Health: Transforming Your Care

Ministerial Statement – in the Northern Ireland Assembly at 3:00 pm on 9th October 2012.

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Photo of Edwin Poots Edwin Poots DUP 3:00 pm, 9th October 2012

With your permission, Mr Deputy Speaker, I wish to make a statement to the Assembly on 'Transforming Your Care', the report of the review of health and social care services in Northern Ireland, and my plans for public consultation on changes arising from proposals in the report.  Members will recall that 'Transforming Your Care' was presented to the Assembly on 13 December 2011.  The report outlined a compelling case for the reform of health and social care services, and it proposed a new model of care built around the individual patient and service user, not institutions.

I have said many times that my aim is to have a health and social care system that is safe, resilient and sustainable into the future.  For that to be the case, it is essential that we take decisions that will ensure that our services are fit for purpose for the challenges that lie ahead.  My vision is to build a health and social care system that improves care, ensures better outcomes for patients and clients and enhances the experience of health and social care for all our service users.  To achieve that vision, we need to look at how we can improve our health and social care and, in so doing, reshape how we interact with all those who use our services.  I am convinced that that aim is shared by the people who deliver services daily throughout our health and social care system.

I have set out, on a number of occasions, the inescapable context for change.  Our society is changing; we have a growing and ageing population, with people living longer.  That, of course, is something to celebrate, but it also means that there are more people with long-term conditions.  That, inevitably, places more demands on our health and social care services, including our hospitals and other resources.  The treatment and care of citizens is also changing.  We have increasingly specialised services, with technology driving many improvements in how we can design and deliver care.  Therefore, changing how our services are provided is an inevitability.  I want to ensure that those changes are planned and managed so that they will bring optimum benefits to patients, service users, staff and the wider community.

We need to recognise fully the implications of the demographic changes and the demands and pressures that they bring.  'Transforming Your Care' indicated that demand for services could grow by around 4% a year by 2015.  We need to improve services, but we need to do it in a way that secures improved productivity and value for money.  We need to think differently about health and social care and about how we use and deliver services in response to changing circumstances.  What has not changed is a belief in the core principles of the NHS, which are that health services are generally free at the point of delivery and are based on individual need, not ability to pay; that they are funded by taxation; and that they are available without prior restriction on which cost-effective treatments or therapies individuals should receive.  Thus, the best available cost-effective services will be provided for all citizens.  Those principles remain fundamental to the delivery of our health and social care services.

The proposals in 'Transforming Your Care' set out at a strategic level how we might effectively meet the challenges through a new model for the delivery of integrated health and social care services in Northern Ireland.  The new model of care is focused on ensuring that more services are provided in the community, closer to people’s homes where possible.  It is about prevention, earlier interventions, promoting health and well-being and having more personalised care that is planned and delivered around the needs of the individual and is tailored, as far as possible, to suit them.

A key early objective in the delivery of reform was the development of population plans for each of the five local commissioning groups by the end of June 2012.  The population plans identify the needs of the local population on the basis of demographics and population health trends and identify how those needs should be met in future.  In my statement to the House on 3 July, I advised Members that I had taken delivery of the five draft plans and published them on the departmental website.  The plans are complemented by an overarching strategic implementation plan that draws together the key elements of the population plans, including cross-cutting regional aspects.  The strategic plan is to provide a coherent framework for the planning and delivery of health and social care services over the coming years.  I also advised that, over the summer period, the draft plans would be subject to quality assurance work and, once approved by me, would form the basis of formal consultation.  The quality assurance stage has now been completed, and the revised strategic implementation plan and population plans have been forwarded to me by the Health and Social Care Board.  I have agreed that the revised plans should form the basis of the public consultation that will start today and close on 15 January 2013.

I want to outline to Members the key proposals that have been developed as a response to 'Transforming Your Care' and form the basis of the consultation process.  The draft population plans and strategic implementation plan set out proposals for how our health and social care services can be shaped over the next three to five years.  The consultation that I am launching today will ask patients, service users and the wider public for their views on the proposals.  A consultation document entitled 'From Vision to Action' summarises the main services covered in the implementation plan and population plans and the changes being proposed.  It includes questions to prompt consideration and responses on the proposals — proposals that affect all of us who use our health service.  It is available on the website www.TYCconsultation.hscni.net. 

A fundamental principle within TYC is the shift in service provision:  moving treatment and care out of the hospital sector and into the community, closer to people’s homes.  A key vehicle for facilitating that is the development of integrated care partnerships (ICPs) across Northern Ireland.  ICPs will bring together health and social care professionals across the secondary, primary and community sectors to work in collaborative networks to deliver a more complete range of services for people in their local communities.  They are to be based on multidisciplinary working, with general practitioners playing a leading role but with clinical leadership also available from other health and social care professionals.  In the main, ICPs would focus initially on supporting frail older people to maintain their independence and on people with certain long-term conditions, namely diabetes, stroke and respiratory conditions.  That would include a focus on improving how treatment and care is delivered and the provision of an environment for new ideas and innovations, with a stronger emphasis on prevention and early intervention.  ICPs would also put in place arrangements to identify those who are most at risk of having to go into hospital unexpectedly and to develop plans and actions to prevent the need to go to hospital.  ICPs are a new approach and should play an important role in reducing emergency admissions to hospital and supporting the movement of services out of the hospital sector and into the community.  In so doing, ICPs would involve strong collaboration with providers in the voluntary and community sector and independent healthcare providers. 

With a growing and ageing population, it is essential that we support older people through the prevention of ill health and a focus on health and well-being.  Among those over the age of 70, rates of ill health and disability increase significantly.  Many excellent services are provided for older people.  However, there is still much that can be done to improve the care they receive.  The model being proposed would help to do just that. 

'Transforming Your Care' also highlights the benefits to patient care of new technology, in the form of telehealth and telemonitoring, in helping to support people in their own home and to identify potential problems or a deterioration more quickly to allow earlier interventions to be made.  I have promoted strongly the use of Connected Health to improve patient and client care.  It provides significant opportunities for doing so and will help to mitigate the demands on our resources.  Northern Ireland is well placed to lead the way in developing Connected Health solutions to overcome the challenges we face. 

The consultation document includes proposals around the provision of statutory residential care.  With more people being supported to live independently in their own home, the model of care would change to reflect a fall in demand for residential care for older people.  The statutory sector currently provides around a quarter of all residential care homes.  In many trust-provided homes, more than half the beds are currently unoccupied, due in part to the efforts of trusts to support more people in their own community.  It is expected that demand will continue to fall.  Likewise, a number of homes are in need of significant investment. 

During the next three to five years, the current number of statutory residential homes would be reduced by at least 50% across Northern Ireland, as we support increasing numbers of people to live in non-institutional settings.  That does not necessarily mean a reduction in residential homes provided by the independent sector — where there continues to be a demand for those services, they will continue to be provided — nor does that targeted reduction include homes that provide services for older people who are mentally infirm, including those with dementia, or those in nursing homes.  It is crucial, however, that safe, suitable and better alternatives to residential care, such as supported living, self-directed support and more respite care, are in place for those who need it.  In that respect, closures would be taken forward in a planned and phased way, with residents, families and local communities involved in the local consultation process.  That raises the issue of whether the statutory sector should be involved in the provision of residential home places, and I do not envisage over the longer term that it should be.  It is proposed, therefore, to restrict new admissions to statutory care homes. 

The review of mental health and learning disability, which is referred to as the Bamford review, provides the context for proposals for services for people with mental health issues or learning disabilities.  The proposals focus on the continued implementation of the Bamford action plan, including raising awareness of mental health issues and reducing the stigma associated with mental ill health; continuing to extend the care provided in the community rather than in hospitals; and ending long-term residency in institutional care.  The proposals being consulted on include reducing the number of people in institutional care and inpatient beds by moving existing residents into community living through intensive home support alternatives that are based in the community, supported living arrangements, individual budgets or nursing or residential home care where appropriate.  We will work towards ensuring that no one will be a long-stay resident in a mental health or learning disability hospital by 2015, with people moving instead to alternative community-based living arrangements.  Changing how we support and care for people with mental health issues or learning disabilities would inevitably lead to changes to the long-stay units, with some closing or being used to provide more immediate or short-term care. 

The proposals for mental health care also include the development of six inpatient acute mental health units for those aged 18 and over.  To reduce stigma and ensure access to acute elective care, it is desirable to locate mental health hospitals close to acute hospital provision where possible.  There would be one site in each of the Northern, Southern, South Eastern and Belfast Trust areas, with two in the Western Trust area, suggesting that those should be located in proximity to Altnagelvin Area Hospital and the South West Acute Hospital.  It is also important to recognise the key roles that carers play and to improve access to the respite and short-break services that are so vital to improving their quality of life. 

We need to ensure both the future sustainability of our hospital configurations and that acute services adhere to best practice in quality outcomes, infrastructure and staffing.  The TYC report concluded that it is likely that it will be possible to sustain only five to seven major acute hospital networks in the future.  Creating hospital networks and reorganising acute services would mean that hospitals would not work in isolation.  Hospitals of different sizes would work with each other to deliver the fullest range of specialist and acute services.  That would mean that, for the majority, each acute hospital network would serve a resident population of 400,000, but, in the case of very specialist services, it would serve the whole of Northern Ireland. 

It is imperative that hospital services are provided in a safe and sustainable way.  There is evidence that, where the volumes of activity for a speciality are relatively low compared with the norm, there is greater potential for higher mortality rates.  There are also implications for the skills of specialist staff in circumstances where they do not see enough cases regularly to keep their skills up to date.  Specialist posts in hospitals with relatively low volumes of activity also have implications for recruitment, with a resultant over-reliance on locum staff. 

The consultation includes proposals for the reconfiguration of acute services.  Those are based on criteria that have been developed to provide a consistent basis against which our hospital services will be reviewed on an ongoing basis.  The criteria, which are outlined in the consultation document, are these: safety and quality; deliverability and sustainability; effective use of resources; local access; and stakeholder support.  The consultation invites views on those criteria.  The consultation document also sets out options for how the acute hospital networks would develop and how services would be configured.  The four hospitals in Belfast — the Royal Victoria Hospital, Belfast City Hospital, Mater Hospital and Musgrave Park Hospital — would operate as one network, with clinical services dispersed across the sites in the best available configuration.  Emergency department configuration across the network will be consulted on separately.

I am well aware of the local population's concerns about the reconfiguration of services in the Northern Trust area.  We cannot ignore that significant change would need to occur at the Causeway Hospital.  The community in that area needs to be able to access quality services over the coming years, and it is important that we plan carefully to deliver on that objective.  The consultation seeks views on three potential options for addressing the fragility issues at the Causeway Hospital.  I am clear that there is merit in examining the benefits of strengthened networks between the Northern and Western Trusts or by possibly transferring responsibility to the Western Trust, if that were to work better.  As with all the proposals, my concern is the service for the patient.  Following the completion of the consultation exercise, decisions would need to be made quickly on the way forward to ensure that sustainable services are in place for the long term.

In the Southern Trust area, the existing networking between Craigavon and Daisy Hill hospitals would be built on, with further changes to maximise effectiveness in line with the acute care criteria.  In the South Eastern Trust area, the proposal is for a network of the Ulster, Downe and Lagan Valley hospitals, with links with Belfast.  The GP out-of-hours care model for urgent care at Downe Hospital would be extended to Lagan Valley Hospital.  In the Western Trust area, the new South West Acute Hospital would network with Altnagelvin and Craigavon hospitals.  Altnagelvin would provide a wider range of services in future, including cancer services and enhanced orthopaedics and cardiology.  There is also scope to develop our links with the Republic of Ireland and Great Britain to improve healthcare for citizens here and to be able to offer services to those from other jurisdictions.  The consultation will seek views on developing those links.

Population health and well-being are crucial elements of TYC and support the Department’s proposed framework for public health, Fit and Well — Changing Lives, which is currently the subject of public consultation.  I encourage responses to that exercise.

On maternity and child health, the proposals reflect a commitment to the implementation of the objectives in my Department’s maternity strategy, published in July this year.  That means promoting the normalisation of birth and increasing the number of women having their antenatal care in the community rather than attending hospital.  The proposals in the consultation document will also seek to support healthy pregnancies and promote good parent/child relationships in a child’s crucial early years, as well as supporting child health through the prevention of ill health and promoting health and well-being.

It is essential that children be given the best possible start in life.  That includes a focus on early intervention and a multiagency approach in family and child care, preventing children having to be separated from their family and enabling some children to remain safely with their family.  Where that is not possible, we want to ensure that alternative arrangements can be put in place to bring permanency in the best interests of the child.

The consultation document also includes proposals for how people are treated at the end of life, to ensure that there is choice in how and where care is provided.  People must be treated with compassion and dignity through palliative and end-of-life care, with the aim of reducing the number of people admitted to hospital inappropriately.

My aim is to ensure the safety of all patients and clients and the quality and sustainability of our services.  I know that that aim is shared by all who provide that care.   It is vital that we continue to take decisions and pursue actions that are necessary to improve outcomes for the population.  The proposals in 'Transforming Your Care' and the response to them focus on how we plan and deliver services to support the reform and modernisation of our health and social care system.  Where, following this consultation exercise, it is concluded that specific major changes in services should be progressed, further public consultations will be undertaken for those specific services.

This exercise is not about cost cutting but about improving service delivery and making better use of the available resources.  It is incumbent on us all to ensure that the resources allocated to health and social care are used in the best possible way for the benefit of all citizens in Northern Ireland.

As with any major change in delivery of services, there will inevitably be impacts for our workforce.  We need to ensure the best possible deployment of staff in delivering services in the future.  It is also anticipated that there would be reductions in our overall workforce of around 3% over the next three to five years.  The changes proposed with the shift in services into the community may mean some staff working in a slightly different way or in a different place.  Some staff may choose not to make the change, and they will be supported in their decisions.

The consultation exercise seeks your views as patients, clients, services users, service providers and citizens about how we respond to the proposals set out in 'Transforming Your Care'.  During the consultation process, there will be a series of public engagement events.  We will aim to ensure that everyone is informed and involved in the process and has opportunities to make their views known.  I therefore encourage you to engage with this important consultation, let us know your views and be part of the delivery of change.  I have also agreed that an information leaflet should be provided for every household in Northern Ireland to inform citizens about Transforming Your Care and advise them on how to be involved in the consultation process. The leaflet will be issued next month.

We have an opportunity now — one that does not come along too often — to reshape our health and social care system to improve care and the outcomes for users.  We should build on the excellent practices that already exist to help make improvements across the system.  I believe that there is broad consensus in our community and among those who deliver health and social care on the need to make change.  I want everyone to contribute to that change so that we move in the right direction and in the interests of the quality of care for our community and the sustainability of our services.  I commend the statement to the House.

Photo of Sue Ramsey Sue Ramsey Sinn Féin 3:15 pm, 9th October 2012

Go raibh maith agat, a LeasCheann Comhairle.  I thank the Minister for his statement and for the briefing that he provided to me and the Deputy Chair this morning.  It is a long statement, and there are a lot of issues that people need to take hold of in it.  I agree with the Minister that everybody should get involved in the consultation exercise.  If we want to make change, we need to make sure that everybody is part of that change.

Minister, I have a couple of questions.  Your statement referred to the proposal to close at least 50% of statutory residential homes, but that does not necessarily mean a reduction in the number of private residential homes.  Can you provide assurances today that the Transforming Your Care strategy does not represent the privatisation of elderly care?  There is also the issue of GPs being central to everything in primary care.  We are talking about moving people from the acute sector into the community.  Will you outline whether all GPs are signed up to this at the moment?  If they are not, what could be the impact of that on communities?  Finally, did the equality screening exercise that you carried out identify any groups that would be adversely affected by the proposals?

Photo of Edwin Poots Edwin Poots DUP

I thank the Member for the question.  First, with respect to the closure of residential homes, there is less demand for residential care.  Throughout the Transforming Your Care process, we have identified a greater desire among the public, as there is among young people who become incapacitated, to spend their later years in a real home — the home of their choice — as opposed to a residential home.  In that respect, we need to observe and honour the wishes of the public, and we ato do that.  Providing more respite care for carers and more support for people in their own homes is one aspect of that.  However, it will be demonstrated by a reduced demand for residential care homes.

Secondly, many of our residential care homes were built in the quite distant past.  Many do not meet the standards for room sizes, overhead hoists, and so forth, which would be available in many other facilities.  I cannot ask members of the public to use a facility owned by the public that is perhaps not as good as a facility that is available in the private sector.  Therefore, if the private sector is doing its job well in that respect, it will continue to receive support to carry out that work.

With respect to GPs and their support for the process, we have set up integrated care partnerships.  Although people will focus on a whole range of things, I encourage them to focus very strongly on integrated care partnerships, because that is the area in which we will drive the change needed to move people from secondary care to primary care.  In general, GPs are getting involved in that, are supportive of the consultation that is happening and are working with us on a lot of the issues.  There are a few who are not.

A primary equality screening exercise was carried out on the draft strategic implementation plan.  That took place over the summer period.  The screening exercise has not highlighted adverse impact on any of the section 75 groups.

Photo of John Dallat John Dallat Social Democratic and Labour Party

We have one of the longest lists of Members wishing to ask questions.  I therefore ask you to be brief in your question and allow as many Members as possible to have the opportunity to question the Minister on this important document.

Photo of Jim Wells Jim Wells DUP

The Minister outlined a series of clinical networks between various hospitals.  Does he have any plans to reconfigure the boundaries of the local commissioning groups and/or the trusts?

Photo of Edwin Poots Edwin Poots DUP

We are looking at stronger networking at the moment, and there are some fairly obvious opportunities for that between the likes of the South West Acute Hospital and Craigavon Area Hospital, as well as Altnagelvin Hospital.  There will be a gravity pull towards Altnagelvin Hospital for many of its services, because the new radiotherapy centre will be open by 2016.  I expect that people will prefer to go to Altnagelvin rather than Belfast.

The orthopaedics unit at Altnagelvin Hospital will be enhanced and, because there is no fracture clinic or orthopaedics unit in the Northern Trust area, I suspect that people in that part of Northern Ireland will want to go to Altnagelvin.

We are introducing 24-hour cath labs in Belfast and in Altnagelvin Hospital, which will be a huge step forward in the treatment of people who suffer heart attacks.  That will be a superb service, which will be readily accessible to people in the Northern Trust area at Altnagelvin.  In addition, there is already a strong urology services network between the Causeway Hospital and Altnagelvin.

In all this, there may be the opportunity to strengthen that network and have more consultants available to work at Altnagelvin and the Causeway Hospital, thereby helping to deal with some of the fragility issues at the Causeway Hospital.

Photo of John McCallister John McCallister UUP

I welcome the Minister's statement.  He will know — I have mentioned it before — that one of the most difficult things he has to do under Transforming Your Care is to move money from the acute side to the community side.  There is much to be welcomed in his statement, but there is no reference to the money or to the progress that he is making on shifting that financial responsibility.  Why not, and will he update us on that?

Photo of Edwin Poots Edwin Poots DUP

I thank the Member for his question.  I wish him well as he moves on from being health spokesman for his party.  We had a good working relationship and I trust that that will continue to be the case with Mr Beggs as he assumes that position.

The situation is that we had planned to move around 5% of the funding from secondary care to primary care.  That is a crucial role, and, as I indicated in my response to the Chair of the Committee, the integrated care partnerships would have that very important role.  The GPs will be closely involved in developing the systems and mechanisms whereby work that was once carried out in the hospitals can be carried out in the community.

Some of that work will involve shifting allied health professionals who are available in the hospital setting into community settings, so that they are available in a local health clinic rather than a hospital that may be further away.  The shift in funding that we are looking for by 2014-15 amounts to £83 million.  The Health and Social Care Board and others who are working with integrated care partnerships will put an immense amount of pressure on them to deliver that change.

Photo of Conall McDevitt Conall McDevitt Social Democratic and Labour Party

I commend what is a very comprehensive statement.  There appears to be a shift towards a totally privatised residential care sector.  That sector is currently well regulated from the point of view of standards in residential homes, but there is no financial regulation around the robustness of the businesses that are responsible for those homes.  Therefore, there is no safety net if something goes wrong.  How will the Minister be able to assure us that those homes are underwritten properly if we go down that road?

Photo of Edwin Poots Edwin Poots DUP

I did not raise that issue today because I thought that it had been dealt with when we first brought forward Transforming Your Care.  We are looking at nursing homes and residential homes having to apply for a bond in the first place and lay down a bond, just as builders who start developments do with Roads Service, for example, to ensure that they are sustainable, so that we do not have a situation in Northern Ireland such as what happened in GB with Southern Cross.  That recommendation is in the Transforming Your Care document, and I refer the Member to it.

Photo of Kieran McCarthy Kieran McCarthy Alliance

The headlines in this morning's 'Belfast Telegraph' tell us how the majority of our nursing profession are under extreme pressure, and that they are dissatisfied.

Staffing levels are poor, the workload is increasing, and nursing care is being delivered by less-qualified staff.  Given those depressing facts, is the Minister satisfied that patient care remains genuinely paramount as he pushes ahead with Transforming Your Care, or is what we are hearing just empty rhetoric?

Photo of Edwin Poots Edwin Poots DUP 3:30 pm, 9th October 2012

I would never say that what you read in the 'Belfast Telegraph' is empty rhetoric.  I disassociate myself from such a view — that paper occasionally gets it right.  However, if it is talking about the standards of care, I suspect that it is not getting it right.  In spite of all the damning news put out by a number of media and press outlets, people whom I do not know regularly approach me in the street.  They tell me that they were in hospital and received excellent care; that a relative was in hospital and received excellent care; or that an elderly relative who had fallen received care that was second to none when undergoing an operation and then getting back on their feet.  I hear that all the time.

I get fed up with Members who want to come here and denigrate our health service.  It is one of the best in the world, and I am very proud of it.  I am very proud of our nursing staff, as they make an excellent contribution.  I welcome the survey that received responses from 14% of the qualified nursing workforce across Northern Ireland.  It is important that we listen to the concerns of nurses who take the time to participate in surveys.  However, the numbers represented here are every low, and I suspect that many of the nurses who did not respond are very satisfied with the work that they carry out.  I may have some insight into that issue.

Photo of Paula Bradley Paula Bradley DUP

I also thank the Minister for a very comprehensive statement.  Will he outline the opportunities that Transforming Your Care offers to the voluntary and community sector and to social enterprises?

Photo of Edwin Poots Edwin Poots DUP

Social enterprises and the voluntary and community sector will provide very exciting opportunities in the future.  Healthcare is an area in which we can support communities.  We can create more jobs there, and we can create opportunities for people, particularly the long-term unemployed, to get into useful, viable work.  The wide range of services provided by the voluntary and community sector will be vital in ensuring that proposals in the 'Transforming Your Care' report are realised.  It is likely that there will be significant additional demands on that sector and that it will help to sustain and develop services.

I am committed to a mixed economy for the provision of care.  We talked about the private sector earlier.  The community sector can do an awful lot in, for example, domiciliary care.  The voluntary sector does excellent work in mental health and learning disability care.  It is very important that we use those people — I mean "use" purely in a kind way — to maximise the delivery of health and social care.  In doing so, we can provide the best possible health and social care to the people who need it, whether they are patients or people who have a learning disability or mental health issue.

Photo of Mickey Brady Mickey Brady Sinn Féin

Go raibh maith agat, a LeasCheann Comhairle.  I, too, thank the Minister for his statement.  I am pleased that networking between Daisy Hill and Craigavon will be built on.  The 'Transforming Your Care' report came out in 13 December 2011, and a leaflet will be issued to the public next month, almost a year later.  After a lot of general information on the report, we are now getting some of the specifics.  Is the Minister happy that the leaflet will provide enough information to enable people to make a qualified and measured response to the consultation?

Photo of Edwin Poots Edwin Poots DUP

I want the public to be as well informed as possible so that I will be made aware of any genuine concerns at an early point.  Sometimes, politicians and others get a little exercised about an issue but do not really reflect the views of the public.  I want to hear from the public.  If the public think that this is the correct trajectory, that is good.  If they think that we are on completely the wrong course, I need to hear that, change course and seek to amend. 

  We have sought to take as wide a view as possible in the drawing up of those reports thus far.  However, I think that this is the most crystallised opportunity yet for the public to get involved in the consultation process and make their views known.

Photo of Pam Brown Pam Brown DUP

I thank the Minister for his statement to the House.  What would the introduction of a 111 number mean for Transforming Your Care?

Photo of Edwin Poots Edwin Poots DUP

The 111 number is currently being piloted in parts of England and is due to be rolled out in spring 2013.  It is being introduced there to make it easier for the public to access healthcare services when they require medical help quickly but their condition is not life-threatening.  The introduction of a 111 number has the potential to drive improvements in the way in which health and social care delivers care.  It would provide the opportunity for aligning call-handling and triage processes with other urgent care services, including the Northern Ireland Ambulance Service.  A single number would assist in ensuring that patients would have access to better information and more help and understanding on how to access the best care, especially urgent care, when they need it, with patients being referred to a service that has appropriate skills and resources to meet their needs. 

My Department and HSCB and NIAS colleagues are monitoring the development of the 111 service to ensure that we learn from experiences in England and add value to any service that may be developed here in Northern Ireland.

Photo of Samuel Gardiner Samuel Gardiner UUP

I thank the Minister for his statement.  When the report was published, he said that he would need £70 million to see it through, including £25 million for 2012.  Will he provide an update on his efforts to obtain that money?

Photo of Edwin Poots Edwin Poots DUP

Thankfully, I can.  The HSCB has undertaken work to consider the financial implications of TYC and its linkage to quality improvement and cost-reduction work.  The financial modelling exercise has been conducted at a high level.  It has concluded that there still remains an affordability gap for 2014-15.  However, that is not unusual at this stage. 

Normal processes will follow with the HSCB to understand more fully the financial gap and how it will be resolved.  In addition, the shift left into primary and community care and other investment proposals in the strategic investment programme and population plans have to be taken forward with the budget allocations that are available. 

I am grateful for additional funding from Sammy Wilson and the Department of Finance and Personnel.  My Department made a bid of £90 million through the Executive's invest-to-save programme in 2012-13 to support the implementation of TYC and other health and social care proposals.  We believe that it is a well-considered proposal.  We hope for a positive outcome on it.

Photo of Cathal Boylan Cathal Boylan Sinn Féin

Go raibh maith agat, a LeasCheann Comhairle.  Cuirim fáilte roimh ráiteas an Aire.  I welcome the Minister's statement.  I refer him to the Bamford review.  He mentioned continuing to extend care that is provided in the community.  He may not be aware that during Question Time, his party colleague the Minister for Social Development said that the Housing Executive was not meeting its Bamford targets.  How does the Minister propose to implement fully the Bamford action plan?

Photo of Edwin Poots Edwin Poots DUP

We intend to meet Bamford targets by delivering, by 2015, on moving people out of hospital care into the community.  I pay tribute to my colleagues in the Department for Social Development.  Perhaps they have been more capable of delivering on that than the Department of Health and have been in a slightly better position.  They have worked closely with us thus far.  I look forward to working with them over the next two to three years.  I made a strong commitment, today and over the past number of months, that my Department would, indeed, want to deliver that by 2015.  DSD is a crucial partner in ensuring that that happens.

Photo of Seán Rogers Seán Rogers Social Democratic and Labour Party

I thank the Minister for his statement.  Where is the proof that there are safer and better alternatives to statutory residential care?  My colleagues and I in South Down know that places such as Slieve Roe House in Kilkeel offer an A1 service in statutory residential care.  In passing, the Minister mentioned the private sector doing its job well enough.  Can he reassure me that the private sector would provide the same level of care?

Photo of Edwin Poots Edwin Poots DUP

Reassurance comes from the RQIA and the regulation of residential and nursing homes.  A very rigorous regulation process takes place, and I welcome that because the stronger the regulation, the better the outcomes for the people who we are providing care for.  However, if the Member is of the view that homes that were built 30 or 40 years ago and which would cost a huge amount of money to renovate are better than homes that are newly built, I can tell him about Blair House, which I recently opened in Newtownards.  Mr McCarthy, Mr Hamilton, Mr Bell, Miss McIlveen and others were present at that opening.  I do not hear any of those Members saying that that is a poorer service or poorer care than we are offering in the public sector.  It is a brand new facility that has been built to be fit for purpose.  The unfortunate reality is that not all of our facilities are fit for purpose, and to bring them up to that quality of service would cost many millions of pounds.  I believe that that money would be better spent elsewhere in the health and social care sector.

Photo of Adrian McQuillan Adrian McQuillan DUP

I thank the Minister for his statement.  Minister, can you outline the benefits of transferring the responsibilities of the Causeway Hospital from the Northern Trust to the Western Trust?

Photo of Edwin Poots Edwin Poots DUP

We already have evidence of how networks can work well, and I point strongly to the existing Daisy Hill/Craigavon network.  I had the privilege of going to the high dependency unit in Daisy Hill Hospital, where I saw how new technology can assist.  Through a robot, an intensive care consultant talked face to face with the individual at Daisy Hill, and the consultant, who was in Craigavon, could analyse that individual and work closely with the doctors there and provide that added experience and skill set without being on site.  I can see opportunities for Causeway Hospital, where it is perhaps more difficult to get consultants, to get consultant support through new technology advances, which will enable us to sustain services in a better way than might otherwise be the case at Causeway. 

I outlined how Altnagelvin will be developing radiotherapy services, a 24-hour cath lab and wider orthopaedic services.  All of those will be hugely beneficial to the people in the Causeway area.  The networking between the hospitals is important in that, if you have a consultant who is based in Altnagelvin, it is much easier to get that consultant to travel to Causeway to carry out work.  A lot of the consultants who are based in Antrim live in Belfast, so it is more of an issue to get those consultants to work at the Causeway Hospital.  As a result of networking with Altnagelvin, there are greater opportunities to have more consultants with the specialist expertise to work in that facility.

Photo of Oliver McMullan Oliver McMullan Sinn Féin

Go raibh maith agat, a LeasCheann Comhairle.  Minister, you touched on part of the question that I was going to ask in your answer to the Member who asked the previous question.  Can we be guaranteed by you that the Northern Trust will remain and that this will not, in some way, lead to the future demise of the Northern Trust because of the public problems that it is having?  Given the rural area that we cover here, I take it that the Ambulance Service comes under the same vein of thinking.

Photo of Edwin Poots Edwin Poots DUP

There are no proposals to do away with the Northern Trust.

Photo of George Robinson George Robinson DUP

Will stronger networking arrangements for the Causeway Hospital, either with Altnagelvin or with Antrim, make it a more attractive place for specialist doctors to work in?  I thank the Minister for his statement.

Photo of Edwin Poots Edwin Poots DUP

As I said to Mr McQuillan, I do think that.  It is a much more attractive option for a doctor to be living somewhere between Causeway and Altnagelvin, which is a particularly beautiful part of the world with good schools available.  The scale of work there will test all the skills of a young, go-getter consultant and allow them to expand their skills.  They get all of that, and they also get a very pleasant area to live in with good schools and so forth.  So, it is a much more attractive option to consultants than is currently the case to have that facility available.  We all need to recognise that there is an issue with consultants at the Causeway Hospital.  We are operating with too many locums, and we need to fix that.

Photo of Stewart Dickson Stewart Dickson Alliance 3:45 pm, 9th October 2012

I thank the Minister.  Minister, will you agree with me that you have an uphill struggle in selling your plans to what is effectively a sceptical public?  I look forward to the analysis of the consultation process.  The public are particularly sceptical about elderly care and the care packages that are proposed.  Do they not, in reality, create a great deal of social isolation among elderly people?  Do you not share my serious concerns about the closure of trust homes?

Photo of Edwin Poots Edwin Poots DUP

Social isolation will not be resolved by taking people from their own homes and placing them in nursing or residential homes.  If that is Alliance Party policy, the public would be truly sceptical of it.  I am not sure whether that is the party's policy as Mr Dickson in not the health spokesperson. 

Elderly people, generally, want to be in their own home where they have been for all of their life.  To deal with social isolation, we need to look at the opportunities and to work, particularly with the voluntary and community sector, on how we bring people together with other people to enjoy a bit of fun and conversation.  However, that does not mean putting them into residential homes or nursing homes.  Mr Dickson is coming out with a flawed policy.

Photo of Roy Beggs Roy Beggs UUP

I thank the Minister for his statement and put on record my appreciation of the nurses and doctors at Antrim hospital who treated me for a minor injury during the summer. 

From family experience, I am aware of two elderly people who were returned to their homes following hospital treatment with very limited independence and mobility.  Within a short time, GPs had to be called and ambulances returned those people to hospital before both were successfully rehabilitated at Clonmore residential home.  If, as is the case in the draft plan, Clonmore, Lisgarel and Joymount residential homes were to close, how would such patients be successfully rehabilitated?  How are the existing patients to be cared for?

Photo of Edwin Poots Edwin Poots DUP

It is very important that, first, people do not stay in hospital longer than is required, because hospital is not a place to be if you do not need to be there.  Secondly, we must have appropriate discharge so that, at the same time, we do not discharge people who are not ready to go home or, indeed, to intermediate care.  An intermediate care facility has been developed right beside Antrim hospital.  It is a brand new private sector facility.  So, those facilities can be offered to people.  Whilst we may not deliver the service, it will not stop us from buying that service.

Photo of Mervyn Storey Mervyn Storey DUP

I thank the Minister for his statement, and we look forward to engaging in the consultation process over the next number of months.  The Minister rightly makes reference to a focus on early intervention and a multiagency approach to family and children's care.  With my education hat on, I want to ask him this:  what plans are there to extend the Roots of Empathy programme for schoolchildren?

Photo of Edwin Poots Edwin Poots DUP

The Roots of Empathy programme is excellent value for money and is a programme that I support strongly.  A high level of interest has been shown by stakeholders, including staff at primary schools and early year providers, in the Roots of Empathy programme.  The PHA is examining the possible scale and pace of expansion of the programme, and a major benefit of it is the legacy of skilled staff who represent a major resource and support to schools.  In 2013-14, over 100 schools across Northern Ireland will run the programme to the benefit of over 1,500 children.  Schools are being selected to reflect higher levels of disadvantage, albeit that school populations cannot always be identified so precisely. 

Our early years interventions and interventions in the primary school years have to continue because they are absolutely critical if we are to get better educational outcomes.  If we get better educational outcomes, we also get better health outcomes, better job prospects and have less trouble with young people getting involved in the juvenile justice system.

Photo of Ian McCrea Ian McCrea DUP

I, too, welcome the Minister's statement.  He used the words "compassion and dignity", which are two words that, unfortunately, cannot be used for the many patients who wait for hours on end in the A&E at Antrim.  Will the Minister assure me that he is determined to improve the A&E services at Antrim and that there is the capacity in the Northern Trust to return that compassion and dignity to those patients?  Will he also comment on how he sees the importance of the minor injuries unit at the Mid Ulster Hospital?

Photo of Edwin Poots Edwin Poots DUP

I thank the Member for his question.  Unfortunately, we are where we are with Antrim Area Hospital.  I will still go back to the fact that two hospitals closed consecutively — the Mid Ulster and the Whiteabbey emergency units — but we did not have the capacity at that time to absorb all that.  The decision that was made was unfortunate, but, nonetheless, we have to live with the consequences of it.  We are working our way through it in Antrim, and a new facility is being developed.  I am dissatisfied with where we are with reducing the waiting times, so I am not satisfied that we have reached a stage that is acceptable either to me or the public.  So, more work needs to be done there.  Staff in the HSCB know that we are dissatisfied, and staff in the Northern Trust know that we are dissatisfied.  The pressure will continue to be piled on those organisations to ensure that we get a service in the Antrim Area Hospital that is considerably better than that that has been experienced since the closure of the Mid Ulster and Whiteabbey hospitals.  The minor injuries unit in the Mid Ulster provides a very important service.  I encourage people to use it, as it is an excellent facility.

Photo of Jim Allister Jim Allister Traditional Unionist Voice

The Minister is going to consultation.  Is he listening, or is this just a process that has to be gone through so that we can get to the predetermined outcomes that already exist?  Certainly, where the Causeway Hospital is concerned, the omens are not good, because any of the hospital meetings that I have attended would not accord, for those stakeholders, with the Minister's vision of the hospital as a satellite outpost of Altnagelvin.  What acute services does he anticipate retaining in that satellite outpost of the Causeway, and what about the rump of the Northern Board?  Will it ultimately be rolled into Belfast, where some people seem to think Antrim exists to serve in any event?

Photo of Edwin Poots Edwin Poots DUP

The Member can put labels on particular facilities and run those facilities down if he so desires.  I happen to think that the Causeway Hospital provides a good service, and I wish to continue with most, if not all, the services that are provided at that hospital, if that is possible.  However, if the Member thinks that the current situation, where you have nine consultant positions, with six covered by locum doctors because the posts have not been filled, is sustainable, he truly is on a different satellite from the rest of the Assembly.  The truth is that we need to ensure that there is real and true sustainability, and we need to think somewhat differently about how we achieve that.  If there is a lack of consultants taking up the positions that exist in the Causeway, it is because what has happened and what has passed heretofore clearly has not worked.  So, we need to have that full-time, sustainable service at the Causeway.  That is what we are working towards.  I hope that the Member will work with us, as opposed to against us.

Photo of Michaela Boyle Michaela Boyle Sinn Féin

Go raibh maith agat, a LeasCheann Comhairle.  I thank the Minister for his statement.  He alluded to the impact on the workforce and the possible reduction of 3% in the next three to five years.  Has he had any discussions with the unions on possible workforce reductions?

Photo of Edwin Poots Edwin Poots DUP

Yes, my officials met the unions today to discuss the outworkings.  Over the course of each year, there is around 2% staff turnover in the health and social care system, so, over three to five years, there will be 6% to 10% of a staff turnover.  For us to lose 3% of staff should not involve compulsory redundancies.  There may be some specialist areas in which there is the occasional voluntary redundancy, but I suspect that that would be quite limited.  Most will be found through people who are retiring or moving on and through reassigning positions.  In all of this, we will still be employing and taking on new people to come and work in the health and social care system over the next three to five years, but we will not be under as much pressure to recruit as many.

Photo of Gordon Dunne Gordon Dunne DUP

Minister, as you are aware, there is considerable interest from GPs in such areas as Bangor and Lurgan in the provision of hub well-being centres.  How can such proposals be forwarded under Transforming your Care.

Photo of Edwin Poots Edwin Poots DUP

Transforming your Care does see the way forward.  We have identified 27 areas for hub centres, and that process will be moving ahead.  As I indicated previously, we are taking forward two pilot projects at present.  What I will say, and say very clearly, is this:  for the centres to work, I believe that we need the GPs under the same roof as the specialist nurses and allied health professionals, providing that multidisciplinary team.  If GPs do not want to do it, they will damage the prospects of achieving this.  Therefore, where we have areas where general practitioners are keen to get involved in the development of new hubs and put their name to the paper as being a key player in that, the centres will be delivered much more quickly.  They will deliver considerably better services for the public, because a GP, linked with a podiatrist, a physiotherapist, a senior diabetic nurse, and all of that, will be able to provide the range of skills under the one roof that will avoid hospital admissions.  I encourage the primary care practitioners to help us and to come together with us to ensure that that is the case, because it will dramatically change the care that we provide for the wider public.

Photo of John Dallat John Dallat Social Democratic and Labour Party

That concludes questions on the statement.  I ask Members to take their ease for a moment.

(Mr Principal Deputy Speaker [Mr Molloy] in the Chair)