Northern Ireland Assembly

Mr Berry:

I thank Mr Coulter and Mr McFarland for giving us the opportunity to debate this motion today. It draws to our attention the issue of waiting lists and suggests that bed-blocking is the main factor.

As the entire country knows, our waiting list problem is the worst in the United Kingdom. Sadly, it is a growing problem. According to Health Service figures quoted by Mr Coulter, over 50,000 people in Northern Ireland are on the waiting lists here.

Sadly, there are just two options for patients in our Health Service. They can die or be cared for privately. Our constituents often contact us to complain, not about funding but about the serious problem of the cancellations of their operations. Appropriate funding is important, but the Department of Health, Social Services and Public Safety and the departmental Minister must take an overall look at the strategy and structure of the Health Service. At present, Health Service officials are running around like headless chickens. You can pour millions of pounds into the Health Service in Northern Ireland, but the proper structure is not in place to manage the crisis affecting today's society.

Over the past year, the Minister of Health, Social Services and Public Safety has issued four press releases in which she announced initiatives to deal with the waiting lists. She issued a statement in January in which she vowed to deal with all these problems, but nothing concrete happened. She repeated herself in June when the figures rose again, and so far her initiatives have failed to accomplish anything. The continuing rise in waiting lists shows that. We see some 600 cardiac patients on a waiting list. We see people lying in hospital for at least two weeks before they get fracture operations. We could go on citing examples. When we see this and nothing is being done in the hospitals about it, we can come to only one conclusion: that the Minister of Health, Social Services and Public Safety is not up to tackling this problem.

Certainly we need an assurance from the Department that appropriate funding is being provided. Another part of the problem is the cancellation of operations. The rate of cancellation is alarming; indeed, there are times when it reaches almost 30%. I can think of one constituent who phoned one of the hospitals in Belfast to see if his operation was set to go ahead the following day only to be told "Sorry, but your operation has been cancelled." He had to make the call himself to find out exactly where he stood. Patients are continually fasting for operations only to be told the next day that their operations have been cancelled. This can occur five or six times before they get their operations.

This is a matter that the Minister needs to look at urgently and, I hesitate to say, review. Until now, all we have been getting from the Health Department the Minister is one review after another. Next, we will find that the review itself is going to be reviewed, and I dread to think what will happen after that. It frightens me to think of the money that is being wasted in the Health Service at present. The acute hospitals review group that has recently been set up is another waste of money. The chairman receives £400 per day when the review group is sitting, and the other members receive £200 per day. Why not go back to the 'Fit For the Future' document which included starting points and parts which could have been implemented in full? The Health Department and the Health Minister are wasting a lot of money that could be used for such services as community nursing.

The motion also draws the issue of resources to our attention. This too is a big problem, but there are many instances when resources are wasted. Look, for example, at the thousands of pounds being frittered away on the Republican gravy train in the Minister's Department. It has spent over £25,000 to date on the Irish language.

In other words, the political agenda matters more than the Health Service. The cost of the Minister's political agenda would supply the very nurses that the motion calls for, and in the motion she should have been condemned for putting herself before the Health Service. Let me underline that: she puts herself before the health of the community in Northern Ireland.

What sacrifices is her Department making to demonstrate her interest? Where are the announcements that her Department is cutting back to free up these resources for the nation's health? There are none. What we get instead is ever-growing expenditure on her political agenda. If the people want to know why there are not enough resources to supply the nurses that are needed, they must look to where the money is being spent by the Health Minister: on double advertising, on cross-border trips, and so on. The list goes on, and all around the Minister of Health there is pure wastage.

4.45 pm

These are not the actions of a Minister of Health, Social Services and Public Safety but of someone who has other interests at her heart and at her door. It is important that appropriate funding be provided, but there must also be a proper strategy and proper structures to take forward this health service. At present, it is in dire straits, and action must be taken as soon as possible.

We often overlook the tremendous work done by local GPs and nurses on the ground, who are often stressed out - although we should not be surprised at that. I am sure that everyone in this House would like to commend the tremendous work done by all the local medical staff. We are aware of the dire straits they are in and the difficult times in which they find themselves. Often their hard work and dedication goes unnoticed. As a House, we must commend - and I have no doubt that Members will commend - the staff, community nurses, local GPs and the members of staff, including the medical staff, in the hospitals in Northern Ireland.

As local representatives, we must not only ensure that proper and appropriate funding is supplied for community nursing and other parts of the health service, we must also strive to do our best to lobby and ensure that the proper structures are delivered to the Health Service in Northern Ireland. If this does not happen, things will get worse - perhaps out of hand - in the days ahead.

Ms Ramsey:

Go raibh maith agat. While I too welcome the ethos that underpins the motion put forward by two of my Colleagues on the Health, Social Services and Public Safety Committee, part of me believes that it has been poorly thought out.

I agree - and I am sure that those who have yet to speak will concur - that there is a need for community nursing to be properly funded, but nobody should be under any illusion about the current state of the health service. Everyone in this House, in the Health Service and in the community knows that we have a serious problem in the hospitals throughout the year and that it peaks in the winter months when there is much media publicity.

I agree with Rev Robert Coulter when he says that to have 50,000 people on a waiting list is unacceptable and that it should not happen. But to think that these problems can be addressed solely by calling for appropriate funding for community nurses shows a lack of understanding of the causes of the problems. Community nursing certainly has a role to play in tackling the problem, but does the motion refer to health visitors, district nurses or school nursing? The problems in the acute sector are broader than just community nursing; they are about community care and acute care, and a balance between them is needed.

I also welcome the Minister's recent statement and the budget proposals that she brought forward, in which she pointed out that an additional £274 million was needed. That money will not sort out the Health Service's problems. It will only make a start, although £274 million will make quite an impact.

The years of underfunding by previous British Ministers needs to be raised, and the Barnett formula that is used to calculate and distribute funding needs to be examined. I do not think that it has worked for many years, and it has had a damaging impact on the health service - an impact which all of us witness every day.

Members pointed out the various problems in their constituencies. The financial allocation is only 54% of the amount that is allocated per head of population in England. That is an overall shortfall of 46%, so where is the equality of opportunity? There are also other areas in the Health Service where we are being short-changed.

I agree with Mr Coulter that the golden handshakes that have been given to chief executives in the Health Service, when viewed alongside the serious underfunding of that service, send out a completely wrong message to people who are on a waiting list for an appointment. They see the chief executive in their trust board area getting loads of money and, at the same time, whistling 'Dixie'.

That is a serious problem. We must look at where the money is not coming from, and especially at the Barnett formula, because the underfunding is serious, and 46% is not to be sneezed at. It will make a great impact if we achieve even the English per-capita level. People should not merely call on the Minister to provide appropriate funding, for we must tackle the issue on another tier and call on the Department of Finance and Personnel, its Minister and the Executive to argue that additional money be made available. In this way, underfunding in our hospitals and the problems of community nursing can be tackled.

We must also deal with delayed discharges, bed capacity in hospitals and the shortage of additional nursing, which have already been revised. It is very hard to get nursing staff. We must tackle the issue of primary care, and preventative work must take place to ensure that fewer people end up needing acute services. While I welcome the ethos of the motion, the Assembly and those who moved the motion should support the Minister in her fights and arguments for additional money for the Health Service as a whole. None of us agrees with the idea of taking money from one service to prop up another. The entire service must be properly funded. Mr Berry said that the Minister wanted to follow a political agenda. Health should not be a political agenda, for health is the only thing which affects each one of us, whether sitting here or out in the community. Be it underfunding of hospitals or children's services, a health issue will affect everyone of us in our daily lives. Once again, I wish to say how I welcome the ethos of and the thinking behind the motion.

Mrs Carson:

I support the motion before the Assembly today which ask the Minister to ensure appropriate funding for local community nursing. I must agree with what Mr Berry said about our enormous debt to the staff in local hospitals, general practitioners and community nurses. Nothing said here today is intended to be detrimental to them. It is the system under which they are forced to work that we are critical of.

It is simple to call for more funding. From the very beginning of the Assembly, there has been a cry for funding from every Department, and the Minister herself has told us that central funds have underfunded health. The Department of Health, Social Security and Public Safety is a bottomless pit, and money will not put it right. The Health Department has grown. If there was a problem over the years, the remedy was to form a committee. This part of the United Kingdom, with a population of 1,600,000, has a proliferation of boards, trusts and quangos, all with extremely well-paid senior staff doing administrative work that could be done centrally.

We are all too aware of the problems facing health services, and particularly acute services. My area has seen the demise of the South Tyrone Hospital. I use the term "demise" although the closure has been deemed temporary, for who has ever heard of temporary death? This "temporary" closure has placed tremendous pressure on Craigavon Area Hospital. Last year, in the midst of the winter crisis, South Tyrone's doors had to be opened and the hospital fully utilised, since Craigavon Hospital could not cope with the bed shortage. I have heard that, over the summer, beds have been removed from South Tyrone. We have even been told that they have been sold, although we are not quite sure to whom.

This morning I received a letter from Craigavon Area Hospital Group HSS Trust. It is a horror tale of disaster, and I do not know how the people of Northern Ireland, and south Tyrone in particular, are going to cope with it. They catalogued their problems with South Tyrone Hospital. It is going to be utilised again and the beds have gone - they are not even in the building. Will we see patients lying on the floors of South Tyrone hospital, in Third-World conditions?

The Minister announced her acute services review group in August, conveniently during the recess. The review group sounded good. It showed that she was doing something. However, she was only using the method for dealing with problems that has always been used in this particular area of the Health Service - by forming another committee. The remit and the language used in her announcement was woolly. It took me six weeks to elicit a reply to my concerns. I obtained details of the membership and pay of the group from the Minister. It will be £2,000 per day for 50 days - that £100,000 could be better spent on community services.

If our Health Service needs critical appraisal to sort out this bed blockage, why were the chief executives and the administrators, who have all the information and statistics at their fingertips, not brought together to initiate a think-tank to sort out the hospital crisis? They are the people, along with senior civil servants, who have been running the health service during direct rule. We cannot blame British Ministers, and our Minister is only doing what she is told. The responsibility to sort out this mess is being diverted to another quango, wasting even more money in the process. If the Minister wants to do something, why can she not make sure that the administrators are doing their job in the first place?

A Department think-tank could have reported to the Health, Social Services and Public Safety Committee - a body that seems to hear about events or decisions only after they happen. If the proper sequence had been followed, the Committee could have reported the findings from the think-tank to this Assembly. The Civic Forum - another super-quango - could have its first debate on the subject of local community nursing. It would greatly interest elected Members to hear its suggestions.

Last week at Question Time the Minister implied that I was pursuing her for an answer to the different questions I have raised about expenditure because of her political affiliation. That is totally untrue. I was making representations for the people of Fermanagh and South Tyrone, regardless of race, religion or creed, and urging the Minister to ensure the efficiency and effective running of the Department. I urge the Minister to fund the necessary home care programme to eliminate the pressure of bed blocking in hospitals.

Today's letter from the Craigavon Area Hospital Group (HSS) Trust says that their ability to meet demand for services is now critical; that the demand on urgent admissions has been unrelenting all year; that GPs cannot get patients into hospital without first sending them to accident and emergency; and that demand for services far outweighs available resources.

The letter also says that, despite all the discussions regarding contingency plans for dealing with winter pressures, which were required by the Minister, the trust is no further now on than they were this time last year. This is an indictment of the Northern Ireland Health Service. It is a total disgrace.

As regards bed blocking, we in Fermanagh and South Tyrone do not have enough beds - the people will be on the hospital floors this winter. It is imperative for the well-being of the people in my constituency - indeed, in Northern Ireland - that this problem be treated with urgency. Somebody has to do something to get this bed blocking sorted out, once and for all.

I support the motion.

5.00 pm

Mr Deputy Speaker:

I have been fairly indulgent in allowing some Members to stray from the content of the motion, and I must ask others to bear that in mind.

Mr O'Connor:

I support the motion moved by Mr Coulter and Mr McFarland. As Mr Coulter pointed out, there are four boards and 19 trusts for 1·6 million people. We are overburdened with bureaucracy. He also mentioned the £1 million in golden handshakes given out to certain trusts' executives, as detailed in a report by the Comptroller and Auditor General last week. I refer Members also to the previous report, in which the Chief Executives of these trusts gave themselves whopping great pay rises, and bonuses on top of that, which were then consolidated into their pay.

The reality is that there are people at the bottom end who are out doing the spadework on a daily basis, while these chief executives get five-figure pay rises- which is more than the former earn in a whole year. The chief executives give themselves a rise and a bonus and consolidate it in so that they get it again the following year. A lot of money is being wasted at present. Non-executive directors receive over £1 million in bursaries, or whatever the correct terminology is. How much money does it cost to employ a nurse? Starting off at £12,500, that would pay for 80 nurses for a start. Do we really need this bureaucracy?

Ms Ramsey mentioned the need for more money in the Health Service. We agree. However, savings could be made with the money that is already there. We need to look now at this issue in a completely new way. We have democracy. We have a locally elected Minister. We have a Health Committee. Do we really need 19 trusts and four boards in the future? I believe that we do not and that that money could be much better spent on providing the type of care we are talking about.

I know from my own experience the truth of the part of the motion that says

"and consultants can treat additional patients currently on waiting lists."

It is a sad situation when a person goes to visit a consultant and is told that he will have to wait 10 months for an operation. However, if he had £1,800, that same consultant could take him into a National Health hospital and operate the following week. That is totally wrong.

Also, in the community sector, people are going into hospital for gall-bladder operations, for example, and they are out in two days. That places additional strains on GPs, nurses, occupational therapists and physiotherapists who have to come to these people's homes to care for them. For people who have had strokes, speech therapists are also required. We need to look at how we can provide a better service. There are examples of best practice operating in England.

In the Exeter area there are a number of community hospitals. This may well be a model of best practice where, with the type of innovations suggested earlier, people will be able to have their operations, move to the community hospital closest to their homes and be visited morning and evening by their GPs. A nurse-manager would also look after them. Larne has lost its hospital. We were given all sorts of promises about developments at Antrim Hospital, but these promises have fallen through. We cannot even get public transport to the hospital. We need to bring care back to local communities because people prefer to be near their families. We can get the services we need at community hospitals.

In the City Hospital a fortnight ago, a person who had had a heart bypass the previous day was put onto a chair because the bed was needed. He sat on the chair all day because there was no ambulance available to take him to Antrim Hospital. That is the sort of thing that is happening in the Health Service in Northern Ireland now. Something has to be done about this. I hope the review group that the Minister has set up will address these problems.

While we appreciate the need for extra funding, throwing money at things is not always the answer. It is important to take a complete look at what we are doing and how we are doing it. In future, as the population of this country gets older and life expectancy increases, there will be more elderly people who will continue to need community support. Sometimes it is not just about the money - sometimes they cannot get enough people to provide the services.

I support the motion. I hope we will start to see changes shortly, because the people expect to see them. They expect us to deliver change. We need to set our spending priorities. Earlier it was suggested that you cannot take money from one service to prop up another. Further, we cannot take money away from one Department to prop up another. We need to have a realistic approach to these problems. We need to examine whether the money currently in the Health Service could be better targeted to provide the type of care that people in Northern Ireland need and deserve.

Mr Deputy Speaker:

The Speaker's Office has allowed a further hour for debate tomorrow morning. All those people who have put their names down will be given the opportunity to speak. I will be calling people strictly according to party strength.

Mr Neeson:

On a point of order, Mr Deputy Speaker. Normally in a debate the Speaker goes round all the parties. Is this a new practice for the Speaker?

Mr Deputy Speaker:

There is no new practice. The method has been used since the day the Assembly began.

Ms McWilliams:

On a point of order, Mr Deputy Speaker. It is news to me also that you have departed from this. I raised this earlier in the debate. It has been the custom for all the different views - particularly for the views of those who consider themselves to be in Opposition - to be represented. The Speaker has used a protocol whereby he goes round each party first, before considering party strength. This is particularly important when four of the parties are represented in the Government.

Mr Deputy Speaker:

I assure you that a further hour will be given tomorrow and that all parties will have an opportunity to speak.

If we continue this we will create difficulties for ourselves.

Ms McWilliams:

Further to that point of order, Mr Deputy Speaker. You may not have understood the point. There is not going to be a debate if you continue to call only the parties that are represented on the Executive and leave those parties which consider themselves to be in opposition to the last. By that stage, I imagine, many Members who will already have spoken in the debate will have left, and the differences that we have will not be dealt with.

Mr Deputy Speaker:

All the parties present will be given the opportunity to speak this afternoon.

Mr Kane:

In support of this motion I am compelled to inform the House that without a considerable increase in funding for community nursing and the accompanying care packages, we are risking the danger of triggering what is potentially a disastrous chain of events. Bed blocking is the first consequence of underfunding. I am sure that everyone knows what that is, as it has unfortunately been around for some time. The term refers to non-acute patients who must remain in hospital because there is a lack of resources to care for them at home or to allow them to be placed in private residential or nursing homes. A further demand is often placed on Health Service resources. While in hospital these patients can contract infections, such as Methicillan Resistant Staphylococcus Aureus (MRSA), which increases the demand for scarce medical beds.

The second stage in this chain of events is that the system becomes so overloaded that there is an overspill of medical patients into surgical wards. This not only hampers the delivery of surgical procedures but also increases the risk of the super-bug infection through these medical outliers.

Ultimately, as a result of continued underfunding of community nursing and the accompanying care packages, we may arrive at a point, particularly during peak demand, when the Health Service is so inundated that it fails to deliver. We only have to cast our minds back to the bed crisis at the beginning of the year. By way of illustration, in my health trust area there is an estimated six-month waiting list for placements in nursing homes for non-acute medical patients.

The story is similar for care packages involving community nursing. I call upon the Minister and her Department to increase funding immediately and make community nursing a reality rather than an ideal. I unreservedly support the motion.

Mr M Murphy:

Go raibh maith agat. I support the ethos of the motion. It is important that appropriate funding for community care is available, but let us make sure that it goes to the services most in need to maintain proper health care. Patients in acute hospitals must have an accessible, acceptable, efficient and effective service delivered as close to them as possible. Those services must be convenient, effective and efficient in delivering the fundamental right of access to health and social care. Waiting times should be short for outpatient appointments and for admissions to hospitals. Emergencies should be dealt with immediately, and urgent cases should not have to wait for treatment, with proper nursing care. Patients and their relatives should find it easy to understand how the Health Service works.

At the same time, the service must have sufficient caseloads to establish and maintain the expertise of services and staff. Services should facilitate further staff training, and we should aim to maintain the pool of locally qualified and suitably trained staff who are able to deal with the vast bulk of patients concerns and needs.

5.15 pm

We have to ensure that the quality of service is maintained. More routine procedures should be provided locally, which would provide local community nursing for patients in hospitals and in aftercare. In order to maintain the service that is required, appropriate funding needs to be given to the Minister of Health, Social Services and Public Safety, and £274 million should be forthcoming from the Minister of Finance and Personnel. Go raibh maith agat.

Mr McCarthy:

I support the motion. This afternoon has been interesting in that three of the major parties have said publicly that they would do away with the boards and trusts. That is either a new way forward or hypocrisy, for it is the first time I have heard of that policy. I hope that when the next election comes round those parties will put that policy to the people.

For far too long many of our people have had to suffer totally unnecessarily because past authorities did not, or could not, provide the appropriate funding to carry out the Government policy of care in the community. We heard recently of vast sums being paid out of the health service budget to senior officials in the form of retirement or redundancy payments. There was a public outcry, and rightly so. Rev Robert Coulter has already mentioned that. Perhaps if less money had been paid to those officials, there might have been money available to enable convalescent patients to vacate their hospital beds and return to their homes and community to be looked after and properly nursed back to health. That would have freed hospital beds for new patients. We have all heard about patients having to lie on trolleys for hours on end, and in many cases they cannot be admitted to hospital at all because of the severe lack of beds. There is still a big bed blocking problem. Our hospitals and authorities should be ashamed of themselves because of that intolerable situation.

We must have proper funding, including the resources to recruit and retain professional staff such as occupational therapists, physiotherapists, social services staff and many others, so that the Government's policy of care in the community can be properly carried out. Any new resources must be on a recurring basis.

We are all aware of the disasters in hospitals, surgeries and elsewhere last winter. The Assembly should act now so that there is no repetition of last winter's fiasco. The health of our community should be the number one priority, and I support the motion.

Ms McWilliams:

First, I would like to take up a point raised by Mr Berry, who unfortunately is not now present. He seemed to be incredibly critical of our Minister of Health, Social Services and Public Safety. He attacked her for not having made enormous changes in this area. Despite what I said earlier about parties in opposition, I am with the Minister on this issue. We cannot sit as responsible Members of this Assembly and put the entire blame on our Minister.

I have several reasons for saying this. In 1992 the British Medical Association (BMA) said that community care funding should be ring-fenced and sufficient to allow the most appropriate use of NHS resources. The BMA also said at its meeting in 1992 that it was concerned about the inadequacy of provision for community care for vulnerable groups. It urged the Government to develop protocols to promote co-ordination between the various agencies involved, to provide adequate resources and to monitor the process. In 1995 the BMA again expressed grave concern about the arrangements for the long-term care of patients, the ambiguity surrounding the finance of long-term care, and ageist attitudes towards the provision of healthcare funding for the elderly, encouraged by the competitiveness of the NHS.

At the 1996 meeting the BMA said that the problem of hospital bed blocking by patients awaiting social services assessment needed to be addressed urgently. In 1997 the asociation demanded that there be no premature discharge of long-term institutionalised patients into the community without adequate resources and support, in 1998 it said that it wanted the underfunding of community care services to be urgently addressed by the Government.

The only issue that applies is the BMA's 1999 statement that the Government should implement rapidly and in full the recommendations of the Royal Commission on long-term care for the elderly.

Therefore Mr Berry should look back over the years and check what has happened with regard to underfunding, and he should look at the criticisms voiced and the crises that have occurred in the interaction between acute hospitals and community care.

I will return to the matter of the elderly, but for the moment I will move to another issue. When Mr Coulter put down the motion I am sure that he did not intend our focus to be simply on the elderly; indeed he emphasised that in his opening remarks. The need for more specialist nurses in the area of child and adolescent mental health also needs to be urgently addressed. It is a tragedy that in Northern Ireland there are young people in adult psychiatric wards.

We also need more nurses - midwives in particular. They have to cope with an increasing workload from patients who are discharged earlier and earlier from the maternity beds. We know that there has been a reduction in in-patient maternity beds over recent years, but I do not want to revisit that dispute.

Good-quality innovative practices could be introduced to address some of the issues. One of these innovative practices would be to increase the number of specialist nurses who are empowered to prescribe. A Touche Ross consultancy report shows that this would save £20 million. I assume that this is a UK figure - it would be good to see the figure for Northern Ireland. It would be beneficial if health visitors, and district nurses in particular, were increasingly able to prescribe, and I am glad that we are moving in that direction.

I also note from this report that £7·3 million could be saved from GP time if nurses were able to prescribe. A 24-hour nurse telephone consultation service known as NHS Direct is another proposal from the Royal College of Nursing. The British Medical Association, the district nurses' and health visitors' associations and the Royal College of Nursing are all at one on this issue.

The South and East Belfast Trust gives some idea of the direction that we could be moving in. It has a rapid response service which is in operation 24 hours a day, seven days a week. It has catered for 2,000 seriously ill local people in their own homes, and it is argued that only 0·1% of them required a planned admission as a result. In other words, 99·9% have been successfully treated at home and have avoided admission to hospital.

I agree with the old slogan that Gardiner Kane mentioned (and it is sad when you think about it) - "The operation was a success; it's too bad the patient died." This is particularly relevant, given the increased incidence of the hospital-acquired infection MRSA.

From personal experiences reported to me by constituent, I knows how demoralising it can be when people are moved into hospital and out of their familiar environment. If they are in hospital for a long time, it is hard for them to regain their independence when they return home. We should remind ourselves that the elderly have contributed to society and it is our responsibility to give them dignity and the quality of services that they require.

I remain very concerned about the deficits in community care budgets. I know that the Minister has addressed the issue in her current bid. On the Health, Social Services and Public Safety Committee, I urged her to earmark funds. Year after year those funds are raided. One in six delayed discharges is due to lack of alternative care arrangements. Let us save the money, rather than make it an increasing economic problem. We need to get the services in the right place. We have also heard today that some of the problem is due to boundary disputes. I remain extremely concerned about the allocation of funding for addressing waiting lists and for community care. I gather from the Eastern Health and Social Services Board minutes for August that the money had still not been allocated at that time.

Mr Beggs:

We all know that waiting lists in Northern Ireland are unacceptably long. In my constituency, which is covered by the Northern Health and Social Services Board, it is worse than average. The board area covers 24% of the Northern Ireland population, but it now contains 39% of what the Health Service describes as excess waiters. I should explain that an excess waiter is someone who has been waiting more than 18 months for elective surgery. I would also like to highlight the unacceptable fact that 1,190 patients from the Northern Board area have been waiting on these lists for between 12 and 18 months for elective surgery, according to the July 2000 figures.

In assessing the gravity of the situation, we must bear in mind that these waiting lists are the final stage. First, patients have to queue to see the consultant. Then they have to queue for tests, X-ray, MRI or blood tests. Then they come back to see the consultant, and when they are diagnosed they join the final waiting list. So people in Northern Ireland could be waiting two to three years, or even longer, on waiting lists for urgently needed treatment.

Although everyone supports additional health spending, there is a need to ensure that the money that has been allocated is wisely spent. Members have referred to areas where there is a need for improvement. The motion identifies one area, and I agree that there may be other target areas. The bed blocking referred to in the motion is a result of the lack of a health policy in Northern Ireland. Why does the money not follow the patient? Why is money not automatically available to patients who have finished their acute hospital treatment and are ready for discharge into local community unit nursing care? I do not understand. One of my constituents was pressed for seven weeks to organise the movement of her husband from an acute hospital in Northern Ireland, although no funding was available from the local health board and she did not have private money to finance it. She felt that she was blocking a bed and that she was at fault. It was not the patient's fault. The fault was with health policy in Northern Ireland. It is staggering that this happens when we are supposed to have an integrated health and social services system.

5.30 pm

Such instances have an impact on the Health Service, the community and, indeed, the individual family involved. In this case a senior citizen was placed in an unnecessary stressful situation. She was also forced to make daily lengthy journeys to visit her husband in the acute hospital in Belfast, rather than much shorter journeys to the local nursing home.

When we consider the effect of this situation, there is also a cost to health management involved. In reply to my letter of 14 August the Health Minister advised me that treatment in an acute hospital such as the Belfast City hospital costs the Department £665 per week, whereas treatment in a nursing home costs £333 per week. On a simple economic basis, money should be following the patient to a more conveniently located nursing home closer to the home and family.

Patients are being faced with unnecessarily lengthy stays in acute beds when nursing care closer to the family is more appropriate to their needs and would cost half the price. It has been estimated that approximately 50% of patients in some wards are awaiting relocation to nursing homes. If that is the case you can begin to appreciate the unnecessary waste of public resources that is leading to this problem.

I wrote to the Health Minister about the number of patients in the Northern Health and Social Services Board area awaiting discharge from acute hospitals. I was advised that in February this year 145 people had been waiting for more than three weeks for such a move. Of that number, 88 had been waiting because of a shortage of community care funding. There is a clear need to address this issue and I will be listening closely to what the Minister has to say.

Patients are being stranded in expensive acute beds and there is need for a policy change. It means that others needing urgent treatment face prolonged waiting periods, and that consultants are not seeing the patients who need their attention. Consultants are inspecting patients who no longer require their expertise and who simply need community care nursing.

As regards waiting lists, I had one constituent who, while waiting for urology treatment, was forced to make 20 visits within a six-month period to the emergency services because of the painful situation that he was in. That was due to a waiting list. Another elderly patient was denied specialist antibiotic treatment for two weeks because no bed was available.

The Minister, in 'A Framework for Action on Waiting Lists' is still talking in vague terms. Under the heading 'Management Action' the health boards and trusts have to develop waiting list action plans. Come on. The time for developing action plans is past. What have they been doing? What do they do on a weekly and monthly basis? Surely this is something that should have been addressed constantly?

The situation requires firm decision-making and clear direction to ensure that beds and resources are used efficiently and that funding is available for nursing care, which will then enable consultants to treat those on waiting lists.

For too long the focus has been solely on the acute services. The community health care sector clearly interacts with elective surgery and I urgently ask the Minister to address the lack of funding for community nursing as part of the solution to solving the unacceptably long waiting list.

I support the motion.

Dr Hendron:

I am very pleased that the Minister is present for this important debate. I wish her well in making her bid within the Executive for proper resources for health and social services for the people of Northern Ireland.

I also want to congratulate Rev Robert Coulter and Mr McFarland for bringing this very important motion before the Assembly. I note the comments made by Mr Coulter and other Members on waiting lists. Almost everyone in this Chamber could go on for an hour on that alone. However, I am very conscious about using my medical and public representative hats. We find this right across the board, not just in cardiac surgery but in dermatology and psychiatry. People who require outpatient appointments may not be seen for several months, and even then the appointment may be cancelled or postponed for another couple of months.

The Comptroller and Auditor-General's report is amazing. I think that many of us were aware to some extent that these things were happening, but we did not know the figures. It is morally wrong that people who leave the Health Service and are given a pay-off can then take up a new job in the health service here or elsewhere.

I look on the community nurse as the very bedrock of the Health Service in Northern Ireland. They are dedicated professionals who are overworked and underpaid. I totally support what most Members, especially the proposer of the motion, have said in this discussion about bed-blocking, waiting lists and community nurses. You cannot talk about community nurses in isolation; Ms Ramsey and Mr Berry made that point very strongly. You must also include the other primary-care professionals. We need a multidisciplinary approach to the delivery of primary care, which would be in the best interests of the public in Northern Ireland. We need a radical change, not only in the resourcing of community nursing, but in the resourcing of primary health care, guaranteed quality parameters and financial accountability.

Reference was made to the Royal Commission on Long-Term Care for the Elderly. Some of us recently met with Prof Robert Stout, Professor of Geriatric Medicine at Queen's University Belfast. While some of the recommendations of the Royal Commission on Long Term Care of the Elderly have been carried out, the most important have not. Again, a quality multidisciplinary approach in the care of the elderly would make sense.

We need an integrated primary-care service. I welcome today's debate - first, because of the importance of the community nurse in the Health Service and, secondly, because of the wider debate on the future of primary care which is now taking place and which will increase in pace over the next few weeks. Reference was made to 'Fit for the Future'. I appreciate that the Minister started out with a clean slate. She also has the benefit of the massive consultation which took place across this land over a couple of years and led to 'Fit for the Future - A New Approach'. I mention that in passing. It is very important that the Minister has asked for people and groups, including the Assembly's Health Committee, to respond to her.

We need an integrated primary-care service with appropriately resourced primary-care teams. The community nurse would play a pivotal role in such a team, and esteem between disciplines would be essential. The aim of health and social services in Northern Ireland should be to enable people who live in the community to receive as much care as possible at home or in their own locality if they so wish. Secondly, specialist services should support these services and provide responsible consultancy advice to patients should they remain at home.

The debate is about waiting lists, discharges from hospitals and community nurses. It is therefore relevant to make reference to the debate that is going on at the moment on Muckamore Abbey. As Members know, there is a move to discharge many of the people there into the community. Friends and parents of patients in Muckamore raised this when I paid a visit there on Thursday of last week, and I know the Minister has recently been there.

The point was made, very strongly, that community care is totally under resourced at the moment. How can friends and relatives be confident that patients in the secondary settlement wards, when they are discharged into the community, will be looked after as well as they were in the hospitals? This being Human Rights Day, I should say that the principle is for people with a learning or physical disability, or who are elderly, to stay in the community. Those who look after them need our total support to do that.

One poor lady who died in July. Much has already been said about that. When people with a fractured neck or femur are hospitalised there is usually an attempt to operate on them within 24 hours so that their general condition does not deteriorate and they do not contract terminal pneumonia or renal failure, as happened to the lady whom I mentioned.

It is so important that people who go into hospital with a fractured neck or femur are not left lying around for several days. Most of them do survive and are eventually operated on, but when they are discharged there is a longer period of convalescence and their quality of life is reduced. Apart from the suffering of the patients and their carers, the community nurse, a pivotal person in the recuperating stage, has her workload increased.

A further point is that community nurses are human beings who are part of a most noble profession. They are not just workhorses expected to carry every load that is thrown at them. We want people discharged early into the community, but it is important to remember that while community nurses are carrying out their work in health centres and so on, they are also running well- woman clinics, well-men clinics, for which I am thankful now, diabetic clinics, immunisation clinics, cessation-of-smoking clinics and drug and alcohol addiction clinics.

In recent times we have had new and very expensive drugs, like Zyban, to help people stop smoking. It is not a question of just writing a prescription and, hallelujah, the person stops the next day. It is an expensive drug and there is a protocol associated with dispensing it which community nurses are involved in. We also have drugs like Orlistat to help with obesity. Community psychiatric nurses are worth their weight in gold, and I want to pay tribute to them as well as to health visitors, midwives and everyone involved in primary care.

Any community nurse in Northern Ireland will tell you, and I know every Member of the House will agree with me, that we really depend upon the work of the carers in Northern Ireland to look after the elderly and the physically handicapped. I mentioned Muckamore before, but there are also many people in the community with learning difficulties, and we pay tribute to those carers who work alongside the community nurses.

Let us resolve to ensure that, along with the Minister, the Department and every Member of the Assembly, in our new integrated and primary-care services, community nurses play a pivotal role with the other members of the primary-care teams.

Rev Dr William McCrea:

May I put on record my thanks to both Mr Coulter and Mr McFarland for the motion before the House. It gives us the opportunity to deal with something that goes to the very heart of the community.

Every one of us, at some time or other in the life of someone in his family, will have known what it is to have serious illness in the home.

I listened with care to the opening remarks of Ms Monica McWilliams of the Women's Coalition about my Colleague Mr Paul Berry. It was interesting to hear how she started her remarks. Just a matter of weeks ago there was the matter of the bug in the water in the Lisburn area, and the swords were out for the Minister who was responsible. He was practically blamed for putting the bug into the water. However, there seems to be a slight difference in how Ministers are handled. Perhaps that is because that Minister happened to be a member of the DUP and the other belonged to IRA/Sinn Féin.

5.45 pm

Ms McWilliams:

On a point of order, Mr Deputy Speaker. The Member has named me. I can assure him that I was not involved in the debate on that occasion.

Rev Dr William McCrea:

That may be a point of information, Mr Deputy Speaker, but it is not a point of order. Nevertheless, I am happy to accept the information. However, many of the Member's Colleagues were very happy to be involved in the debate. Of course, Ministers bear the responsibility of their Department.

This is an important matter to the people of Northern Ireland. The Health Service is in crisis - not just a part of it, but all of it. Rev Robert Coulter talked about trying to imagine the situation and about the stress in the family circle, but unless you have been in that situation you cannot understand the stress that families go through, especially in cases where a loved one needs heart surgery or is suffering from a life-threatening disease and is simply told that his name will be put on a waiting list and is likely to be there for a long time.

The family of one person in my constituency was actually asked if they thought that that person would be around to get much-needed adaptations done to his home. That is the reality of the situation. The family was asked if the person was liable to die before the work was carried out.

There is much talk about care in the community. It sounds ideal, but it is not in reality. Many people feel completely deserted. There is a vital need for nursing care or any other type of care in the community.

The situation is not helped by £1 million golden handshakes, fat-cat syndrome and the increases of thousands of pounds for trust senior officers. This all brings the Health Service into disrepute.

With regards to the £1 million golden handshake, surely a Minister could have intervened in that matter. It is absolutely disgraceful that a person can get a £1 million golden handshake and then go on to get another job in the Health Service. Bearing in mind the great lack of finances available to deal with the Health Service at present, I am sure that nobody here believes that this is an acceptable situation.

Unfortunately, whilst we have been facing this crisis in the Health Service for many years, those at the top of the Department were encouraging an answer to it, namely the closure of hospitals. The people of south Tyrone have been faced with what is described not as a terminal but a temporary closure of their hospitals. I listened to Mrs Carson talking about a temporary death, but I wonder how that fits in.

We have the situation at the Mid-Ulster Hospital and the Whiteabbey Hospital, where, under the new plans, and despite the present crisis, there is nowhere for people to go. These hospitals are filled with people, both throughout the winder and during the summer.

They are filled with people at this very moment. Yet it is planned that these hospitals will close down and other acute services will be done away with. That is also a disgraceful situation, and I trust that the mindset in the Department - for it is a mindset in the Department - will be changed and that there will be a radical rethink of the situation.

In talking about the appropriate funding that is necessary for community nursing, I have to point out that the complexity of this issue goes much deeper than the brief comments contained in the motion. I know that the motion is the catalyst to allow us to deal with many of the issues.

However, the Department has commented recently that services in the Province have been underfunded and that an additional £275 million is needed to rectify existing problems. This statement may be accurate, but, with an increasingly ageing population in Northern Ireland, it is important that measures are put in place to ensure that existing funding, and any additional funding, is used in the most effective way. The old adage when there is a problem is "Throw money at it." That is not the answer. Money could be thrown at the Health Service, and except it were used in the most effective way, it would only bring the service into further disrepute. That should not happen, but we do urgently need money for the Health Service.

In relation to bed blocking, waiting lists and the effective use of consultants' time, it would be inappropriate not to draw the attention of the House to the fact that the acute hospital budgets and the community nursing budgets are operated independently in most cases across the Province. There is often, therefore, a conflict of interest between acute hospital needs and community care trust needs. Unfortunately, the client often becomes of secondary importance in the equation.

Such budgetary concerns, alas, have caused blockages and prevented the provision of additional services to those currently on the waiting lists. Additional funding to community nursing alone will not solve the fundamental problem in the delivery of quality and effective health care. It is time that the Department tackled the glaring inefficiencies in the man-management of budgets and instructed the health boards to develop strategies that take an overview of the effective delivery of good and efficient services.

Although identifying the weaknesses in the system, everyone today - and I know that this applies right across the House - has applauded the work ethos of the nurses and the social workers in trying to overcome the apparent downfalls of the system. I join with each Member who has congratulated the excellent staff that we have in the service. Let it be abundantly clear that although there is criticism of the Health Service and of management - especially top management, and perhaps overweight management - and administration, no criticism whatsoever is being levelled at those who work in the system, and who are giving an excellent service to the people.

Sadly, I must forecast that the crisis of last winter - which resulted in the abuse of patients seeking admission to hospital, and of those who waited patiently for discharge while attempts were made to put arrangements in place - will undoubtedly happen again this winter unless some urgent measure is taken.

Such abuses must be stopped. I ask the House to ensure that the boards, the trusts and the Department are held accountable for not tackling the fundamental issues which prevent alternatives from being effectively developed in the Health Service.

I support the motion.

Mr Deputy Speaker:

There remain a small number of Members wishing to speak. The Standing Orders require the interruption of business at 6.00 pm, so I propose to suspend business now. The debate will be resumed at 10.30 tomorrow morning.

The debate stood adjourned.

The sitting was suspended at 5.53 pm.

<< Prev