With your permission, Mr Deputy Speaker, I will answer questions 1 and 2 together, as they both relate to cancelled hospital appointments.
My Department has had the integrated elective access protocol in place for a number of years. That requires that, for outpatient appointments, six weeks prior to the appointment, patients are issued with a letter inviting them to contact their Health and Social Care trust to agree and confirm their appointment. Partial booking allows patients to choose a suitable date and time for their appointment. The protocol also requires consultants to give a minimum of six weeks' notification of intended leave of absence in line with locally agreed human resources (HR) policies. Those policies are intended to reduce the likelihood of hospital cancellations at short notice and to give trusts greater assurance that clinics will proceed as planned.
I am pleased to advise the Assembly that the number of patients who do not attend outpatient appointments has reduced from 10·3% in 2010-11 to 9·4% in 2011-12. Trusts are working to reduce that further by, for example, piloting the introduction of a text-reminder service for appointments. The rate of consultant-led appointments that hospitals cancelled has also reduced over the past four years, decreasing from 12·3% in 2008-09 to 10·8% in 2011-12. Those reductions are welcome, but I want to see further improvement.
Go raibh maith agat. I thank the Minister for his answer. I would like him to separate the number of appointments that patients cancelled from the number of those that consultants, private clinics and hospitals cancelled. How do the latter cancellations relate to the amount of money that is being paid into private clinics?
As I said, the number of consultant cancellations is now sitting at 10·8%, and it was 12·3% in 2008-09. Therefore, improvements have been made. I think that the Member needs to understand that there will always be consultant cancellations. That can happen because of ill health, consultants being engaged in emergency work or having spent the previous night carrying out emergency work and are, therefore, unable to fulfil an appointment. It might also be because consultants have been called on to carry out further training, which is an important element of their work. Therefore, there are a number of reasons why consultants have to cancel their appointments.
Go raibh maith agat, a LeasCheann Comhairle. I suggest to the Minister that some patients are saying that they have been told that their appointments have been cancelled, only for them to be rearranged for a private clinic with the same consultant. Is the Minister aware of that practice? How does it represent value for money?
We operate under a protocol for doctors that was established in London, and that agreement is carried out across the four countries. Our position is that doctors are allowed to carry out work outside the time that they are employed in the National Health Service (NHS). I suspect that if we wished to change that, it would be very challenging. Consultants' ability to move makes them very accessible, and they can move to locations that best suit their needs. Therefore, we need to be very careful about how we approach the issue. Doctors are allowed to practise outside the National Health Service. I think that some of the agreements that have been made with them have not necessarily been in the public's best interests, but seeking to change those will be very challenging.
A cancellation can, but will not necessarily, lead to a delay. For example, patients may have had their original appointment brought forward; they may have received their treatment; or they may be in hospital on the appointment date. Obstetric patients may have cancelled because their baby was delivered by the time of the appointment, or some cancellations may be a result of internal patient administration system adjustments that do not affect a patient in any way. So it can cause delay, but in many instances it does not.
It is crucial, particularly in hospitals where accident and emergency services are important and we want to retain those services, that emergency surgery continues to be available. Without emergency surgery, you do not have a full-scale emergency department.
Community Resuscitation Strategy
I have asked the Chief Medical Officer to set up a working group to develop a community resuscitation strategy aimed at co-ordinating the available resources to maximise the number of individuals trained in emergency life-support skills in order to improve the survival rate of those who suffer an out-of-hospital cardiac arrest. The working group is chaired by the Northern Ireland Ambulance Service and includes representatives from my Department, health and social care bodies, community and voluntary bodies involved in resuscitation training and representatives from the other Northern Ireland Civil Service Departments, such as Education and Culture, Arts and Leisure. I have asked for the strategy to be ready for consultation by October 2013.
Last year, my Department completed a pilot scheme to test a model of cascade training in ELS and the use of automated external defibrillators (AED). The pilot was designed to test the feasibility of training a number of volunteers in ELS skills and in the use of an AED to the level of being able to cascade the training to others. The volunteers were from organisations involved in sport, including the IFA, GAA, and some district councils. The pilot scheme was completed and evaluated in 2012. The evaluation led to two key conclusions. The first is that cascade training is feasible and is a viable way of increasing the pool of people who can provide emergency life support or use an AED in an emergency. The second conclusion is that it is essential that an organisation taking part in this type of scheme must have commitment from its senior leadership or management and that such commitment must be communicated to people throughout the organisation.
I pay tribute to all across Northern Ireland involved in this valuable work, including Health and Social Care and a number of voluntary organisations, such as the British Heart Foundation, ABC for Life, the Red Cross and St John Ambulance, as well as the sporting bodies.
We intend to have a strategy available to allow us to make those decisions. The Chief Medical Officer and a team are working up that strategy, and we anticipate that its impact will be positive. Currently, around 90% of people who have a cardiac arrest outside a hospital environment do not survive. In places where there has been extensive training, such as Seattle, the survival figure has gone up to around 52%, which demonstrates that a lot of progress can be made in this area if we train more people. That is why we have tasked the Chief Medical Officer to carry out this work. Ultimately, it will save many lives.
Advice on reducing the risk of sudden infant death syndrome has been provided since the early 1990s, when the Reduce the Risk of Cot Death campaign was introduced. The initial leaflet focused on the sleeping position of the baby and contributed to a welcome reduction in the number of unexpected infant deaths. To ensure that the benefits are sustained, my Department periodically updates the advice to take account of additional identified risks. The most recent version of the leaflet was published in December 2012. In addition, sections on reducing the risk of cot death are included in 'The Pregnancy Book' and 'Birth to Five' book, which are issued to new parents at antenatal clinics or GP surgeries.
The main points were as follows: the safest place for your baby to sleep is on their back, in a cot in a room with the parents in the first six months; place the baby in a feet-to-foot position in the cot; do not let your baby's head become covered; smoking in pregnancy greatly increases the risk of sudden infant death syndrome; do not let your baby get too hot or too cold; breastfeeding your baby reduces the risk of sudden infant death syndrome; research shows that using a dummy at the start of any sleep period can reduce the risk of sudden infant death syndrome; and, if your baby is unwell, seek medical advice promptly.
The good news is that in 1990, there were 56 cot deaths, and last year, there were five. This is an absolutely dramatic reduction, which has avoided an awful lot of pain and anguish that many parents of young children would have had to endure.
Go raibh maith agat, a LeasCheann Comhairle. I thank the Minister for his answers thus far. What work has his Department undertaken with other agencies to help alleviate the immediate stress that families face after a sudden death, by agencies investigating such a death, accepting that that needs to be done, but in a sensitive and timely manner?
In each trust, we have specialist counsellors who are there to provide advice and support where that is appropriate and where it is wanted. Many people will never go through a greater trauma than losing their infant at such an early stage, after having had the joy of giving birth in the first instance.
I do not see any redeeming features of cigarette smoking. One in two people die from them, and the impact that they have on others is damaging, so whatever we can do to dissuade and discourage people from commencing smoking, we will attempt to do that. We could get into a longer debate about the means of doing that, but I do not think that now is the appropriate time.
Royal Belfast Hospital for Sick Children: Cardiac Care
5. asked the Minister of Health, Social Services and Public Safety, following the recent legal decision in England that the review into paediatric congenital cardiac surgery was flawed, what impact will this have on the review of children's cardiac care in the Royal Belfast Hospital for Sick Children. (AQO 3691/11-15)
The recent legal judgment in England does not impact on the review being undertaken by the Health and Social Care Board on the future commissioning of paediatric congenital cardiac surgical services for Northern Ireland. The Northern Ireland review is, therefore, continuing as planned, and I expect to reach a decision on the future commissioning of that service in the coming months.
The Committee should have been informed, and I apologised to the Chair earlier for that slip up. That is something that we accept. The framework gives us the ability to actually arrive at a decision point on that very important and very sensitive issue. On the one hand, I have many parents saying that I could be putting their children at risk by taking surgery outside of Northern Ireland. On the other hand, I have people from the medical side who are saying that if the skills and capacities do not actually exist in Northern Ireland, I could be putting children's lives at risk by insisting that surgery continues to take place in Northern Ireland. One can see the very difficult place in which we are on that issue. What I will seek to do is to ensure that we do not put children's lives at risk anywhere, that we seek to ensure that the provision of that service is as convenient as possible and that the quality of care that is provided to parents and to their little ones — who are the most important people here — at the time that they need that care is of the highest standard.
I declare an interest as the parent of a five and a half-week-old son, Evan, who is currently awaiting heart surgery in Belfast.
From my experience, the cardiac and paediatric surgeons and the anaesthetists in the Royal Victoria Hospital are of the highest professional and specialist standard, as I am sure the Minister will agree. Does he also agree, however, that if he reduces the number of surgeries that are completed in the Royal, it will become increasingly difficult to recruit to those posts, which are necessary for follow-on surgeries, not just for the heart but for non-related cardiac surgeries on children who have already had successful cardiac operations in Belfast?
One of the important issues for me is the potential knock-on effect for other services. It may not just be the paediatric congenital cardiac surgery that is affected as a result of not providing that service in Belfast. We have to take all of that into account and take cognisance of it.
First and foremost in all of that, we will be looking at what is in the best interests of the children and how we can provide the best possible care. I was aware of the Member's son, and the whole House will wish his son and his family well as they go through this time. I know that the Member will want to ensure that his child is afforded the best possible treatment, and that is what we want to do for every child in those circumstances.
There was an analysis of the public consultation, and the working group considered the main themes arising from the respondents and the key clinical issues that were raised by clinicians.
The draft post-consultation document incorporates changes that cover options for future commissioning of the service, the selection criteria and the weightings to be attached to the assessment of those options. Following the approval of the framework, it will be applied to the options that are outlined in the post-consultation document, with the aim of identifying a preferred way forward for the provision of the service.
I have had a number of discussions, and senior departmental officials are engaged in ongoing discussions. One of the issues will be the ability of the hospital in Dublin to take additional capacity. Around 140 operations are being carried out currently on children from Northern Ireland, and around 40 of them take place outside Northern Ireland, mostly in England but some in Dublin. We would prefer to do more of that surgery in Dublin if we can be assured of quality standards, and I think that we are getting there.
They intend to build a new facility in Dublin, so there may be a course of work to determine how we can manage the services over that time if additional services are to be carried out in Dublin. A lot of work has been done, and there is a lot more to be done before we get to a final outcome.
Health Innovation Corridor
I understand that the health innovation corridor in the north-west is still in the early stages of development and, to date, I have not had any discussions with the Minister of Enterprise, Trade and Investment about it. However, Minister Foster and I are committed to the pursuit of healthcare innovation through our joint memorandum of understanding on connected health and prosperity. Therefore, I welcome this initiative and I will be interested to see what emerges from it.
It will be important that the initiative is complementary to the broader eHealth and innovation agendas that are being taken forward by my Department and Invest NI. I would also encourage organisations that are associated with the initiative to become members of the Northern Ireland Connected Health Ecosystem, which is a forum that brings together organisations from the health, academic and industry sectors to consider the development of innovative solutions to address needs that are identified by the health sector.
I thank the Minister for his comments. I agree that any such initiative has to be complementary to whatever exists. However, the facilities in the north-west such as Project Kelvin, the Clinical Translational Research and Innovation Centre (C-TRIC) and the university research facility, which are the only such facilities in the North should, therefore, be supported and developed accordingly.
I am very supportive of the development of innovation in healthcare. I had the opportunity to visit C-TRIC, so I know the excellent work that goes on at that facility. Project Kelvin brings an added dimension, with the ability to pass information very quickly to and from the United States of America in particular. We are in an advantageous position on a lot of these things. Northern Ireland needs to develop innovation in healthcare. That is why we have the memorandum of understanding between Invest NI and the Department of Health, which was signed by Arlene Foster and myself. That is why we have established an ecosystem. That is why we have established a task and finish group between the Department of Health and Invest NI, with support from other people in business and academia, to identify how we can deliver on innovation.
Two meetings have been held to date comprising representatives from the University of Ulster, C-TRIC, Derry City Council and Co-operation and Working Together. The initiative has been linked to the One Plan, which is about economic regeneration in Londonderry. Considerable work is being done between the key stakeholders on how we develop these things.
I am committed to research and development and innovation in health and social care services as a way to meet major challenges, including demographic change. Our work in progress on addressing the innovation challenge was outlined in a statement that I made to the House in December. There is the regional health and social care resources directorate fund, which provides additional funding to enable Northern Ireland-based researchers to apply for major awards through applied programmes of the National Institute for Health Research. Synergies with Invest NI R&D programmes are increasing the ability of clinical, academic and business organisations to make discoveries and apply them for improvement in the prevention, diagnosis and treatment of illnesses, and care of patients and clients.
The shift towards a population with a higher proportion of older people requires a change in how the services are delivered while we maintain the high quality that people want and deserve. There is a whole course of work. We are delighted to note that Therese Murray, the president of the Massachusetts Senate, was able to join the event on the north-west health innovation corridor. I was very pleased to meet Senator Murray at an EU/US connected-health marketplace conference in October 2012, when we announced a new research partnership in medical device technologies and innovation between the universities of Ulster and Massachusetts. That partnership will bring together experts on both sides of the Atlantic, which will be to the benefit of Northern Ireland and the United States.
Termination of Pregnancy Guidelines
I have circulated draft guidance on termination of pregnancy to Ministerial colleagues, seeking their agreement to hold a public consultation. I intend to discuss the document 'The Limited Circumstances for a Lawful Termination of Pregnancy in Northern Ireland' at the next meeting of the Northern Ireland Executive. Following public consultation, I will submit a final guidance document back to the Executive for their consideration. It is my intention that publication of the final document will take place in the autumn. The draft guidance document does not change the law in Northern Ireland, and it does not make it easier for a woman to have a termination of pregnancy.
I take this opportunity to apologise to the House for being absent during Finance and Personnel questions.
I acknowledge the publication of the guidelines and welcome the fact that they are now out for consultation. Does the Minister agree that we must now move, without changing the legal position in this jurisdiction, to ensure that we are able to guarantee that everyone operating in this field does so within a regulated context?
I would very much like that to be the case. It is essential that people who work in this very sensitive area ensure that whatever they do is within the legal framework. The guidelines are an asset to people who want to work within the legal framework and will help them to ensure that that is the case.
I have not had discussions with the Justice Minister, but I have instructed my staff to write to him to seek a meeting on the issues that were raised last week. I welcome the fact that the Justice Minister recognises that this is a justice issue in that the legislation is justice legislation and his Department is involved. We need fully and frankly to discuss how best to move forward, particularly in light of last week's vote, which allows Marie Stopes to operate in an unregulated way, which is something that I could not support.
In 2008-09, there were 44; in 2009-2010, there were 36; and in 2010-11, there were 43. In the rest of GB during that period, there were 189,000. Some people talk about the number of people who travel. Regrettably, around 1,000 people with registered addresses in Northern Ireland did travel. However, the proportionate number here would be 4,000, if you look at the number of terminations that have taken place across the UK. Therefore, one can see that not having the ability to pop into a facility that can basically give you an abortion on demand significantly reduces the number of terminations that take place. Consequently, many tens of thousands of children have grown up in Northern Ireland over the past 45 years who would not have had that opportunity in England or Wales.
Fire and Rescue Service
On 1 November 2012, in a written statement to the Assembly, I referred to a number of allegations about potential fraud, theft or other irregularities in the Northern Ireland Fire and Rescue Service and announced that I had tasked the departmental accounting officer with responsibility for ensuring a satisfactory and independent investigation into the specific material allegations that have been made.
The Department for Social Development corporate investigation unit has been commissioned to undertake a detailed investigation, and I expect to receive its report by the end of this month. Once I have had the opportunity to consider its findings, I will ensure that that report is made public.
Gabhaim buíochas leis an Aire as an fhreagra sin. Mr Deputy Speaker, I would like to take the opportunity to apologise for not being here to ask my question during questions to the Minister of Finance and Personnel.
There have been a number of reports before now. Was anyone disciplined for anything that was in those reports?
There certainly was a recommendation for disciplinary proceedings to be carried out. The Fire Service board should be very careful about how it handles things because in one particular report, it was very clear that discipline was the expected outcome. Sometimes, people can use the system to avoid disciplinary procedures. It would be a travesty if that were the case in this instance, and the board would be snubbing the House if that happened. That is something that it should reflect on and be very careful about.