HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY
4 October 2007
Members present for all or part of the proceedings:
Mrs Iris Robinson (Chairperson)
Mrs Michelle O’Neill (Deputy Chairperson)
Mr Thomas Buchanan
Rev Dr Robert Coulter
Dr Kieran Deeny
Mr Alex Easton
Mr Tommy Gallagher
Mr John McCallister
Ms Carál Ní Chuilín
Ms Sue Ramsey
Mr Michael McGimpsey ) The Minister of Health, Social Services and Public Safety
Dr Miriam McCarthy ) Department of Health, Social Services and Public Safety
Dr Andrew McCormick )
Ms Patricia Osborne )
The Chairperson (Mrs I Robinson):
Members will recall that the Committee identified several issues that it wished to raise with the Minister, and he has said that he will take them in the order in which they appear in the Clerk’s paper.
I will ask Mr Buchanan, Dr Deeny and Mr Gallagher to outline the problems with services provided at Tyrone County Hospital and Erne Hospital before the Minister responds.
I have some issues to raise. I thank the Committee for supporting us and for agreeing to bring the matter to the Minister’s attention.
We have a substantial number of patients in the south-west quarter of Northern Ireland who are serviced be two hospitals, one in Enniskillen and one in Omagh, and the service that those people receive from both hospitals is far from acceptable.
As the Minister will know, we in Omagh have lobbied for a long number of years to retain services at Tyrone County Hospital, and, even as we sit here today, the hospital campaign steering group is again meeting the Western Health and Social Care Trust in Omagh. That shows how great the concern is in Omagh. When a decision was made to erect the two hospitals in the south-west, there was controversy. However, that has now been resolved, and that controversy is now in the past. We are now concerned about both hospitals’ service provision, which we believe that that provision is not there.
When Angela Smith was the Minister with responsibility for health, she made it quite clear to the people in the south-west quarter of Northern Ireland that the services would remain — the status quo would be maintained — until such times as new hospitals had been built. Other health professionals reiterated that line, yet that is not what has happened. There is still a huge gap in services, especially in my constituency of West Tyrone. We talked earlier about people with mental-health problems and anxiety, about suicide, and so on, but the gap in services with which we have been left in my area is creating anxiety among people in the area. We feel that the Department and the trust have let us down. We are continually told on paper — it is a paper exercise — about the services that are provided at Tyrone County Hospital. When we ask for a briefing, we are told that x, y and z services are being provided. That may be the case on paper, but that is not the case on the ground.
Take, for example, day-care services. GPs were told on paper that Tyrone County Hospital had a blood-transfusion service that they could use. However, GPs were never informed about that service. Again, it is a paper exercise. When we ask the Department about the blood-transfusion service, officials say that it is in place. The GPs, however, who are the people who are supposed to be delivering the service, have never been informed about it. Those are some of the things that are happening in Omagh.
We were also told that a 24/7 blue-light ambulance would come to Tyrone County Hospital. Again, sadly, that was not the case, simply because of Northern Ireland Ambulance Service protocol. As a result of that protocol and, perhaps, inexperience on the part of Ambulance Service staff, they cannot make that decision. I received a letter from the Minister about which patients could be taken to Tyrone County Hospital, and I will read an extract from it:
“Patients with medical problems, minor injuries, including head injuries, simple fractures or nosebleeds may continue to be taken to Tyrone County Hospital.”
That is what is said on paper. However, it is, once again, merely a paper exercise, because that is not happening on the ground. When the Ambulance Service attends to a patient, it automatically takes them to Erne Hospital in Enniskillen. It brings no patients — or very few — to Omagh.
I know of one case — there are many more — in which an elderly gentleman had an accident about four miles from Tyrone County Hospital. The ambulance came to lift him, and the crew said that they had to take him to hospital in Enniskillen. The gentleman refused, saying that he was going to hospital in Omagh. The ambulance staff said that they were sorry, but that they could not take him to Omagh. He let the ambulance go on its way and got into a neighbour’s car. That neighbour took him to hospital in Omagh, where he was seen by doctors. There is a big discrepancy in service provision in the south-west quarter of Northern Ireland that must be addressed.
I have some questions that need to be answered today. Can the Minister explain to the Committee why all patients with minor injuries must bypass Tyrone County Hospital and go straight to Erne Hospital? Why is that the case?
Will the Minister also explain why the Ambulances Service in County Tyrone is operating with a severe shortage of fully trained paramedics? It is using young, inexperienced ambulance personnel as a substitute. We were told that we would have a fully equipped Ambulance Service in place before the accident and emergency (A&E) services closed. The A&E department has been closed for more than a year, yet a fully equipped service is still not in place. Omagh is still short of about eight fully trained paramedics. Will the Minister tell us what is going on? Promises have been made, but they have not been fulfilled.
Will the Minister explain why 17 beds have been taken out of commission in the medical services of Tyrone County Hospital without consultation with GPs or anyone else? That hospital provides a medical service. Why were those beds removed by stealth? Why have theatre nurses been laid off and theatres closed from 5.00 pm on Fridays until 9.00 am on Mondays?
We were told that the ear, nose and throat (ENT) services for children in Omagh was closed because there were no paediatricians on site — it was unsafe. However, the paediatricians, while they may not have been living in the hospital, were on site working in other parts in the hospital and could have been called on if required. The children in my area now must travel 70 miles to Belfast to have their tonsils removed. There are no paediatricians on site in the hospitals in Belfast — they are on call, but they are not on site. Therefore, if Omagh was considered unsafe because no paediatricians were living on site, how can other hospitals, which are in exactly the same position, be considered safe? That disparity must be addressed.
When the children are leaving Belfast to return to Omagh, they are told that, if they have a bleed, they must go to their nearest A&E, which is in Enniskillen. Erne Hospital has no paediatric surgeons or anaesthetists, yet I am told that, when a bleed occurs, a surgeon or an anaesthetist must deal with that problem — not a paediatrician. There is a surgeon and an anaesthetist in Omagh. There may be a paediatrician on site in Erne Hospital, but I understand that there is no paediatric surgeon or anaesthetist there.
Why has the hospital in Omagh been rendered so unsafe? Theatres were closed, yet Health-Media.Net came in and used the theatres in Omagh at weekends to reduce the National Health Service’s waiting lists. Is Health-Media.Net reducing the waiting list in Omagh and Fermanagh? Not at all. It is bringing in people from other areas in order to reduce waiting lists in those areas. Health-Media.Net consultants said that they were totally shocked that Tyrone County Hospital had been run down, given the high standard of equipment, cleanliness and first-class staff.
If those theatres in Omagh are not considered safe for the people of Omagh, how can they be considered safe for Health-Media.Net to use? Patients from other areas fill wards 5 and 6 in order to reduce Health Service waiting lists. I have talked to patients who have used those wards, and they are full of praise for the Omagh hospital and its people. The entire population of the south-west is being left without services.
Tommy, can you leave some questions for other Committee members to ask?
I wish to raise one more issue. This is important to the people of my constituency. People from Tyrone and Fermanagh are being taken to Erne Hospital to undergo surgery. That hospital has seven surgeons.
An important and serious issue has arisen as a consequence of serious adverse incident (SAI) notifications being placed against the names of some surgeons, resulting in some surgical patients from Erne Hospital being transferred to Altnagelvin Area Hospital in order to rectify their surgeries. A surgeon may receive one or two SAI notifications, but, if that continues, that surgeon should be retrained. Some people who are present know what I am talking about, because they sit on boards that are responsible for clinical governance and which act as a safety net for patients. However, those issues are going unnoticed. There are 27 such cases, and we have information on the origins of 16 of them. Another, which is to be confirmed, hangs in the balance. I could go on —
I think you could, Thomas.
There are concerns about the suitability of the site for the new hospital in Enniskillen, because the area is boggy. I want the Minister to clarify the situation pertaining to that and other issues, which I will write to him about. Minister, I am pleased to have had the opportunity to raise those matters, which are of great concern to the people of Tyrone and Fermanagh, and I look forward to receiving answers to all of my questions.
The Minister should know that, this morning, the Committee met health professionals, including GPs and people involved in midwifery who wished to have their concerns highlighted at this meeting. I must leave to catch a flight, but those people asked me to pass a document to the Minister, which raises questions for him to answer.
I invite Michelle O’Neill to stand in for me. Please accept my apologies, but this is a time when the schedules do not add up.
(The Deputy Chairperson [Mrs O’Neill] in the Chair)
On a point of order, Deputy Chairperson, in proceedings of the other Assembly Committee of which I am a member — the Committee for Regional Development — it is forbidden to raise issues that relate purely to constituency matters. The main role of Committees is to scrutinise and shadow the work of Departments. I understand that there are concerns in the south-west, but they should be raised by members in the context of wider concerns, rather than in a constituency role. Members should consider matters of health, social care and public safety in relation to Northern Ireland, rather than just West Tyrone.
To clarify, I raised my concerns at a Committee meeting two weeks ago, and the minutes will show that it was agreed to invite the Minister to this meeting, and that the lack of service provision in hospitals in Fermanagh and Tyrone would be on the agenda.
The Deputy Chairperson (Mrs O’Neill):
That is fair enough Mr Buchanan, and, Mr McCallister, your point has been made. The points that have been raised are relevant to the wider area of policy, and not strictly constituency issues.
With respect, I am quite sure that Tom Buchanan was clearly referring to the people of his constituency of West Tyrone.
The Deputy Chairperson:
Yes, but he referred to the wider area, not to individuals. Mr Buchanan and Dr Deeny, do either of you wish to add anything before the Minister replies?
Perhaps I should wait, rather than duplicate questions.
The Minister of Health, Social Services and Public Safety (Mr McGimpsey):
It would be helpful if Kieran asked his questions now, so I can respond to the whole menu of questions.
I would like to interject at this point, if that is all right. I agree with some of what Tom Buchanan has said, particularly about the way in which the Health Service is being delivered in the rural west. There is a perception, at least, that certain inequalities exist in the level of service that is provided to the people of the west. I am concerned about the ambulance fleet, and the issue of getting people to hospital in an emergency — within the golden hour.
The main problem has been the delay in the delivery of the new services. Tom has already expressed his views about the Enniskillen site. Delays feed uncertainty, so we are caught in a difficult situation. There is concern about cutbacks, which have resulted in a reduction in the number of available beds. That is happening at Erne Hospital too. That situation will feed affect new PPP contracts. Someone will point to the budget in 2004-05 and 2005-06, and those who are tasked to deliver the facilities under the new contract will get away with delivering the very minimum. That is a concern that people raise when they hear that beds are being removed from hospitals. The projects are under way, but we need to see more progress. I would like to hear the Department’s view on that.
I hope that, between us, we can continue to make the case for an air ambulance. However, we particularly must make the case with other Departments for better roads throughout the south-west, especially the road between Omagh and Enniskillen.
Forgive me for sounding as though I am holding out a begging bowl, but the new Western Health and Social Care Trust is dealing with a deficit of £3·3 million. I do not wish to argue about how that happened, or where the responsibility lies, but people’s health is at stake, and we are already bearing the brunt of some of the damage that is being done to the Health Service by that deficit. The Executive have to find a way to resolve that situation, because it is unfair to the people in the west to have to pay the price for what happened in the past. The £3·3 million deficit is certainly not the fault of those who depend on the Health Service. I hope that that situation will be examined seriously.
I must make a few points before you leave, Minister. First, I completely refute what John McCallister said. I do not care what other Committees do. With no disrespect to John, our job is to scrutinise, monitor and hold the Department to account. If it is not doing its job, it is our duty to say so. If there was something wrong at Craigavon Hospital, is John saying that we should not discuss it, because it is sited in another constituency? Not at all. This is our job; it is what we are here for.
I apologise to our visitors if they feel that we have gone on and on about these matters. We will continue to go on and on, until such times as we have proper healthcare for our people. This problem is so serious, Minister, that four or five GPs are away from their patients today. I am here because I was elected on this issue. One GP met the Committee Chairperson with a delegation from Omagh, and at least two more were at the protest meeting with the trust. The situation for our patients is so bad that we are leaving our jobs in order to represent them.
I am speaking as a GP, and as a chairman of a GP association. Our GPs, thankfully, are uniting on this issue. This is a very important matter, John. If we were talking about South Down — which is where I am from — I would be backing you, and saying these are exactly the issues that we should be discussing.
I am not saying that it is not an important issue.
It is an important issue.
It is a hugely important issue, but the Committee’s time cannot be monopolised by one issue. Tom Buchanan spent a lot of time asking questions that should have been put in writing to the Minister.
The Deputy Chairperson:
Members, please speak through the Chair.
The issue is about inequality of healthcare provision. I am going to hand the Minister a document that was drawn up by his own Department, relating to the requirements of section 75 of the Northern Ireland Act 1998. We are considering the legal aspects of the situation.
I will not go through all of the figures, and I will try not to keep the departmental officials here for too long. I have statistics for the time that it takes for patients to get access to the medical services that they require — that applies right across Northern Ireland, John. For inpatients in rural areas, the average time is 18·8 minutes; for access to maternity units, it is 25 minutes. The figure varies from 18 minutes to around 27 minutes. For patients in my area, another hour can be added on to that time.
That is never going to be acceptable. Emergency healthcare services are non-existent for the people whom I represent. They should not be treated as second-class citizens. Three hospitals have closed in and around my constituency. This is not a matter of one hospital fighting another; it is a matter of three hospitals closing down, including those in Magherafelt and Dungannon. Those areas have not been considered, and the patients are furious.
I am proud that I am from Downpatrick in South Down. There has been agreement to build a hospital in that area costing £65 million, and local GPs are being equipped with what they need: A&E, coronary care, and inpatient medical treatment. I have two relatives — a sister, and a sister-in-law — who work in that area. However, £190 million of public money is being spent in Omagh, but we will not have those same facilities. Why?
To repeat Tom Buchanan’s question: why have ear, nose and throat operations been stopped for children in the area that I represent? Those operations do not require a paediatrician; they require an anaesthetist and a consultant ear, nose and throat surgeon. Why, then, are the same operations being performed elsewhere with no paediatric backup — for example, at Musgrave Park Hospital?
I am furious with Miriam McCarthy. I spoke to Miriam two years ago in my health centre, and told her that mothers in that area were delivering babies on floors, and by the roadside. That is still happening, Minister, and nothing has been done. Twins were recently delivered in Omagh, and there were four deliveries in the 10 weeks before the election. Is that the way County Tyrone is going to be left? Is the Minister aware of the problems facing GPs, including GP recruitment problems? That is why GPs are up in arms.
A disastrous situation exists in respect of ambulance protocols. I said at a previous Committee meeting that we should take evidence from a representative of the Northern Ireland Ambulance Service — perhaps Dr David McManus, its medical director. Who drew up the ambulance protocol? Perhaps the Minister can deal with that issue. The current situation is such that children who are suffering fits are driven past a hospital — they could be having a fit for over an hour. I, as a doctor, am qualified to treat them in a health centre. Is there going to be a situation whereby we can get the ambulance to take those children to a health centre, and bypass a hospital? GPs are covered to treat children. That protocol was drawn up to get people away from Tyrone County Hospital. However, I am not blaming the Minister for that situation.
This week, I spoke to two representatives of the interests of disabled people. Both of them said that a legal challenge should be brought in respect of section 75 of the Northern Ireland Act 1998. I am now considering that. As everyone will know, there are various groupings of people whose rights should be protected by section 75. If one examines that, one will see that, in the area that I represent, children and women are discriminated against in health matters. Has there been an equality impact assessment of how disabled people have been affected by the decision to strip the whole of central Ulster and the whole of County Tyrone of acute medical services?
I wish to end on a positive and hopeful note. As a locally elected MLA, and as a Minister, you have the opportunity to put this issue to bed, so that I will not have to continue to come back to it, time and again.
I say to the Minister what has already been said to his predecessor, Shaun Woodward: patients must be put first. I have worked in healthcare for 21 years. The care that patients receive now is worse than it was 21 years ago. I plead with the Minister to put all patients throughout Northern Ireland first — including those in County Tyrone — before the wishes and plans of civil servants. We have lobbied for years, but no one listened. The Minister is now in charge, and can put the issue to bed.
Ms S Ramsey:
As members of the Health Committee, we all have a duty to scrutinise the Department. I take on board Mr McCallister’s earlier point.
There is inequality in the delivery of health services west of the Bann. Committee members would fail in their duty as elected representatives if they did not raise those issues. Therefore, I support the inclusion of those issues on the agenda. Just because colleagues from west of the Bann have brought those matters to the forefront does not mean that no one else in the Committee has an interest in them.
I welcome those comments.
A raft of issues has been raised. I managed to write some down, but not others. Some were questions, although others sounded like allegations. It would be helpful if Mr Buchanan and Dr Deeny wrote to me about some of the issues that they raised. I will then be able to respond in detail.
The Deputy Chairperson:
The meeting is being covered by Hansard.
I realise that. However, the members referred to there being further matters. Therefore, it would be helpful if they could put in writing all the issues on which they want me to respond — those that appear in Hansard, and any further issues. That will allow me to respond in detail.
I entirely agree with Mr Buchanan’s opening remarks, which referred to decisions that were made on hospital provision in the south-west: a new acute hospital in Enniskillen and a new, enhanced local hospital in Omagh, which will include a health-and-care treatment centre, and a mental-health hospital. Those decisions have been made. I am concerned to deliver on them as soon as possible. Therefore, I do not accept that I have let down anyone in the south-west quarter.
I am interested in — and want to respond to — points that have been made on current service delivery. Several points have been raised in the Committee and elsewhere: I want all of them brought into the open. That is important because there are implications for the Department and for individual members of staff.
I need to be able to respond in depth to remarks that were made about Tyrone County Hospital and the service that is being delivered there at present, not least because of the allegations about staff at that hospital and how hard those professionals work. I need to investigate the bona fides of those allegations — for example, the claim that ambulances drive past Tyrone County Hospital to take patients to Erne Hospital. I must get chapter and verse on that. I ask that members put those issues in writing so that I can respond to them.
For the record, the new facility at Enniskillen will be a 300-bed acute hospital with a full range of services. It will cost £250 million, which is a substantial investment, bearing in mind the point that Mr Buchanan made earlier that extra money cannot simply be asked for — it must be used efficiently. Additionally, there will be a new, enhanced local hospital in Omagh. It will have 150 beds and will include a mental-health hospital, a health-and-care centre, and will provide a range of services, such as a 24/7 urgent-care centre, outpatient services, diagnostic services, day procedures, day-case surgery, renal dialysis, inpatient beds, and ambulatory care services. I announced the plans to build a new hospital in Omagh at the Tyrone County Hospital. The new hospital will cost £190 million. Therefore, there will be a capital spend of £440 million in the south-west quarter.
Those costs are part of my Department’s capital CSR bid for the next three-year period; they are already accounted for. I refute that I am letting down, in any way, the people of the south-west, because those services are on the way.
Angela Smith said that she would maintain services, as far as possible — she added that rider. There are issues concerning recruitment; for example, Kieran Deeny said that he could not recruit GPs. I am aware of those difficulties, and I have had discussions about them.
Tommy Gallagher made a key point: the decisions about the acute hospital in Enniskillen and the enhanced local hospital in Omagh were not made by me — I confirmed them. The decisions were made by Des Browne after long deliberation under the Developing Better Services programme. I confirmed those decisions, and, as I said, those services will be delivered on the ground.
However, Tommy’s point was about access, and there has been much discussion about that. There are new dual carriageways from Omagh to Londonderry, and from Omagh to Ballygawley. Those will be crucial for providing and speeding up access.
I am taking up the matter of the Omagh-to-Enniskillen road with DRD, and I have planned meetings with Conor Murphy. The road surface is a key issue for local representatives also, because the travel time between those towns is well within an hour, but the surface is poor. When the new provisions are in place, the people of Omagh will be within an hour’s drive of major acute hospitals at Altnagelvin and Craigavon, and the brand-new acute hospital at Enniskillen. They will be able to travel to hospital well within that time when the new roads are completed.
I shall ask Miriam to address the delivery of services in Tyrone, about which allegations were made.
First, as far as ambulances are concerned, when I was in Omagh to announce that there was to be a new hospital, I stated that there would be a 24/7 urgent-care centre. I gave that undertaking because people had accused me of taking away that service. In fact, the trust is currently recruiting the six doctors who are required for that service.
Secondly, I said that I would review ambulance services in the area, and that work is under way. Thirdly, I said that I would consult on a midwife-led maternity unit. That consultation is also under way.
There has already been significant investment of £1·3 million in ambulances over the last 18 months. I will run through some of that, because that is important for Tom Buchannan and for Kieran Deeny, and, frankly, because of some of the allegations that have been made about the Ambulance Service, untrained staff, staff shortages, and about ambulances driving past the hospital in Omagh when they should be stopping there.
In 2006, the Department agreed additional ambulance cover through voluntary overtime, and on provision for a clinical support officer on the ground. In July 2006, the Department agreed the provision of an intermediate care crew and one paramedic rapid-response unit. In August 2006, the Department provided an additional 24/7 A&E ambulance, for which 11 additional staff were recruited and trained. In January 2007, a second rapid-response unit was put in place, and a new A&E ambulance replaced the existing spare one. In February 2007, two intermediate care vehicles for the Omagh area were commissioned. In March 2007, a new ambulance deployment site was established at Fintona, and a paramedic trained in thrombolysis was introduced on a pilot basis to deliver clot-busting drugs to heart-attack victims. Yesterday, my Department gave approval for the Ambulance Service to introduce automatic vehicle-location systems and satellite navigation to help ambulance controllers to target the nearest ambulance resource to emergency calls.
The Western Health and Social Services Board has also been asked to develop proposals to improve emergency response and transfer arrangements for the population of Fermanagh and West Tyrone, and it will report in the autumn.
I have responded fully to the Committee. I have listened carefully to what was has been said. So much was covered today that I will examine other matters, such as the Castlederg issue. With respect to protocols, I am a Health Minister, not a medical person. I rely not only on the advice of civil servants, but on advice from far and wide, including that of senior medical people throughout Northern Ireland. That includes very senior consultants, GPs of long standing, allied health professionals, nurses and midwives. I talk, therefore, to a wide range of people. This is not merely a Civil Service exercise by any means.
A series of protocols exist throughout the Health Service, and there are protocols for ambulances. A surgery-and-trauma-destination protocol was implemented by the Ambulance Service on 31 March 2006. That was in response to changes in Tyrone County Hospital acute services. That protocol was agreed by the Western Health and Social Services Board, the former Sperrin Lakeland Health and Social Care Trust, and the Ambulance Service. That protocol was issued to local GPs in March last year. The protocol stipulates that patients with abdominal pain, gastrointestinal bleeding, significant trauma, or who are unconscious, should not be taken by ambulance to Tyrone County Hospital. Patients with medical problems, minor injuries, including head injuries, simple fractures or nose bleeds may continue to be taken there. Where there is any doubt, the patient should not be taken there. That is the protocol, agreed 18 months ago. That was issued to all relevant stakeholders, including GPs.
Additionally, there is a paediatric-destination protocol, introduced in 2005, with a similar buy-in and wide agreement. That stipulates that children under 16 with anything other than minor injuries should not be taken to Tyrone County Hospital, but to hospitals with inpatient consultant paediatric services, unless otherwise decided by a doctor.
Such protocols are not decided by civil servants, but drawn up on sound and experienced medical advice. They are for the benefit, safety and better treatment of patients.
There are some other issues. I am anxious to receive written questions from Committee members, particularly on the issue of ambulances driving past hospitals. That is the type of remark that promotes anxiety and fear, if it is left unsubstantiated. If that is substantiated, I will deal with it; if not, it amounts to scaremongering that will alarm the people of Omagh.
Miriam will provide information on what is happening at Omagh.
Dr Miriam McCarthy (Department of Health, Social Services and Public Safety):
There have been a number of changes over the last couple of years at Tyrone County Hospital, all of which have been made to fundamentally improve quality and safety of care. All those changes have been concerned with putting patients first and providing for patient safety.
The majority of those changes emanated from reports on clinical governance, which raised some concerns about elements of care and which necessitated some degree of change and consolidation to protect patient safety.
Those of you who listened to the news this morning will have heard that a report is being released today on survival from cancer. We have seen great improvements in that survival rate over the last decade. A significant component of that improvement has been the reorganisation of cancer services. Instead of providing those services everywhere, we have consolidated them on fewer sites and improved their quality.
We are witnessing the tangible benefits of people living longer. We cannot provide everything at each location, while simultaneously providing the high standard of quality that people need and deserve. It must be recognised that that is a reality for healthcare in general, not just in the south-west quarter or in the rest of Northern Ireland but further afield.
The transition that came about as part of those changes necessitated a number of support elements. When we consolidated critical care, we tried to ensure that those patients who required level-three critical care — those who needed to be put on a ventilator — were not retained in Tyrone County Hospital but were sent to a larger acute hospital. When we consolidated the surgical services on 4 April 2006, we worked closely with the trust to ensure that a protocol was in place so that patients with a surgical problem, such as abdominal pain or a bleeding ulcer, were not taken to Tyrone County Hospital as an emergency. To do so would have been inappropriate, because there was no surgeon there and they could not have their operation there in the middle of the night. The patients had to be taken elsewhere. Those protocols were designed to ensure that patients got to the right place in a timely manner — not to disadvantage them but to improve patient safety.
A number of months before that, a protocol was put in place for children, and Dr Deeny is correct to say that children who are having fits are not normally taken to Tyrone County Hospital now. The reason for that is that if a child or a baby arrives at Tyrone County Hospital, there are no appropriately trained staff to resuscitate them. Children are not small adults; they require specialist care, so it was felt that it was more appropriate to ensure that children were taken to a hospital that had all the necessary staff and facilities.
I apologise for interrupting, but I cannot listen to this. I have been a doctor for 27 years, and doctors can treat children in health centres, where we have resuscitation equipment, despite not being trained anaesthetists.
The Deputy Chairperson:
Let Miriam finish.
Dr M McCarthy:
I shall reflect on some of the steps that have been taken with quality and safety in mind. Recently, a change that sparked debate and controversy was the change in paediatric ENT. There is an excellent ENT surgeon in Tyrone County Hospital who has a worldwide reputation, and that is a skill of which we are proud. However, the Department and the trust were concerned that children were admitted for overnight stays in a small hospital that did not have the correct environment, support or staff. The Department recognises the great quality of the ENT surgery, and the decision was not a reflection of that but of the aftercare and the fact that children were being treated in an appropriate environment.
That guidance applies not only to a single service. There is an onus on all trusts to meet the clinical guidance that is set nationally. In essence, that guidance says that children should be looked after in a paediatric environment. That means that there should be not only the physical facilities but paediatrics-trained staff, as well as there being a paediatrician and anaesthetist available if a child should have problems in the middle of the night. That may not happen often, but it happens often enough for us to ensure that they must be in the correct place. That was the reason that that step was taken.
The skills of the surgeon, and his particular expertise, are still being utilised, and we do not want to lose them. However, for those who require an overnight stay after a tonsillectomy, the trust has deemed Altnagelvin Area Hospital or Erne Hospital to be a better location. Most parents recognise that that marginal inconvenience is better if their child’s safety is preserved. Those issues have been difficult for local people, but they are about improving quality and safety.
On the subject of beds in the hospital, we have a 24-hour urgent-care and treatment centre. As the Minister said, there is a strong recruitment drive under way to employ additional staff-grade doctors, who have expertise in medicine, and in assessing older, acutely sick people. A few nights ago, there was an advertisement in the paper for those posts, and if recruitment is successful, that will improve the front-door quality of care for people who come to the hospital with urgent problems.
There is still a very good consultant-led medical service at Tyrone County Hospital that is supported by a number of junior staff. There have been some recent physical changes in the hospital to do with refurbishment and the improvement of facilities. A major reason for the refurbishment is to address the issue of mixed-sex wards, which the trust, and, I am sure, patients and families, were not happy with. The refurbishment will probably include the moving of beds and relocation in the short term, but that will help to ensure that there is no mixed-sex facility, and that appropriate isolation facilities are available for people with infectious diseases.
Those are improvements that should happen fairly quickly in Tyrone County Hospital, all of which will improve the quality and safety of patient care. I have not answered all the points that Mr Buchanan and Dr Deeny raised, but those are some of the major ones that were asked.
I want to put on record that the Minister is letting the people of the constituency of West Tyrone down. He is not listening to the health professionals, elected representatives — including members of his own party — or the community.
Since he has ducked and deflected all the questions that have been asked, I want him to answer this question: why, when Omagh is further away from acute life-saving services than similar towns, will the Minister not give the people of Omagh what they ask for? This morning, I took my daughter to Altnagelvin Area Hospital, which took me one hour and 15 minutes. My native town of Downpatrick has the life-saving services of an A&E facility, coronary care and inpatient medicine, and quite rightly so. I, as a doctor, am asking that the Minister do the same for Omagh, which is a bigger town than Downpatrick and further away from life-saving services. Why are there different rules for different areas of Northern Ireland?
The appropriate way in which to deal with those types of localised issues is for Committee members to write to me. I will then consider the points raised and respond to them. There is currently acute service at Tyrone County Hospital under Dr Russell. Clive and I were at Regent House Grammar School and Trinity College Dublin together — I know him very well, and he is at least as medically experienced as Kieran. He deals with those issues.
He will not be there in two years’ time.
Who says so? Let us see what happens. Now we are fighting about what will happen two years from now.
To put the situation in context, here are two market towns: Omagh, which has a population of 20,000, and Enniskillen. In Enniskillen, an acute hospital is being built at a cost of £250 million, and, in Omagh, £190 million is being spent to enhance the local hospital, which will have a mental-health facility. That is a huge investment. In addition, Altnagelvin Area Hospital is a major acute hospital, which also services the Western Health and Social Care Trust area. We must get those hospitals into operation quickly.
Tommy Gallagher made the point about current access to Altnagelvin Area Hospital from Omagh — that situation will change. There is a new road that goes through Ballygawley and Omagh to Londonderry. The Minister for Regional Development must look at upgrading the road between Omagh and Enniskillen. That would significantly ease access problems.
To start to fight battles over what may or may not happen in two years’ time is pointless. In 2011, the Department anticipates that the new Erne Hospital will be up and running. To call the site it is being built on a bog is news to me. I was a builder all my life; I was on site with the builders and their machines. I would be surprised if that site were a bog, not least because the part on which I stood was a substantial hill, which was several feet above bog level.
The enhancement to the hospital in Omagh will be completed by 2012, which is not long away. We all need to work to get the very best hospitals for Omagh and Enniskillen. However, the last time that I was in Committee, Kieran told me to keep my hospital. If I did not put acute services in the hospital, he said that I could keep it.
Yes, I did.
That, to me, is not what the people of Omagh want. It is certainly not what they are telling me that they want. The staff will not forget about the Omagh hospital, as well as the new hospital in Enniskillen. Most people there are urging me to get them up and running, and I am looking to do that.
Ms S Ramsey:
The Minister offered to meet with the Committee. We need to accept that offer, because there are genuine concerns in the constituency and among this Committee. The Minister has tried to deal with those concerns, but he has also added to some of my concerns. The meeting on the issue of Omagh hospital should take place as soon as possible.
I would be delighted for that meeting to take place.
I have one more point to make.
The Deputy Chairperson:
I fully appreciate where you are coming from and I am supportive, but your views have been well aired and we have a number of issues to cover.
I have one thing that I must say —
The Deputy Chairperson:
No, the Minister has agreed to another meeting, Tommy, so you will have to save your point for then.
Just one word.
The Deputy Chairperson:
No, it is finished; that is the end of it.
I want to make one point. The Minister said that my comments were allegations. I want to make it clear that they are not allegations — they are facts. Only one week ago, my niece fell off her bicycle and fractured her arm and cut her head. Where did the ambulance take her? Not to Omagh, but to Enniskillen.
The Deputy Chairperson:
OK, Thomas, you have made your point.
That is a fact, not an allegation or scaremongering. The sooner that the Minister listens to the people of Omagh, Fermanagh and the west of Northern Ireland, the better.
The Deputy Chairperson:
I propose that we break for five minutes and return to the clár — agenda — after that.