I beg to move

That this Assembly recognises that emergency services play a critical role in providing care to those in urgent need; expresses deep concern at the findings of the Northern Ireland Audit Office (NIAO) March 2025 report on ambulance handovers, which outlines how severe delays are putting patient safety at risk and wasting significant resources; notes that only 7% of handovers meet the 15-minute target, with some exceeding 10 hours; further notes the impact of delays on emergency response times, hospital capacity and front-line staff; and calls on the Minister of Health, with the support of Executive colleagues, to urgently introduce the recommendations set out in the SDLP policy Help Can’t Wait, including the introduction of the W45 policy used by the London Ambulance Service, the standardisation of guidance across all health and social care trusts, a commitment to increase medical capacity, improve processes to reduce ambulance handover delays and improve patient flow across the health system.

The Business Committee has agreed to allow up to one hour and 30 minutes for the debate. The proposer of the motion will have 10 minutes to propose and 10 minutes to make a winding-up speech. As two amendments have been selected and are published on the Marshalled List, the Business Committee has agreed that 30 minutes will be added to the total time for the debate.

I note and welcome the amendments that have been tabled. We do not disagree with the sentiments expressed in either of the amendments, as they recognise the interlinked issues that have aligned to leave our health service in such disarray, but the wide-ranging calls in both amendments, worthy as they are, threaten to deflect attention from and prevent action on the focus of our motion.

(Madam Principal Deputy Speaker in the Chair)

The whole system needs fixed. We support transformation, but we cannot continue to wait for everything to be fixed before we fix anything. Our focus today is on improving the Ambulance Service and ensuring that people can access emergency care when they need it. While transformation will require tough decisions, as we keep saying and keep hearing, there will be concerns in some areas at the prospect of losing services from the local community. However, the one thing that fills all of us with dread, wherever we are, is the fear that, in the event of an emergency, be it one of our elderly parents falling down the stairs or a young child badly injuring themselves jumping down them, it will take hours for an ambulance to show up, while someone we love lies suffering or maybe even dying before our eyes. What we propose today is something that the SDLP is passionate about. Something that we all agree on is that our health service is in a precarious position. We are passionate about that too. Throughout a patient's pathway, we hear stories of a service that is falling apart at the seams. Whether it is the emergency departments (EDs), the extensive waiting lists or the struggle to allocate care packages, we can all agree that, if we are to improve patient outcomes and deliver a fit-for-purpose healthcare system for the future, we must act now. Quite simply, we must transform our healthcare system if it is to survive.

The SDLP does not believe that it is right to lay all of that at the feet of the Health Minister. One Minister cannot do it all on their own; rather, as our motion proposes, while the Minister has primary responsibility around the details, the buck stops not with him but with the Executive as a whole. I will say again that transformation requires difficult decisions and buy-in from all Executive Ministers, and it should compel all Ministers to consider the way in which they operate. Our health service, rather like our Executive and, indeed, the Assembly, is highly interdependent. What impacts one part will directly or indirectly impact all others. It is in that spirit that we have genuinely and sincerely tabled the motion for today.

The SDLP policy paper 'Help Can’t Wait' makes a number of recommendations, which are not easy. We are well aware that the recommendations that we have made will not sit easily with everyone. However, we ask everyone to consider at the outset that the recommendations are a result of best practices and facts and should be seen through the lens of wanting to improve patient flow in our hospitals and, therefore, improve patient outcomes. In essence, we propose a solid example of transformation in health.

It begins with ambulance handovers. There is a target time across the NHS for ambulance staff to hand over a patient when they arrive at the emergency department. It is 15 minutes. That is 15 minutes to get the patient in and get the ambulance back on the road to do it all again. While that is an aspiration, we know that, despite the best efforts of our heroic paramedic staff, one can only imagine the horrors that they have to face in a day or night at work. They are worthy not just of our gratitude but of better pay, conditions and support.

It is great to see that workforce being bolstered now by the first cohort of graduates from the paramedic course at Magee College. We need to improve our system to maximise the benefit of that brilliant workforce. Paramedics do not want to sit all day at hospitals when there are lives out there to be saved. Every minute and every hour that a patient waits outside an emergency department is a minute or an hour that another patient must wait for an ambulance.

The W45 policy is relatively new and relatively straightforward. In essence, if a patient has been waiting for 45 minutes outside an emergency department and is yet to be handed over, the ambulance crew will safely bring them into the emergency department, at which point, staff can begin their assessments and triage.

Will the Member give way?

Certainly.

Last night, I had my own experience with triage. My son threw his submarine at me and split my eye open, so I had to be triaged through the emergency department at Daisy Hill Hospital. I was most impressed by the efficiency of the triage. Incredibly, when I entered the hospital at 10.30 pm, the emergency department and the waiting room were packed, but the efficiency, compassion and professionalism of the staff were extraordinary. The patience of the patients waiting to be attended to was also extraordinary. The stress placed on emergency departments is extraordinary, and that also needs to be sorted, but, obviously, the emphasis of our motion is on the Ambulance Service.

I thank the Member for his intervention. I know that, at the outset, it appears shocking that we would propose putting more pressure on our already overworked emergency department staff. I get that, and I will get to it. That is why the SDLP undertook a fact-finding visit to the London Ambulance Service and to Guy's Hospital and St Thomas' Hospital in London to see the model in practice, and it was startling.

When the model was proposed, the London Ambulance Service heard similar concerns and, indeed, criticism, including rather toxic press coverage. The result, however, has been that category 2 response times have been reduced by 50% right across the London network. At Guy's and St Thomas' NHS Foundation Trust, we saw the model in action, from a patient being brought into the ED and triaged to then starting on their pathway within minutes.

What makes it work? Two things: process and culture. The process involves not only the W45 policy, because also enshrined in NHS England policy is clear guidance that, as soon as an ambulance arrives at a hospital — once it goes through the gate — the patient becomes the hospital's responsibility. The culture is one of wanting to make things work. Staff explained that, when the policy was introduced, they consciously decided that they would make it work. There was no other option, and it does work.

What is the process here? What is the culture here? The process here requires some work. The permanent secretary wrote to all trusts in 2020, stating that, from the moment that an ambulance arrives at the emergency department, patient care is the hospital's responsibility. That guidance could be tightened to reflect the fact that, from the moment an ambulance arrives at the hospital, the patient is the hospital's responsibility. In addition, staff capacity needs to be enhanced, hence the reason that we propose a minimum investment of £4·3 million to provide 24-hour band 5 nursing support at our emergency departments and to provide band 7 nursing practitioners to help enhance patient flow. Those processes seem to be relatively easy and cost-effective ones, and they can be introduced and implemented quickly.

Our biggest challenge is the culture here. Right across the North, people are afraid and exhausted. They are afraid of needing to be brought to a hospital or of needing to phone an ambulance. They are exhausted from hearing the endless stories of healthcare falling apart, of political fallouts and of staff having to take highly risky decisions. The public have been conditioned to think that this is the best that it is ever going to be. That is on all of us: on every MLA, every Minister and every media outlet. The truth is that it should not be this way and that it does not need to be this way.

We can do better. We can deliver a healthcare system that works for staff and patients. We know that the entire system needs to be changed, but we must start somewhere, Health Minister.

Thank you, Mark.

I beg to move amendment No 1:

Leave out all after "emergency response times," and insert: "and front-line staff; calls on the Minister of Health, with the support of Executive colleagues, to urgently pursue additional care capacity in the community to tackle the bottleneck created by delayed discharge from hospital and improve patient flow across the health system; and further calls on the Minister to improve processes to reduce ambulance handover delays by exploring the potential introduction of the W45 policy used by the London Ambulance Service, providing access to same-day emergency care for patients not requiring admission, improving coordination between all health and social care trusts in relation to emergency care and delivering on commitments to increase medical capacity and enact a 10-year workforce plan for the Northern Ireland Ambulance Service."

Alan, you have 10 minutes in which to propose amendment No 1 and five minutes in which to make a winding-up speech.

Thank you, Madam Principal Deputy Speaker. I thank the mover of the motion.

I begin by saying something that none of us in the House should ever tire of hearing, and it is that, day after day and week after week, dedicated paramedics, ambulance crews and all other front-line healthcare workers go well over and above their role in order to save lives and to provide comfort in people's moments of crisis.

Let us be honest, however: their ability to do so is being increasingly and dangerously compromised. The Northern Ireland Audit Office's report, which was published this month, made clear the interconnection between ambulance handovers and pressures in the health service over hospital bed space and over delays in discharging patients. Ambulance waiting times are one symptom of the challenges that the health service faces. Without good patient flow through the hospital system, more patients cannot be admitted to EDs, while sick patients in ambulances cannot get into hospitals because well patients cannot leave. Unless the issue of delayed discharge is resolved, the Ambulance Service will only ever be operating at a fraction of its real capacity.

I am on record saying in the Chamber that, when you begin to fix the wider social care system, you begin to fix the health system in the Province. The number-one reason for delayed complex discharges is that no domiciliary care packages are available. That is why my party added that to our amendment. The report laid bare the state of the health service for that sector. At a time when it is being reported that money will be the cure for some of our ills, it is also being reported that £50 million has been lost through Ambulance Service inefficiency since 2019. It gets worse with the high reliance on private ambulances. Just 20 private ambulances were required in 2019, rising to 1,100 in 2023-24 at a cost of £3·6 million, yet handover delays continue to increase. Significant costs are also cited for ambulance staff overtime, which has been running up to £37·8 million since 2019. Those are just some of the negatives.

How can that be fixed? The report recommends fixing patient flow. It also recommends implementing the 46 recommendations in the 'Getting It Right First Time' (GIRFT) report and to use the best practice that is in place in other parts of the UK. The report also makes 11 individual recommendations, calling for trusts to work together, better regulation of the private ambulance sector and well-functioning handover zones at each of the major EDs. The report painted a bleak picture of all nine hospitals having seen their handover performance fall between 2019 and 2024. It points to a Province that is in a crisis of patient safety and resource management. The backlog at our hospitals means that ambulance crews are stuck waiting and unable to respond to new emergencies. At the end of January, the Minister advised us that there is active recruitment for over 1,000 nursing vacancies. We must also ensure that there is staff retention and recruitment in the Ambulance Service so that vital skills there are not lost.

From January to August last year, there were no Saturday nights when the Province had a full rota of emergency ambulance crews. The Northern Ireland Ambulance Service aims to have 52 crews out on a typical Saturday. On three occasions, just 36 were in place. The impact is cascading and far-reaching. Emergency response times are compromised, hospital capacity is choked and healthcare staff are overwhelmed. Waiting on an ambulance is a horrible experience. I have been there twice in as many years, waiting on one for my father, who had suddenly become ill. On both occasions, his wait was relatively short in the grand scheme of things, but how stressful must it be to have to wait hours on an ambulance for a loved one when time is of the essence? Bundling very ill people into taxis and the back seats of cars should never be the norm. How can we ever forget the story from December 2024 of a popular County Antrim man who died when his wife was forced to transport him to hospital in their car due to there being no ambulance available? Our hearts go out to that family and the many others who are in the same position.

My party is happy to explore the introduction of the W45 policy, which the London Ambulance Service has implemented to reduce delays and enhance patient care. The evidence points to the W45 policy being a targeted, efficient approach that aims to significantly reduce ambulance handover delays, in that it requires that no ambulance crew be kept waiting at a hospital for more than 45 minutes. If that threshold is breached, the patient's care is formally transferred to the hospital and the ambulance crew is released to respond to new emergencies. That policy is supposed to prioritise patient flow, which is something that we have all been calling for, and to ensure that ambulance crews are not held hostage due to bottlenecks in hospitals. It also creates accountability in the healthcare system by making it clear that patients must be accepted into hospital in a timely manner. Hospitals can no longer be car parks for ambulances. Implementing the W45 policy here in the Province would send the message that we want to see true efficiency, we value our front-line staff and, above all, we value the safety of our patients. However, we have to recognise that the policy alone is not enough. To do it right, it needs to be paired with an increase in medical capacity, improved patient flow systems, an increase in the number of available beds, standardisation of guidance across all health and social care trusts and implementation of the recommendations of the Audit Office report. The health service can no longer afford fragmented practices that vary from one trust to another. Consistency and acting like one trust are essential.

I beg to move amendment No 2:

Leave out all after "Executive colleagues," and insert: "to adopt a whole-system approach to tackling handover delays by increasing medical capacity, including the recruitment of additional healthcare professionals, investing in primary and community care to reduce hospital admissions, engage meaningfully with the Minister for Health in Dublin to explore opportunities for all-island and cross-border health services to improve efficiency and patient outcomes and to explore digital health initiatives with the potential to enhance coordination, streamline processes and improve patient flow across the healthcare system."

The Assembly should note that the amendments are mutually exclusive, so, for example, if amendment No 1 is made, the Question will not be put on amendment No 2. The proposer will have 10 minutes to propose amendment No 2 and five minutes in which to make a winding-up speech. All other Members will have five minutes. Linda, please open the debate on amendment No 2.

Go raibh maith agat, a Phríomh-Leas-Cheann Comhairle.

[Translation: Thank you, Madam Principal Deputy Speaker.]

We all know that ambulance waiting times across the North have worsened significantly. That, alongside the growing delays in ambulance handovers at emergency departments, paints a deeply concerning picture of how patient safety is at risk and the wider health system is being undermined. The recent report from the Audit Office laid that out clearly and highlighted not only the human cost to patients and their families but the serious pressure that is being placed on Ambulance Service staff and resources. We need to hear directly from the Health Minister on how he intends to respond. Recommendations have been made: we need to see their delivery.

I welcome the fact that health has been made a priority by the Executive and, I hope, the entire Assembly. We want to support the Health Minister and ensure that we have a better health service for all our people. Whilst I recognise the significant challenges facing the Minister, people across the North need to see meaningful action, especially in rural areas such as those in my constituency, which stretches from Clonoe to Swatragh. As a resident of Clonoe, I am in the very fortunate position of being 15 minutes up the motorway from Craigavon Area Hospital. However, there are many in Pomeroy, Kildress and Galbally who are much further away from their closest hospital and, therefore, their closest emergency department. Our people need to know that the crisis is being tackled, not just talked about.

We are well aware that ambulances are not a stand-alone service. They are a vital part of our entire health system, but they are not the answer to everything. When a handover stalls, it creates a domino effect, and we all have far too many examples of that. Ambulance availability drops, patients wait longer for help and staff are left stuck between hospital corridors and back-to-back shifts. That is not sustainable, and it is not fair on patients or staff. The problem is not unique to the North, but emergency department attendance here is notably higher than it is elsewhere. Some hospitals are clearly under more pressure than others. We need to understand why emergency department attendance is higher here. At the Health Committee, we have heard in evidence session after evidence session that many people who could and should be cared for in the community end up in our emergency departments. That is not where they should be. That is because of a failure to diagnose early enough and to have proper services in primary care and community care, and we need to seriously address both.

We need to see solutions that are locally tailored, particularly when you consider the added challenge of delivering timely emergency care in rural and dispersed communities such as those that I mentioned in my constituency. That must be recognised and reflected in how resources are allocated, how services are designed and how we, as an Executive, work together across the board to ensure that we deliver for rural communities. We need to look outwards in order to learn from best practice models elsewhere. I absolutely accept that, but we need to ensure that those are tailored for communities and people here. We need to look at things such as the Getting It Right First Time review of emergency medicine, but any strategy must be rooted in the realities of the North: our rurality, our infrastructure gaps and our stretched capacity across the board. The NHS in the North is broken.

The Minister must work across Departments and borders. There is real potential for deeper cooperation with the Minister for Health in Dublin to improve how we coordinate the emergency response in border areas and make efficient use of cross-border health infrastructure, not just in our emergency response but across the board.

As I have outlined, community care is vital, and we should not ignore that when we look at how we can work better together on a cross-border basis.

Those are not just political talking points; they are practical opportunities that could make a real difference to patient outcomes. A truly effective approach must span the entire health system, and that means strengthening primary and community care so that fewer people end up in hospital in the first place. It means ensuring timely discharges with care packages, where needed, so that people are not stuck in beds that they no longer need and, frankly, no longer want. They want to be at home with their family, where they can get better in the way that they want to.

The Member for Foyle, Mark Durkan, made the point that the Ambulance Service can be fixed in isolation without the flow through our hospitals being addressed. Having spoken with health professionals who work in our EDs, I do not believe that that is the way to address the issue. I have given the example before, but it is important to say it again.

I thank the Member for giving way. It is not fair or accurate to say that I said that it could be fixed in isolation without further fixes. Later in my speech, I alluded to the additional investment that would be made in band 5 and 7 nurses in emergency departments.

It is important to look at the flow through hospitals first. My reason for saying that is this, and I have given the example before: when I visited the ED in Craigavon, there were 68 people in beds in the emergency department, and there were 62 people upstairs who were medically fit for discharge but were unable to be discharged for a number of reasons. That is not an acceptable position. The lead clinician on the day said to me, "Please do not allow them to extend our EDs. That is not the answer, and we will not have a resolution". Whilst I accept the motion and ask Members to support our amendment, I say that we need to focus on the flow through hospitals. That means making sure that we have the right workforce in place — I support what the Member said — from paramedics and ED staff to home-care providers and community and primary care staff.

Our ambulance crews do incredible work under immense pressure. The delays that we see are no reflection on them: they are the result of a system that is at and beyond breaking point. However, when paramedics are left waiting for hours outside hospitals unable to respond to new emergencies, we all lose. They lose the chance to rest and recover on what are already demanding shifts.

We cannot lose sight of the fact that behind every statistic is a person — someone who is waiting in pain and distress, often with a distraught family — and healthcare workers who are doing their best under impossible conditions. We need a joined-up, system-wide approach that is not only reactive but proactive. As I have said before — we need to say it again — all five heads of our trusts have said that we need a focus on social care. We will not fix the problem in our emergency departments and the Ambulance Service — more people dying who should not die and families being left with trauma — if we do not fix the flow-through and fix our social care system.

I support the motion. I ask Members to support our amendment. I ask again that our social care system be fixed to ensure that we do not end up with a crisis in emergency care and in order that our ambulance staff can get out to those who absolutely need them.

It is important to highlight some information that I was given by the British Heart Foundation. I will not go through all the statistics, but one vital one is that the number of people who self-present at a hospital has increased from 5% to 12% in the last five years. That is concerning, and it means that, potentially, people have worse outcomes. Everything that we have discussed in Committee and with the Minister in the Chamber is about what we will do to ensure better outcomes. We can ensure better outcomes only by having a whole-system approach. Therefore, I ask Members to support our amendment.

I thank the SDLP for tabling the motion. It is timely, following the publication of the recent Audit Office report on ambulance handover times, and the issue affects everyone in the Chamber. We will support both amendments.

In January, the Alliance Party brought a motion on the issue to the Chamber for debate. It called on the Minister to:

"bring forward proposals to improve the availability and capacity of ambulance services, including the development of an Ambulance Service workforce plan". — [Official Report (Hansard), 13 January 2025, page 53, col 1].

I have personal experience of working in busy A&E departments and wards. I know the impact that wards that are completely full of patients, corridor beds put wherever they can be and A&E departments in which every square inch of floor space is being used can have on ambulance handovers. The staff cannot safely accept a patient until there is room for them to do so. Sometimes, there can be up to two wards' worth of patients being cared for in our A&E departments. That incurs a risk of harm to the patient, who is sick enough to have needed an ambulance to take them to hospital for treatment, and it impacts on Ambulance Service staff, who can sometimes spend their whole shift outside a hospital with a patient in the back of the ambulance, and on hospital staff, who work under extreme pressure for extended periods. That is incredibly stressful and can leave staff with the impression that, despite working hard, they cannot give their patients the care that they deserve. That moral injury is hard to accept.

The report is stark and confirms what we have been hearing for a long time. It states that, from 2023 to 2024, there were 36,000 incidents in which patients experienced some harm as a result of handover delays, and that, in about 3,800 cases, patients were potentially exposed to severe harm. Ambulance response times are suffering, and a concerning 25% of ambulance capacity is lost due to those delays. We have all heard from our constituents of cases of overlong stays and ambulances waiting outside hospitals, sometimes with the engine on to keep patients warm. I have heard of many such cases, including a 29-hour wait that included a shift change for the paramedic team outside the hospital. Paramedics and ambulance staff want to be on the road answering calls, not outside full hospitals.

We know that long waits and overcrowding in A&E departments are unsafe and can lengthen the time that patients need to be in hospital. They are even associated with increased mortality. Emergency medical consultant and chair of the Royal College of Emergency Medicine (RCEM), Dr Russell McLaughlin, reviewed the situation of pressures in A&E in 2022 and concluded:

"there is strong evidence that indicates that in 2022, 1,434 people died as a result of delays in Northern Ireland’s emergency departments".

Overcrowding causes excess deaths. The most recent winter was the worst yet for A&E waits, and I can only imagine what the number is now.

While there are many contributing factors, including workflow, waiting lists and the impact that funding of GP services has, the root cause lies in the hospital system, as Linda outlined. It is about patient flow. Patients who are medically fit for discharge cannot be discharged because of a lack of the social care packages required to meet their needs in the community. That is a bottleneck in the system. We recognise the incredible work being done by our Health and Social Care (HSC) staff — in this case, particularly by the Northern Ireland Ambulance Service (NIAS) staff — who continue to work tirelessly under extreme pressures. We must recognise, however, that the situation is not sustainable. We all know that the budget is tight and that the Minister has a difficult job, but it is unacceptable that patients are suffering harm. We need to improve flow, and that means providing alternative care pathways such as minor injuries units; see-and-treat protocols for Northern Ireland Ambulance Service staff whereby patients are assessed by paramedics as not requiring attendance at emergency departments and can instead be referred to specialist clinical teams or to their GPs; and paramedics making informed decisions about patients who are nearing the end of their life and wish to remain at home.

Another example, visited by the Committee last year, is the joint mental health pilot scheme, in which mental health practitioners work with the Northern Ireland Ambulance Service in the control room. That scheme de-escalated 40% of mental health calls over the phone, to the point where those calls did not require an ambulance response. I am keen to hear from the Minister about the long-term plans for that successful service. Another scheme that reduces inappropriate admissions is the Hospital at Home service in the Southern Trust, through which unscheduled care is delivered to an increasing number of older residents who live with more and more complex needs directly in their homes, avoiding unnecessary admissions, promoting quality of life and freeing up space in our A&E departments.

There is an urgent need to progress health service reform in line with the principles outlined in the 2016 Bengoa report. We could have been nine years into a 10-year reform programme had we not had two Assembly shutdowns since that report. That alone is more than enough reason to reform our political institutions to prevent one party from having a veto and collapsing the institutions.

Time is up, Danny.

No problem.

We cannot address problems, if we are not here.

I appreciate that. Thank you very much.

I suspect that every Member of the House has the same concerns regarding the pressures and delays that the Northern Ireland Ambulance Service faces. Those worries will have been heightened after the recent publication of the Audit Office report. There is no doubt that the current delays are untenable and, ultimately, pose real and significant risks. Whether it is a heart attack, a stroke or a car accident, the sooner an ambulance crew arrives at the scene, the higher the chances are of survival and recovery. I have nothing but praise for how our paramedics deal with the many daily challenges that they face.

We need to ensure that as many crews and vehicles as possible are available to respond. However, we also need to remember that the pressures that our Ambulance Service faces are not unique to Northern Ireland. Over recent months, several ambulance services across Great Britain have declared critical or urgent incidents because of the level of demand. Nevertheless, even with the undoubted strains on the system, we need to make sure that we make the best use of our crews. Therefore, I welcome any and all measures to improve system efficiency and better utilisation of resources.

We also need to be honest and recognise that there is no single or easy solution. If there were, it would have been implemented long ago. I very much welcome the Minister's focus on tackling the broader pressures on urgent and emergency care, particularly in advance of next winter. I hope that, in the meantime, in the weeks and months ahead, the Assembly will approach the issue of necessary investment in our health service with a fair and open mind. The issue of patient flow and timely discharge is at the heart of the problem. While it is essential that the system works as efficiently as possible, ultimately, greater investment in community care will be one of the long-term solutions. That will mean the Assembly doing what it has often said it would, which is to prioritise our health service.

While the motion's intent is to find a solution, it misses the point. That is why Sinn Féin has tabled its amendment. The motion calls for the setting of a 45-minute limit for ambulances to wait before leaving patients in hospital corridors, but where will those patients go? They will go into already overcrowded and understaffed emergency departments that are barely coping as it is. What the British Government have tried to do with the W45 initiative is not about improving patient care but about shifting blame. The British Government know that they have failed to invest in hospital capacity, to recruit enough doctors and nurses and to ensure that emergency services can function properly. Instead of tackling the root of the problem, they are putting vulnerable patients at risk, abandoning them in corridors where staff are already stretched to breaking point.

Will the Member give way?

I will just make a bit of progress.

That is the copy-and-paste initiative that the SDLP wants us to adopt. What happens when a heart attack patient is left waiting on a trolley because there is no one available to treat them? What happens to an elderly person with pneumonia who is left shivering in a cold hallway with no proper medical supervision? That is not efficiency; that is negligence. Worst of all, it is a political trick to shift responsibility away from those in power and on to the backs of our heroic NHS workers, who are already being asked to do the impossible.

We do not need quick fixes, nor do we need bureaucratic targets. We need real investment in our healthcare system. We need more beds, more staff and a Government who care about the lives of their people. If the British Government want to cut waiting times, they should start by fixing and investing in our NHS, not by abandoning patients in corridors like luggage in a lost-and-found.

I support both amendments and thank the Opposition for tabling the motion. It is timely because, unfortunately, the problem has not been fixed, particularly since the Christmas period, when my party tabled a motion on ambulance waiting times. Nothing has changed since then, so it is important that, as we move from spring and summer into the winter months, we have the massive change that is needed. The Audit Office report illustrated how dire the situation is, so it is even more incumbent on us to shine a light on the fact that 3,800 patients were potentially subjected to severe harm in the past year.

As many in the Chamber have referenced, those people are not just a figure; they are individuals with individual circumstances, and we should focus on them.

As regards the specific proposal on the W45 policy, I appreciate and understand where the Opposition are coming from. Whilst I do not necessarily oppose outright the implementation of such a policy, it is important to think about how it would work in practice. When my colleagues and I have been on tours of hospitals, particularly emergency departments, we have seen that the clinicians are very concerned about the fact that they cannot stack up more patients in corridors, because there is, physically, no space for people there. There are no rooms. Some hospitals do not have bereavement rooms, because they are using them for patients. We do not have any space for them.

Northern Ireland Ambulance Service has specific ideas on how to manage that. Some of those policies relate to using St John Ambulance paramedics on rotation and on a voluntary basis. The care of those who are, perhaps, being put into the corridors or wherever space has been found for them could be overseen by the ambulance and paramedicine team rather than the clinicians in the hospital. However, that cannot be done in isolation. It has to be done in conjunction with the emergency medicine staff team at all hospitals that have an emergency department. Following the debate on the motion that we tabled in January, I asked the Minister whether he had engaged with the Northern Ireland Ambulance Service as to whether that could be implemented. I look forward to hearing whether that was explored at all.

Social care is really important, and many Members have focused on it. I want to take a moment to touch on something different. Last week, at the Health Committee, palliative care and the role of the Ambulance Service came up. We have a Northern Ireland-wide Ambulance Service that generally has a regional policy around taking patients, but there is no regional policy when it comes to palliative care. People who should not be in hospital are taken to hospitals, despite it being known that they need hospice care. That requires a significant, isolated focus from the Department. What is happening with those particular patients with regard to social care? We also need an update on the work of the social care collaborative forum. I do not doubt that the Minister will reference that in his winding-up speech, but we need to know where we are with policy decisions by the social care collaborative forum. Not everything requires money. Some things require policy direction and policy decisions, so it is important that we hear about any movement on that.

I support both amendments. Either one or both of them represent something that is more like our position at the moment than the original motion does. However, as I said, it is not a case of outright opposition but of finding out how the proposals work in practice.

My remarks on ambulance handovers will focus on the Northern Trust, particularly on events on 21 December 2024. On that evening, 14 ambulances were servicing the largest trust, being dispatched to locations in Coleraine, Ballymena, Antrim, Magherafelt, Larne, Carrickfergus and Whiteabbey. On that day, 120 working hours were lost because ambulances were sitting outside EDs. That accounted for a quarter of the entire service capacity for that trust.

Allow me to cite the impact of delays on the Darragh family in my constituency. At 7.05 pm, Willy, who had previous heart problems, took chest pains whilst in his house just outside Cullybackey. His wife, Caroline, rang 999 and was told that no ambulances were available and that she needed to take him to the Antrim ED, which was approximately 25 minutes away. Willy was assigned as a category 2 call, as he was suspected of having a heart attack and was breathing. Whilst travelling to Antrim, Willy's condition deteriorated, and he had a cardiac arrest. Caroline had to find somewhere to pull over and to get help from a passing driver, as she could not get her husband out of the car on her own to start CPR. Caroline called 999 again at 7.35 pm, and an ambulance arrived at 7.40 pm, because that call was classed as category 1, as Willy was now not breathing. Sadly, Willy passed away, lying in a wet lay-by 10 minutes from the hospital. Ms Ennis asked what happens if a patient takes a heart attack on a trolley in a hospital, but what happens to a patient who is in a car and takes a heart attack on his way to hospital?

Last Wednesday night, I attended a meeting with the Darragh family to seek answers from the Ambulance Service. We were told that there is a target time for category 1 calls — eight minutes — but that the average response time on that day was 14 minutes and 43 seconds. A category 2 call has a target time of 18 minutes but that the average response time on that day was 60 minutes. Crucially for that family, we were also told that a category 2 call is not assigned to a crew that is in the final hour of its shift. Members, that is as a result of the action short of strike that Unite and NIPSA are taking over the waiting times outside EDs that is causing staff not to finish within a reasonable time at the end of their shift.

What were the 14 operational ambulances doing at 7.05 pm? Coleraine had two ambulances. One of them was sitting outside Antrim ED for five hours and 30 minutes, while the other was parked up in the station and due to be manned by only one person from 4.00 pm. It could respond to category 1 calls only. Ballymena had four ambulances. Two were sitting outside the ED for 50 minutes and four hours and 26 minutes respectively. One was at the scene of a call, while the fourth ambulance was sitting in the station. Antrim had two ambulances. Both were sitting outside the ED for six hours and 15 minutes and five hours and 15 minutes respectively. Magherafelt had two ambulances, both of which were sitting in the dispatch area. Larne had one ambulance, which was also parked in the dispatch area. Carrickfergus had two ambulances. One was at the scene of a call, while the other was parked up in the dispatch area. Whiteabbey had one ambulance, which was outside the ED for six hours and four minutes.

We have already been told that 120 hours were lost in that single day owing to turnaround times at EDs, but how many of us realised that, in the final hour of a shift, because of the current union action, no ambulances are assigned? How many hours are being lost each day as a result of strike action by the unions? When pressed specifically on whether the ambulance crew that was sitting in the Ballymena dispatch area at the time of the first call were members of a union, the Ambulance Service could not tell us, as it does not know and does not ask its staff. To make matters worse, any crews in an ambulance dispatch area during the final hour of their shift are not even made aware that a category 2 call has come in. The current service is therefore not fit for purpose, and people are dying as a result. The system has serious issues, and one of them is the unions' approach, which needs to change and change today.

Thank you, Timothy. I call the Minister of Health to respond to the debate. Minister, you have up to 15 minutes.

Thank you, Madam Principal Deputy Speaker. I must say that I am heartened to note the near-universal acceptance of the fact that the issue is not just about the Ambulance Service but about a whole-system response to the pressures faced and about the flow through our hospitals. If I have time, I hope to return to some of the comments that the Member who moved the motion and the Members who moved the two amendments made.

When we were here in January to discuss ambulance waiting times, I commended the hard-working and dedicated staff of the Northern Ireland Ambulance Service, and I make no apology for my doing so again. The staff — those working on the front line and those working in support of them— are, like all staff across Health and Social Care, the lifeblood of the system. They have worked too hard for too long in a system that does not deliver the type of care that their commitment and resolve deserve. I suggest that, as political representatives, we owe it to them to do better and to relieve them of that moral distress. That is why I welcome the Northern Ireland Audit Office report on ambulance handovers. As we know, it was published on 11 March, and it underlines the seriousness and scale of the pressures facing HSC services. Alongside key officials, I will carefully consider the report's recommendations. I have already noted the recognition of the fact that the root cause of delayed ambulance handovers is wider severe HSC whole-system pressure and hospital discharge delays. Patients are waiting for far too long in ambulances outside our EDs, and that is a direct consequence of poor flow in our hospitals and social care constraints, as Members noted. I also recognise the risk of harm to patients who are delayed at handover on arrival at EDs and the impact of that delay on NIAS's capacity to respond to the next emergency call in the community.

Reducing ambulance handover delays has been and remains one of my key areas of focus, but it is important to reiterate that, while pressures manifest at the emergency department, flow through the system and getting people medically fit for discharge into the community remain significant issues. It has been widely referenced in recent weeks and months that hospital flow is hampered by delays in discharging individuals who are deemed to be medically fit. My Department is taking a number of steps to minimise the challenges in coordinating those delays. To support the adult social care reform programme, we have established a social care collaborative forum. That provides vision and strategic advice and guidance on the delivery of social care. The forum will take forward agreed action across a number of work streams to support improvement and transformation in adult social care.

That work will include a comprehensive review of the regional care home contract and specification, with a revised contract expected to be in place by June of this year. It also means taking forward my commitment to end minimum wage jobs in social care, ensuring that all staff are paid at least the real living wage. The work involves the extension of the early review team pilot model, which reviews needs and ultimately allows additional capacity to be recycled into the system. It also involves digital interventions, such as CareLineLive and the care home availability app, using technology to help ease pressures.

The work involves direct payments and emergency direct payments to enable packages of care to be provided through the employment of a personal assistant. That will improve flow and discharge transitions. The work also involves the extension of the trusted adviser model to a seven-day model across all hospital sites, promoting safe and timely discharges from hospitals.

I thank the Minister for giving way. I am sure that, if the Minister was not able to watch the Health Committee meeting on Thursday, officials will have listened to what was said. Will the Minister commit to meeting those who are involved in palliative care provision in order to ensure that people who receive palliative care, as was mentioned earlier, do not unnecessarily end up in hospital when there are services that could look after them much better in their home?

I thank the Member for her comment. I have absolutely no difficulty in agreeing to that meeting.

Work to address the wider system pressures has to be prioritised. That does not mean that NIAS has been sitting idle, waiting for issues to be resolved elsewhere. Flow and discharge issues are key aggravating factors, but there is much that NIAS can do and, indeed, is already doing. My Department is actively engaged in developing a 10-year workforce plan with NIAS to further develop capacity, capability and the utilisation of the right skills mix. That will allow the Ambulance Service to better meet the needs of our communities by developing the enhanced paramedic role, innovative care pathways and strategic collaborations across the health system.

In 2023-24, NIAS established a new integrated clinical hub, which incorporates senior clinicians. NIAS subsequently changed clinical practices in the integrated clinical hub team to support the management of patients in the community where possible, thus reducing conveyances to EDs while ensuring that patient safety is maintained during extended response times. The integrated clinical hub's highly skilled senior clinicians can identify alternative pathways for patients through the increased use of Hear and Treat and See and Treat pathways, which can be managed through an urgent care liaison desk. That enhanced clinical team provides increasing numbers of patients with advice in order to reduce conveyances to our emergency departments. It also provides advice to support crews, enabling referrals to a range of other pathways, including Hospital at Home and the falls, epilepsy and diabetes pathways.

Learning from the Scottish Ambulance Service, which has integrated mental health professionals into its control room, the integrated clinical hub contains mental health professionals from the South Eastern Health and Social Care Trust who work at weekends to provide expertise that supports patients in accessing alternative pathways for mental health issues. The service currently operates Friday to Sunday from 6.00 pm to 2.00 am. Early data from NIAS shows a 40% reduction in conveyance to emergency departments among patients who are experiencing mental health crises. That has led to much-improved patient experiences. Western Health and Social Care Trust staff are finalising training to work with the NIAS control room, which will enhance their service even further. Funding for the scheme is being provided until the end of March 2026. This year, an external evaluation will be carried out by the Public Health Agency to inform plans for further expansion of the service.

I have previously rehearsed my concerns about the pressure on NIAS staff, who must deal with the welfare and distress of their patients and their carers on a daily basis. Those concerns remain with me. Nevertheless, NIAS is making great strides in supporting staff back to work, improving their long-term absence rates and increasing the available workforce. It is right that the improved absence rate was acknowledged in the Audit Office report, and I hope to see that trend continue.

I remain determined to find better ways for the system to work to tackle the complex issues that we face. That is why I initiated a series of winter planning workshops aimed at identifying new, innovative solutions to the system-flow issues that we face collectively. I attended the first of those events on 4 March and was encouraged by the engagement and enthusiasm from HSC leaders from across the system. The workshop was attended by a wide range of stakeholders from across HSC, including the royal colleges, clinicians and other front-line services. Our system leaders are all involved. There will be three more workshops over the coming months, with the final workshop in June. That will inform a sharper, more focused plan for next year. I expect to see better outcomes in advance of winter, including improvements to ambulance handover times.

Improving those times and response times in the community is a key focus, and, as part of work to explore new methods of working, my officials and the trusts have engaged with the London Ambulance Service to understand better its scheme for releasing ambulances no later than 45 minutes after arrival. We know that that scheme has resulted in significant improvements in handover times across the London area. My officials, alongside clinicians and management from trusts, visited the King George Hospital in London with the London Ambulance Service on 10 March to discuss the adoption of a robust protocol for the escalation of ambulance handovers that exceed the 15-minute target. Those discussions continue at pace with trusts on how the learning can be used to improve handover at our hospitals.

One of the key messages from the visit was that, for the protocol to work, there is a need for a whole-system approach and that emergency departments and the Ambulance Service, on their own, cannot bring about the changes without the support of the rest of the system. It will require leadership, ownership and cultural change, which are at the heart of the planning workshops that I have been facilitating with leaders across HSC. I am pleased that everybody seems to be up for the challenge.

More broadly, my vision remains to keep emergency departments for emergency cases. That is why I have continued to implement the recommendations set out in the urgent and emergency care review. Like elsewhere in the United Kingdom, the pressures across our system are immense, meaning that the long-term vision that I have articulated — improving services and the service that you experience by making it easier to access the most appropriate services at the right time — remains essential.

We published the urgent and emergency care review in 2022 with strategic priorities, including the roll-out of urgent care centres across all trusts, greater use of rapid-access clinics and ambulatory care, the introduction of local and, ultimately, regional Phone First services and improving intermediate care to treat patients in their home as an alternative to hospital admission. An additional recommendation from the review was the initiation of the Getting It Right First Time — GIRFT — review of emergency medicine. Following the completion of that report, commissioned by Robin Swann, my Department considered its recommendations and produced an improvement plan. My Department has also worked with trusts to address specific issues highlighted in that report. I know that there is interest among some in the House in having sight of the GIRFT report on emergency medicine and the associated implementation plan. That is why I will publish both on my Department's website tomorrow. I am pleased to be able to assure Members that the GIRFT implementation plan is on track for delivery.

Since the completion of that review, the GIRFT team has continued to work with my officials and the trusts on their improvement plans and played a key role in the development of the trusts' local winter plans for 2024-25. The GIRFT team has also been involved as external advisers on work to improve and standardise same-day emergency care (SDEC) services, which were commissioned and expanded through the No More Silos programme. I welcome the ongoing support and challenge provided by the team.

Although some progress has been made in delivering changes to services to meet the needs of patients and service users, I am afraid that there is no quick fix, and addressing the current situation will require sustained, long-term effort, additional recurrent funding and support across the political spectrum. The Audit Office report was clear on the need for urgent action — I hear that call — but I stress yet again that we will be limited in the impact that we can make without additional budgetary support, and that impact will be much less again when I am being asked to make additional baseline reductions. I have accepted the challenge to transform the system, as outlined in my recently consulted on 'Hospitals — Creating a Network for Better Outcomes' document, but the long-term, meaningful change that is required to see results must have cross-party support in the Executive, and that must be backed by adequate resources.

Mr Durkan moved the motion. He made just one comment that I take issue with. He talked about the workforce making "highly risky decisions": I do not recognise that phrase. On my visits to the EDs post Christmas, many of the workforce talked about having to make decisions that were the "least worst option", but I gently suggest that that is substantially different from making "highly risky decisions".

Mr Robinson moved amendment No 1. He clearly gets it: a whole-system solution is required. It is about the flow, and I absolutely agree with him that, while we have five separate geographic health trusts, we need standardised regional protocols and to have the five trusts operating as though they were one.

Mrs Dillon talked about looking elsewhere. When I was in Washington earlier this month, I visited a brand new $800-million facility, an enormous emergency department in which corridor care was a thing. Every day, corridors filled with patients to the extent that they had specific corridor care teams. In the other ED that I visited, they said that their ambulances queued up daily to hand over. Therefore, it is not just a problem in Northern Ireland.

The motion calls for money. Sinn Féin's amendment calls for investment. My final message is a simple one. This is planet earth calling the Northern Ireland Assembly. There is a £400 million gap in the projected budget for the Health Department. We cannot commission new services.

I call Órlaithí Flynn to make a winding-up speech on amendment No 2. Órlaithí, you have five minutes.

Go raibh maith agat.

[Translation: Thank you.]

I thank my colleague Linda Dillon for opening the debate on the amendment. She set out clearly the scale of the challenges that we face and the type of response needed. The points raised reflect what many of us hear time and again in our constituencies about ambulance delays that put lives at risk in a system that is under unrelenting pressure and with staff — for me, this is the crucial point — who are already doing their best in really difficult circumstances.

I completely understand that the motion is extremely well intended. Given the financial position that the Health Minister and the Executive are in, it is always important to look and learn from other models of best practice. We can then look to introduce any new model within whatever financial options we have. Mark Durkan touched on the point. If we see a model that is working, that is proven to work and that we want to introduce, it comes back to this issue: how can we fully introduce it to do what it is designed to do, if the staff are the same as those whom we have always had? The staff are already working in really difficult circumstances, and, if we are potentially going to bring in this new model, we will have the same number of staff and the same number of blockages. Obviously, you mentioned —.

Will the Member give way?

Yes.

I am sure that Sinn Féin Members will not spend a long time reading an SDLP document, but it includes additional staff. That is the purpose of it. The premise is that the model cannot be introduced unless there are extra staff to deal with it, or you could use the cohorting method, which is a well-recognised method in the rest of the UK. This is not mentioned without consideration of staff. It is not the same number of staff. You could not do that.

The Member has an extra minute.

Thanks very much for clarifying that. That is important.

On the basis that we get the additional staff and then have the new model, it goes back to the point that Linda made. When we had that session at the Health Committee last year with the five chief executives of the trusts, they were banging on about the point, "Social care, social care, social care". It is then a two-pronged approach. If we can deal with the blockage of social care in the hospitals and if we can get additional staff in the EDs, in theory, this model would work really well, but it is about how you get to that point.

The other wee issue that I want to raise is the staff themselves. It is interesting that Linda mentioned — obviously, it is just one example — the consultant whom she spoke with in the emergency department in Craigavon, where there seemed to be a bit of fear. That consultant said, "Listen, whatever you do, please do not put more pressure on EDs. Please do not put more patients into EDs". It is about how you get around all that. I was really glad to hear the Minister outline some of the work that he has been carrying out around the winter pressures and the workshops that are taking place. We will all look forward to the conclusion of the June workshop, if that is the final workshop, to hear what practical solutions he will be able, hopefully, to deliver coming out of that.

Will the Member give way?

Yes.

Thank you. Your colleague mentioned that, on one of her visits to an A&E department, 60-odd patients were waiting for a decision to admit and 60-odd were medically fit. Sixty patients in an A&E department who should be on a ward is three wards' worth of patients in A&E. The A&E staff have to deliver that care within the confined space of A&E. Does the Member agree that there is simply no space to have three wards' worth of patients in a functioning A&E department?

I totally agree. Think about that in practical terms. I do not need to preach to you, because you have worked in the health sector. Even in that circumstance where there are wards' worth of people in the emergency department, on top of that, you get all the walk-ins and all the additional ambulances, so you get a continuous stream of emergencies coming in on top of what the staff are trying to deal with.

I will bring my remarks to a close. Hopefully, something positive can come out of the June workshop, and we look forward to that. Hospital at Home in Daisy Hill in the Southern Trust, Phone First, the integrated clinical hub and the 40% reduction that Danny mentioned are all really brilliant things that are happening. It really is good work that is happening, but we need to find ways to do more of that. Again, I totally get that the motion is clearly well intentioned in respect of how we make this better. We all want to make it better, so, hopefully, in the next couple of months, after today's motion and after the workshops, we can find a way to bring forward workable, practical solutions that will make a change.

I call Diane Dodds to make a winding-up speech on amendment No 1. I advise you, Diane, that you have five minutes.

Thank you, Madam Principal Deputy Speaker.

First of all, I will say, "Thank you", because the tone of the debate has been helpful, and there is consensus across the House on some of the themes. We are happy to support the motion, but we thought that we should maybe recognise that, although this is a potential solution, there are other issues that need to be addressed. They are ours to address, and we need to get on with doing that.

I thank my colleague Alan Robinson for proposing the amendment and highlighting the difficulties in the health system. At the end of the debate, I put it on record once again that the Audit Office report said that delayed ambulance handovers cost us £50 million over five years, including £13·2 million in the most recent year. They caused a 25% reduction in operational capacity and placed close to 4,000 patients at risk of serious harm. They also contributed £37·8 million to an overtime bill for Northern Ireland Ambulance Service staff. At a time when the health service is under pressure in all directions, those are issues that we cannot ignore. During December and the first half of January, we had ambulance handover delays of 16 hours and nine minutes at the Mater Hospital; 19 hours at Causeway Hospital; 23 hours and 36 minutes at the Ulster Hospital; and 25 hours and 15 minutes at Antrim Area Hospital. Those figures in the system really are unacceptable.

Debates such as this are important, but it is also important that we have a plan of action to understand exactly what we can do to make things better. Sadly, harm comes to patients. Mr Gaston demonstrated that very well when he talked about the shocking and untimely death of his constituent. I do not think that any one of us can feel anything but shame about the system over which we preside. I know that you, Minister, feel the same. I hope that we will be able to make improvements, so that our community across Northern Ireland is not left at risk of those things happening again.

We have discussed across the House many of the issues that are really important when it comes to trying to fix the system, but the one that we keep coming back to is that of the flow of patients through our hospitals. We are in the almost absurd — I use that word advisedly — position in Northern Ireland in which we have sick patients who cannot get into hospital because we have well patients who cannot leave hospital. I do not think that anybody can stand over that kind of situation. No matter what we do, it will come down to fixing the flow of patients through hospitals, including getting them into hospital, onto the ward for treatment and discharged in a timely manner. Any winter health plan to improve the situation will have to demonstrate that that is at its core. That is what will fix ambulance handovers and the harm that is being done to patients and patient safety.

I also refer in passing to our session last week — this was brought up by Nuala McAllister — on the issue of palliative care. There are people whom ambulance crews clearly have to take to hospital because there is nowhere else for them to go. At Christmas, at the Southern Area Hospice Services ceremony of remembrance, a lady spoke to me about her sister-in-law, who died in an ED in Craigavon with, as she described it, not even a pillow —

Time is up.

— for her head.

Time is up.

Minister, I know that you are not —

Time is up.

— in favour of any of this, but I urge you to take urgent action.

Thank you. Much appreciated.

I call Colin McGrath to conclude and wind up the debate. You have 10 minutes, Colin.

Thank you very much, Principal Deputy Speaker. I am glad that we have had the opportunity to have this debate and that we have heard from all sides of the House on the issue. Perhaps the Health Minister expected me to raise it during Question Time last week, but we went down a different route, because it was better to give the issue a proper airing through a motion that would give us a full hour and a half to debate it. It is really important because, as Diane Dodds eloquently put it, sick people are looking to get into hospital, but they cannot do so. We can all agree on that.

I and, I am sure, many Members were contacted by a number of organisations about today's debate. They highlighted the problem that people are getting sicker because they cannot get access to emergency care. Ultimately, people are dying because ambulances are not arriving for them in a timely manner and they cannot get access to treatment. I give a big shout-out to our paramedics. They, along with the whole network of staff throughout the Ambulance Service, work to the best of their ability and beyond it, but they are absolutely constrained. Those highly trained, highly skilled individuals in our community log on for work, get into the back of an ambulance, sit with one patient for eight hours and then come out and log off again. That does not utilise the skills that we have trained them to have or give them the opportunity to perform their life-saving techniques.

I recently visited the Northern Ireland Ambulance Service and got a good snapshot. There were screens showing us exactly what the situation was at any moment. When I was there, there were 21 ambulances sitting outside emergency departments and 22 people waiting for an ambulance. I am not thinking about working through all the solutions; it is not rocket science. Those who were waiting could not get an ambulance because the ambulances were sitting outside the hospitals. By asking a question for written answer, I found out that, in the past five years, 97,000 people's conditions deteriorated whilst they were waiting for an ambulance. In other words, their category was upgraded because their condition got more serious as they waited for an ambulance. One has only to think about the cost to our health service. We are bringing sicker people to hospitals because it is taking us so long to go and get them. Think of the money that could be saved. The Northern Ireland Audit Office did a wonderful job of putting lots of flesh on that bone and telling us exactly what the cost to the system is.

There were two amendments to our motion. From an Opposition perspective, they do, somewhat, speak to the situation that we see in our Executive. The Executive are our Government. Our Government are charged with coming up with solutions to the problems that we face and with the proper and effective delivery of public services. In this matter, however — a matter of life and death — it is about health outcomes and responding to urgent calls. We have one Executive party producing one view in an amendment and another party producing a different view in another amendment. Both amendments obfuscate the matter. In some respects, they offer a bit of grandma and apple pie to the situation and will not result in anything being changed.

I am a bit bewildered that the amendments were accepted, because our motion clearly asks for one thing and one thing only: it is about the Ambulance Service and the W45 policy. We said, "Let us deal with ambulance handovers. Let us smooth that process and get them back out on the road and into the communities".

I thank the Member for giving way. Your point, which is that you are asking for one thing and one thing only, takes away from what Mr Durkan said, which was that we are not asking for one thing and one thing only but are accepting that a whole-system approach is needed. You know this, Colin, because you are on the Health Committee with me: we cannot fix what is happening in our emergency departments if we do not fix the flow through our hospitals.

That speaks to some of the problem. It is possible to fix some of the problem and let that contribute to solving the overall problems that there are. If the other way to look at this is to say that you cannot fix any of it until you have a solution for the entire system, we will wait years and years before there will be any solution. Why will we wait years and years? We have been waiting for years and years. How many of us here were a lot younger — much younger than we are today — when we first heard that there were problems with people getting out of hospital, with domiciliary care and with patient flow? The issue is nothing new. It is not something that has arisen in the past year or two. It has been happening for more than a decade.

Where are the solutions? We are still waiting for them. What happens as a result of our still waiting, and why are we debating the Ambulance Service today? People are dying. It is not just me who is saying that. The Audit Office is saying it as well. People are dying because they cannot get an ambulance. Ninety-five-year-old grandmothers are lying in the street for six or seven hours waiting for an ambulance, yet our Executive say, "Let's fix the whole problem. It's about patient flow here, and we've to fill domiciliary care there, and we've to train staff there". I cannot remember the exact figure, but I think that it would take over £40 million to resolve the issues with domiciliary care. We are being told that we cannot get £2 million or £3 million for our suggested model, yet we are being told that the whole system should be fixed. One part alone of that solution will cost over £40 million.

That is why we have been driven to the point of talking about what has happened in London. Its Ambulance Service recognised that a problem existed, and it said that it could not wait any longer to resolve it. It has now managed to reduce its category 2 response times. It has cut them in half, from 50 minutes down to 25 minutes. Members may not know what category 2 cases are. Category 2 cases comprise acute strokes, heart attacks, significant breathing problems and serious trauma. The London Ambulance Service introduced the W45 policy and cut its category 2 response times in half. Our category 2 response times are worse than what London's were, and it managed to cut them in half by introducing its model. Is it a perfect model for the whole system? No. Do I want to see the whole system fixed? Yes. Is the whole system going to get fixed in the next three or four months? No. I was told in London that it took three weeks to introduce the system.

I thank the Member for giving way. A quotation on the wall in my ministerial office reads:

"If we wait for the moment when everything, absolutely everything is ready, we shall never begin."

Let me assure the Member that I am not waiting until everything is ready.

I welcome the Minister's saying that, because I know that he is not waiting. I know that he constantly says that he does not have the money to deliver the projects that he needs to deliver to be able to fix the whole system. That is why I say that if he is not going to get the money to fix the whole system, there is no point in parties tabling amendments that state, "Fix all of the system".

It is important to put into context why we are suggesting the W45 model. It is not that we are saying that we should ignore everything else. I am a realist. I know that the Health Minister is not going to get £200 million, £300 million, £400 million or £500 million simply to address the issues that need to be addressed in order to sort out all the problems that exist. Based on what we saw in London, we estimate that a couple of million pounds would address the problem. I know that everything that we suggest requires money and that the Minister asks, "Where will it come from?". If we can be told that a couple of million pounds cannot be found to enable us to lift a 95-year-old grandmother off the ground and that we cannot help people in our community who suffer a heart attack or who collapse from a stroke but that people can be told, "About an hour is time enough to get to you", we have even bigger problems than patient flow and other issues.

We will support the amendments, because how could we not vote to support fixing all the problems? We have, however, brought a little bit of focus to one specific issue. I do not know how amendment No 2 was accepted, when it completely rewrites the meaning of the motion. We all understand and are passionate about the issue, and we are generally moving in the same direction. We want to see our Ambulance Service be able to be responsive in our communities and to be there when people lift the phone and dial 999. We want people to know that help is coming, and I hope that that can be the case.

Thank you, Colin. Question Time begins at 2.00 pm, so I suggest that the Assembly take its ease until then. Following Question Time, the Question will be put on amendment Nos 1 and 2 and then on the substantive motion.

The debate stood suspended.

(Mr Speaker in the Chair)