is a regional service, were not consulted. The charity groups that represent sufferers of neurological conditions were not consulted, the patients were not consulted, but, fundamentally, the consultants in the Belfast ward who were expected to implement the decision were not consulted. The letter goes on to say:

The Trust has indicated that the bed closures are to bring us into line with other parts of the United Kingdom. It seems to believe that reducing the number of beds will reduce the average length of stay, while maintaining the same number of patients being treated. No means of achieving this has been suggested. It is already the case that patients awaiting urgent transfer from other hospitals can wait for days to weeks, and patients waiting urgent admission for diagnosis, treatment and assessment can wait for 3 months or more.”

That was the situation before that decision was taken. What will happen with a 35% reduction in the number of available beds?

The letter becomes more difficult for the Department and the trust to explain. It goes on to say:

“The 35% reduction in neurology beds actually underestimates the problem. In 2009-2010, the most recent complete year, patients actually occupied an average of 24·8 beds within the Regional Centre. We therefore already overspill our stated number of beds, representing actual bed occupancy of 107·8% … yet an overstretched service is now earmarked for a 40% cut in resources.”

That is difficult to explain. The letter adds:

“It is estimated that to provide 24hr acute care for neurology in the UK, 15 beds/100,000 of the population are required. The proposed change would take us to <1/100,000 of the population.”

I have worked out that that is close to being correct, with 1·7 million people and 15 beds. It works out at over one bed per 100,000 people in Northern Ireland. The letter adds:

“This is particularly serious since 18-20% of medical inpatients have neurological problems, there is declining confidence among non-neurologists about dealing with neurological disease and symptoms, and there are seven hospitals in Northern Ireland with A&E departments that do not have a resident neurology service – Causeway; Daisy Hill, Erne; Lagan Valley; Downe; Belfast City and the Mater. Even in hospitals outside Belfast that have a neurology service on-site, there is no out-of-hours provision. The unit at the RVH provides the only 24hr on-call service for Neurology in Northern Ireland accessed by GP’s, hospital physicians and A&E units.”

The consultants go on to outline the consequences of that decision. Again, I emphasise that they are the experts. I have a degree in town planning, and I must say that I was a complete novice on this issue before I became the Chairperson of the Committee for Health, Social Services and Public Safety. I respect the views of people who know best; those who are at the coalface and who deal with those patients. Let us hear what they say; not the Department, the Minister or the Belfast Trust. What do they say will happen?

They say that:

“Fewer patients with neurological disorders will be managed within the Regional Centre. Patients will have to be transferred to centres in GB or the Republic of Ireland for acute neurological care.”

How does that square with trying to use resources efficiently? How does it lead to improved service when thousands of pounds are to be spent on transferring patients and their carers to GB and the Irish Republic in order to maintain the current level of service?

The consultants also state that:

“Diagnosis and appropriate treatment will be delayed. More patients with neurological disorders will have suboptimal care. Patients with acute neurological disorders and are admitted to hospitals outside Belfast will find it almost impossible to be transferred to the Regional Centres — currently about 80% of patients in the unit reside outside the Belfast Trust area.”

I must return to the issue that the Minister has neatly sidestepped. He keeps saying that responsibility for the service lies with the Belfast Trust, which is technically correct. However, it delivers that service to all of the people of Northern Ireland, including on behalf of the other four trusts. As it happens, for various reasons, during the past two weeks, I met three chief executives of those other trusts. There had been no discussion with them, nor had there been any with consultants. They were not consulted. No matter whether it is neurology or any other service, if the Belfast Trust provides a regional service for all of Northern Ireland, there must, at least, be a six-month consultation period to seek views from other trusts. I can tell the House that some neurologists outside the Belfast Trust do not agree with the Minister that it is an entirely new and more efficient service.

The consultants go on to state that:

“Patients with neurological disorders will be even less likely to have nursing care from those experienced in managing such conditions. Patients will be even less likely to be managed by therapists — physios, OTs, speech and language therapists etc — who have neurological experience.”

The letter goes on and on. The final paragraph of the letter, which will be in the public domain after the debate, is particularly telling. Remember that it was written on 19 September. It states that:

“If the change proposed to the Regional Neurology service goes ahead as planned on October 1st, it will cause irreparable damage to acute and diagnostic neurology services in Northern Ireland. Those patients who still manage to access the Centre will also be housed in accommodation that is unsatisfactory in almost every respect, falling well short of what anyone would reasonably expect in the 21st century for patients with neurological disease. The plan is ill-judged, ignores clinical opinion and patient need, and appears driven by expediency. We would urge you to review and reverse this decision.”

The letter is signed by nine consultants who operate that unit.

Need I say more about how ridiculous that decision is? I accept that there are times when we receive information on efficiencies and cuts in the Assembly and, when we listen carefully to the Department, we eventually see its side of the story and accept that it has made a balanced decision. However, I can find absolutely no logic whatsoever in this decision.

I pay tribute to all those who spoke in the debate, particularly George Robinson, who has carried the torch on this issue for many people, not only in East Londonderry, but throughout Northern Ireland. He is to be congratulated for raising the issue. He emphasised the fact that 35,000 patients in Northern Ireland — indeed, there was some dispute about that figure, with some Members suggesting that there are even more — suffer from wide-ranging conditions that include epilepsy.

Mickey Brady raised an issue that perhaps should have been debated further: in addition to the reduction in the number of beds, the number of single-bed wards that are available for those who have neurological conditions has been cut. Those who represent people with epilepsy emphasise how difficult it can be for someone who suffers from that condition if he or she has an epileptic fit in an open ward, how embarrassing it can be, and why it is so important to have single-bed wards available for them and for people who suffer from other complex conditions. Few have mentioned that as an issue of great concern.

Mickey Brady also mentioned the lack of consultation with other trusts. Samuel Gardiner, quite rightly, paid tribute to staff. No one is criticising the staff, who provide a first-rate service. That does not stop us from making critical comments about those who cut that service.

Tommy Gallagher, who has done an excellent job on behalf of people west of the Bann on this issue, outlined the issues of delays and the lack of consultation. Chris Lyttle mentioned the £50,000 grant towards improving the service. There is not much sense in paying £50,000 and then implementing such a drastic cut.

Photo of Francie Molloy Francie Molloy Sinn Féin 4:30 pm, 29th November 2010

Will the Member bring his remarks to a close?

Photo of Jim Wells Jim Wells DUP

I ask the Minister to go back to the drawing board and totally review that decision.

Question put and agreed to.


That this Assembly notes with concern the cut in specialist neurology beds at the Royal Victoria Hospital; acknowledges that the Belfast neurology unit is a facility for all of Northern Ireland; and calls on the Minister of Health, Social Services and Public Safety to ensure that the beds are reinstated so that patients with neurological conditions have equal access to specialist treatment.

Adjourned at 4.30 pm.