Northern Ireland Assembly
Tuesday 18 September 2001 (continued)
Dr Adamson:
I also thank Mr McGrady for bringing this motion before the House; as he said, it is extremely important. The agreement of the Department of Health in England to allow health authorities there to commission services from other European countries was prompted by a ruling by the European Court of Justice. It stated that patients facing an "undue delay" in treatment in their country should seek earlier treatment in other European countries. That means that the door is now open for a significant reduction in the waiting lists in England for cardiac surgery, hip and knee replacements, cataract surgery and an increasing variety of other elective procedures. The decision of the Secretary of State to allow individuals to make their own arrangements to be treated in Europe at the expense of the National Health Service may also, I hope, prevent the development of a massive bureaucratic network to facilitate that extension of the service.
Mr McGrady and Dr Hendron have shown that, as most of the progressive countries in the European Union operate without waiting lists, it would not be hard to prove "undue delay" in Northern Ireland. We have the worst waiting lists of any of the four countries of the United Kingdom, yet fundholders in Northern Ireland have shown that it is possible to buy cost-effective services in England and Scotland, despite their own waiting list problems. Patients generally show a willingness to travel rather than wait indefinitely for treatment, and the quality of clinical outcomes is at least equivalent to the quality of service achieved locally. Some health boards have used the facilities of the Blackrock Clinic in Dublin with similar success.
People in Northern Ireland are entitled to treatment equal to that available in other parts of the United Kingdom. Some people feel that when resources move away, it undermines the ability to provide quality services in Northern Ireland. Reliable, guaranteed funding is needed, so that we can retain staff with the required skills and ensure that those skills are kept up to date. On the other hand, some feel that a lack of competition creates complacency. Cardiac surgical services have had guaranteed resources. However, the standard of performance is clearly damaging patients in our Province. There is probably an element of truth in both those arguments. The fundamental aim of the Health Service should be to meet the needs of the population, and we are not doing that at present. Action must be taken, both in the short and longer terms.
In the rest of the National Health Service, there has been a considerable injection of cash, as part of the modernisation process. The NHS plans to achieve parity with European health funding over the next five years. However, the Health Service in Northern Ireland has been demonstrably unable to attract similar injections of cash. We have, therefore, been given an opportunity to redress the balance in a way that would benefit patients immensely. We must always remember that if treatment were more timely, there would be fewer lost working days and benefit claims, and that would be a positive boost to the local economy.
In the longer term, we can consider how to handle existing resources and any increase that we might receive. Like many of my medical colleagues, I believe that using services from other EU countries is an interesting idea and takes us away from the parochial thinking that affects so much of life in Northern Ireland. Are we not all Europeans now? Can we not show the rest of the community that we are equal to the task?
Mr Berry:
I commend Mr McGrady for putting down the motion. It has given us an opportunity to highlight the serious problem of waiting lists.
The whole Health Service in Northern Ireland is in disarray. Regrettably, it does not seem to be dealing with the problem of waiting lists. We listened to Mr McGrady talk about his constituents, who have been waiting for operations for over two years. The Chairman of the Health Committee was just warming to the subject of what is needed deal with the problem.
The waiting lists will get worse if sufficient funding is not found. It is regrettable that the Department's bid for an extra £122 million for next year has no guarantee of being met. It will merely maintain the status quo. Not only is funding needed but, as the Chairman of the Health Committee said we must examine the whole structure of the Health Service. It is disgraceful that there are 19 trusts and four boards. The problem with the Health Service in Northern Ireland is that there are far too many chiefs and too much bureaucracy. Our constituents are not being treated fairly.
In Craigavon Area Hospital and Daisy Hill Hospital 42 patients were waiting in the accident and emergency departments. Over two thirds were waiting for a bed to become available before they could be admitted to a hospital ward. Patients were waiting in the corridors. I went to Craigavon Area Hospital the other night at 10.30 to speak to a constituent who had been waiting for over a week for an operation and was still lying on a bed in the corridor. Her privacy had been taken away. It was ridiculous. That hospital was like something in a Third-World country. It is not just Craigavon Area Hospital; it is a Province-wide problem. The situation should be dealt with. It is distressing for patients and their families. Patients' charter standards are not being met, and urgent action is required from the Minister.
2.30 pm
We need more consultants, nurses and medical staff. If that need is not met, there will be severe problems ahead. In 1998,we had a document entitled 'Fit for the Future'. It recommended that we abolish boards and merge the trusts. Then we had 'Fit for the Future - A New Approach', which advocated merging trusts and increasing the role of general practitioners. Then we had a document titled 'Putting It Right'. The next thing at our door was the Hayes report, which contains a lot of recommendations. The Hayes report says that from now until 2010 we will need 400 more consultants, which will cost £40 million per annum; 250 more general practitioners, which will cost another £25 million; and 2,300 additional nurses - an increase of 20% - which will cost £60 million per annum.
There is no way in which we can meet such costs, and we can start to deal with the problem only if we have more funding. We must call upon the Chancellor of the Exchequer to examine the funding of the Health Service in Northern Ireland. There is no doubt about it - we are underfunded. That must be addressed, so that the Department can deal with the problems it faces. The Department has a responsibility to the people of Northern Ireland, especially those who are waiting for surgery. Health Service structures must be examined immediately, so that there is less bureaucracy and more work is done for all patients in Northern Ireland, no matter what their postcode is.
It is distressing to walk into hospitals in a so-called modern society and see people lying on beds in corridors. One lady waited for heart surgery for over a year. During that time, she suffered another heart attack and had to go through the whole system again, just because she was on a waiting list for over a year.
I commend all the staff of the Health Service, especially the nurses and doctors in hospitals throughout this country. They are being mentally and physically affected by these problems. I support this motion.
Mr J Kelly:
Go raibh maith agat, a LeasCheann Comhairle. I support the motion, but I disagree with Mr McGrady's view about finance. This is a matter of finance. Any consultant, doctor, nurse or hospital executive will say that. There is no doubt that the health services in this part of Ireland are underfunded. Research tells us that the north of Ireland is losing the battle for increased investment in personal health services. We know that there has been an increase of 12% in Scotland as against 7·2% here. In England, £1 billion has been invested in the improvement of primary care because of new initiatives announced last year by the British Government. There is a disparity between the funding of the Health Service here and the Health Services in England, Scotland, Wales and the rest of Ireland.
Waiting lists, as we all know, do not happen by accident. Nurses, doctors and consultants are not happy to see people waiting in corridors for a bed or to be examined or operated on. They are there to ease pain and suffering. They do not want to see that happening in any hospital in this part of Ireland.
The problem goes back to the underfunding of the Health Service in the north of Ireland. It comes down to what is available to cover scarce resources. I was on the phone this morning to a rheumatology consultant. Hundreds of people are waiting for a new drug, at a cost of £700 per month, to ease their pain, but there is no money for that drug. There are people suffering from certain forms of leukaemia who require a drug that eases their pain and helps prolong their life. It costs £100,000 a year to ease the suffering of one person.
It is a question of finance. Doctors and other staff in the hospital services are also under pressure. They are trying to decide how the money should be allocated. It is unfair that that extra burden should be placed on them. We need to know how much money is needed. Mr Berry said that about £60 million per annum would be required if all the elements of the Hayes report were to be implemented, and he said that we would never get that amount of money. However, if we are serious about health, we must be serious about finding the money to alleviate the suffering.
This is a matter not just for the Minister of Health, but for the whole Executive. If the Assembly is saying that the Health Service is underfunded, we should approach the members of our parties who are on the Executive and put the case to them. We should ask them to exercise their influence to find the moneys that are so desperately needed.
Many things in life, including home and family, come down to finance. Finance is the big factor in the problems that confront the Health Service. Doctors, nurses and professionals are trying their best with limited resources and, we must find the money to ensure that the suffering is alleviated, if not obliterated.
Mr McCarthy:
Health should be our number one priority. Someone who does not enjoy good health cannot wholeheartedly enjoy life. It is up to those of us who, thank God, enjoy good health and are in a position to provide a good comprehensive Health Service to enable everyone in the community to be as free as possible from unnecessary pain, anxiety or suffering, and thus live and contribute to society for many years in good or, at least, reasonable health.
The rot in the National Health Service and the increasing waiting lists started some years ago when the Thatcher Tory Government presided over a massive reduction in funding and training, and it has continued to this day. We used to call the Tory Government uncaring and they certainly deserved that title. I hope that those years are now behind us. We were promised a modern, quality Health Service by the new Labour Government - that has yet to be achieved.
Waiting lists and times are getting worse. "Trolley time" and "armchair time" are new expressions, but they are also getting worse and are totally unacceptable. Behind every figure on a waiting list is a human being who is not in good health and is quite possibly in pain, probably severe pain. That could and should be preventable. I have listened to constituents crying for help to get off waiting lists. They have been on those lists for far too long, and in many cases they are convinced that they are being overlooked, forgotten or just not considered to be as important as other patients because they are senior citizens. It is a shame that any official or consultant would discriminate against a patient because of his or her age. The Assembly has offered its support to senior citizens, not only in health care but in other areas that contribute to better health. Elderly patients must never be overlooked or abandoned, and they cannot be expected to remain on a waiting list for any longer than is necessary. Waiting times for patients affect young and old, and there are signs that the waiting lists will continue to increase across the spectrum unless radical action is taken immediately.
There are all sorts of reasons for the situation. The Assembly must tackle the inherited problems. The Health Minister has acknowledged that underfunding has taken place over the years, and Members must give her credit for what she has achieved. However, she must do more. Eight million pounds was found to tackle the waiting list problem. That is welcome, but much more is required. That is why the Alliance Party calls for tax-varying powers for the Assembly. We must have the money as well as the power to make a difference to people's lives.
The Executive must be convinced of the need for considerable extra funding to reduce waiting times and waiting lists. Every effort must be made to ensure that funds are not squandered and that fat-cat handouts are stopped. The public must also help by attending appointments on time and by not making fraudulent prescription claims. Those measures would add money to the Health Service's coffers. The total cessation of paramilitary attacks - which are on the increase - would also help the already over-stretched resources and cut back on waiting times. Those acts of barbarism require emergency treatment that uses resources that would otherwise be used to cut down waiting times.
Even with Mr Blair's return to power, the Health Service continues to fail. Recently, the Department of Health, Social Services and Public Safety has sent patients to other European countries for treatment in its efforts to reduce the waiting lists. That is far from ideal, but I suspect that many patients would be happy to do that if the alternative were to remain at home in pain.
Today may be the last Assembly sitting. On behalf of suffering patients on waiting lists and everybody in Northern Ireland who might be on a waiting list in the future, I appeal to the Minister to do what the Assembly wants to do - continue the business for everyone in Northern Ireland.
Mr Boyd:
Most Members have direct knowledge of the issue of hospital waiting lists, because of the number of constituents affected. It is unacceptable that waiting lists should continue to grow. There are over 54,000 people on waiting lists for treatment and operations, and that brings with it a lot of pain and misery. Northern Ireland has the longest waiting lists in the United Kingdom, and the additional £13 million allocated in the past 12 months to address the problem has had little impact on halting the trend. Waiting lists have increased by 5,000 in the past 12 months, and the situation will deteriorate further in the coming winter months.
Fractures are a huge problem, made worse by the daily paramilitary beatings and shootings that create an enormous strain on vital health resources. Many people bury their heads in the sand and hide from the problem. The Government's patient's charter states that patients will receive treatment within 48 hours of admission, compared with the 24-hour target for the rest of the United Kingdom. Despite that, in the past four months, over 1,000 fracture patients have had to wait more than 96 hours for treatment.
The Royal Victoria Hospital, which is the only facility for cardiac surgery in Northern Ireland, was recently forced to cancel heart operations because of a shortage of beds. That is scandalous. People stay longer in hospital because of the lack of resources for a full care-in-the- community programme. That creates a shortage of hospital beds, and we have horrendous examples of patients sleeping on trolleys and in corridors. Doctors and nurses work a horrendous number of additional hours.
A vital meals-on-wheels service in Carrickfergus may have to cease because of lack of funding. That will result in greater demand for home helps, a service that is already under severe pressure. Despite all of that, many health trust chief executives continue to enjoy huge and unjustified annual pay rises, sometimes up to 27%. Do we need all those boards and trusts?
2·45 pm
Waiting lists for occupational therapy visits are at crisis level. Disabled people are particularly affected, and many have been waiting for months, even years, for grants to carry out essential repairs and improvements to their properties. My local Housing Executive office has told me that money for such much needed work is available but is not being taken up because of occupational therapy waiting lists. That is not a criticism of occupational therapists; it is the exact opposite. I know occupational therapists who are working additional hours without pay to help those in need of their services.
The University of Ulster at Jordanstown made the foolish decision to deny a young person, who attained two As and one C at A level, a place on an occupational therapy course, because she did not get three Bs. She has been able to attend the same course in Edinburgh. There is a possibility that that student and many others will complete their studies in other parts of the United Kingdom and get employment outside Northern Ireland. That situation is illogical. Our occupational therapy lists are critical, and we must aim to keep our young people and their much-needed skills here.
There are no rheumatology services for patients in the Northern Board area, and those awaiting diagnosis are sent to Belfast, which has a waiting list of up to 16 months. That is unacceptable. The hospital waiting list crisis graphically illustrates the folly of those who naively believed that the Assembly would be the answer to all our problems. Despite the additional resources, the waiting list situation is continuing to deteriorate. The Assembly has failed the people of Northern Ireland.
Mr Douglas:
The problem with waiting lists in the Health Service is not new. People are concerned that the lists are growing, while little is done at strategic level to deal with them. I am sure that every Member knows someone who is waiting for an operation or some other surgical procedure. Those with the least need will probably be taken first, but that will only massage the waiting times.
There appears to be a severe problem with orthopaedic procedures. We often hear horrific stories of people waiting days for treatment for broken limbs. The main reason for that is the shortage of beds. The problem is particularly acute in winter, but it is with us at all times of the year. Many surgical beds are taken up by medical emergencies for which there is also inadequate provision. That must be dealt with immediately.
There are difficulties with recruiting and retaining staff, particularly nursing staff in intensive care units. Many major operations could be carried out if suitably qualified staff were available. The main obstacle to recruiting and retaining staff is the poor pay that they receive for the responsibilities that they shoulder. Compared with staff in other countries that recognise the importance and skill of the profession, our nursing staff are shamefully treated and poorly paid. I ask the Minister of Health, Social Services and Public Safety to push for a significant increase in pay for our nursing staff at a time when the pay review body is taking evidence on the subject. We have a dedicated workforce in the Health Service, but we cannot expect people to work for gratitude alone. Hospitals must be well staffed if we are to have a responsive service.
It has been stated that in Northern Ireland we have the longest waiting lists in the UK, but significant strides forward have been made in the area of cardiac operations. That has been possible because the boards have purchased services from the mainland. HCI International Health Centre in Glasgow has carried out many cardiac and hip operations under contract for the Western Board. Most of the patients that I spoke to journeyed to Glasgow, and they gave good reports of their experience and the care that they received. I do not advocate that as a long-term remedy, but if we can see shorter lists and a healthier population as a result of such initiatives, we must provide funding to achieve those aims.
In the past 10 years, we have seen the rolling closure of small hospitals across the Province. The beds that were lost were not replaced by the larger 'golden six' hospitals. Many of those beds were for long-term care and minor operations, which took pressure off the larger centres and provided step-down care. If that system were adopted, we would see critical care places released more swiftly, and more people would ultimately be treated. Those spaces would come at less cost to the Health Service, because they would not require the same level of medical supervision and expertise as the larger centres.
We must place the subject at the top of our agenda. Our system must ensure that we have more bed spaces, manned by well-paid and motivated personnel, to ensure that the Health Service can treat more people with appropriate, adequately resourced step-down care. In the long term, it would be cost effective, creating savings in other areas of the health budget.
In the meantime, we must purchase more high quality care from other providers, if necessary. We must not remain at the bottom of the league. We often hear the cry that certain people are second-class citizens. I ask the Minister to ensure that we do not have a second- class Health Service in Northern Ireland.
Ms McWilliams:
As this is one of the last debates before suspension - although there are days yet to play for - I would like to record my concern about what happened during Question Time yesterday, when it appeared OK to beat up the Minister and hold her solely responsible for the Health Service budget. The problem will be resolved only when the Executive sit down this Thursday and make funding available not only for this area, but to address the serious issues that come up every day. The facts are well known, because of the media coverage and because Members have asked question after question.
I was disappointed. Where is the collective responsibility for the Health Service in Northern Ireland? Either the members of the Executive begin to get to grips with the issue and agree that Northern Ireland's Health Service is of concern to all of them, or they leave Minister de Brún on her own to face the Question Time wrath of Members from other parties who feel that that is the way to get the budget increased. Members of other parties represented on the Executive should take the opportunity between now and Thursday to tell their Ministers what they said at Question Time - that they would like to see an increase in the budget.
The demand for £122 million has been put forward as an urgent requirement. As a member of the Committee for Health, Social Services and Public Safety, I am concerned that we will not get £122 million. We will simply go on having this debate. If the budget increase is as urgent as Members are suggesting, it should be the number one priority for Thursday's meeting. Then we could argue whether the Executive are truly functioning or not. Certainly, having witnessed yesterday's responses to Members' concerns about waiting lists, I feel that the Executive's sense of collective responsibility leaves a lot to be desired.
There are three issues. There is the issue of how Northern Ireland is faring compared to the rest of Britain, with regard to funding. It is not just about money, it is also about management and what was once called manpower, but is now called human resources. I have mentioned funding. It is extremely important for the Minister to tell us whether, with the available funding, it is realistic to think about getting the numbers down from 54,000 to 48,000, or anywhere close to the target of 39,000. If that remains a realistic target, how soon will it be met?
Other things happened that were out of the Minister's control, such as the use of single-use instruments in tonsillectomies, which caused waiting lists to go up. Can the Minister tell us about anything else that resulted in targets not being met? Is there another explanation? There may be other explanations; but if it is not about funding alone, we need to know what other things must be factored in. Are sickness levels increasing, or is it that the longer people stay on the waiting lists, the sicker they become and the longer they take to recover? Hence, the waiting list cycle goes on. From calls made today, and on other occasions, to the Royal Victoria Hospital, I know that our regional centre is in danger of collapsing.
Theatres are cancelling operations, and a cancellation culture exists in Northern Ireland's regional centre, where people from across the Province have urgent operations. There are two reasons for that, and a strategy must be put in place. One reason is that there are not enough anaesthetists. The trainee anaesthetists who used to want to work in the Royal after they completed their training no longer want to do so and do not stay to become consultants. The second reason is that there are insufficient intensive care beds. When will there be a framework, and when will the human resource strategy be in place?
Mr McCartney:
I totally endorse Mr McGrady's motion. However, I listened with a degree of political astonishment to Ms McWilliams's remarks -
Ms McWilliams:
For the first time in his life.
Mr McCartney:
I listened to her remarks about the beating up of Ministers. I have made that point since the Assembly began: there is no collective responsibility. The Executive cannot control individual Ministers, who act as warlords in their respective Ministries, and in those circumstances they become the objects of collective criticism and attack rather than of collective support. I am surprised that that astonishes Monica McWilliams - [Interruption].
Members went through a long catalogue of deficiencies in the Health Service, but we must look at the root causes. Many Members are cheerleaders for devolution. Devolution was supposed to bring more sensitive, accountable and effective government. Yet, under devolution, standards of the health care in Northern Ireland are falling below even the indifferent standards of the National Health Service in the rest of the United Kingdom. Devolution was never properly financed from the start. Those who negotiated the Belfast Agreement were so busy with purely political and constitutional matters that they never directed their mind to the price that they ought to have demanded from central Government for taking on the responsibilities of devolved government. Devolution has enabled central Government to distance themselves from the welfare of the people of Northern Ireland. The block grant controlled by the British Exchequer simply leaves the devolved Government to divide an inadequate cake, the size of which is determined by others.
3.00 pm
The reply to our complaints of disparity of service with the mainland will be: "How you allocate your money among competing priorities is a matter for you, not us." However, some economies and some reforms may be made. Dr Hendron and others have pointed out the need for drastic reform in the bureaucratic organisation of the Health Service and the vast amount of money that could be saved by severely pruning bureaucratic expenses, not only in salaries but in the provision of facilities that are available.
I also mention something that was taken up by a number of contributors. I shall indulge, if I may, in a bit of "beating-up" of the Minister responsible. The Minister responsible is from Sinn Féin, a party that Prime Ministers have said is inextricably linked with the IRA. The treatment of victims of the IRA and its counterparts in the so-called Loyalist organisations eats up an enormous amount of money. Every year, huge amounts of money, particularly in orthopaedics, are paid out to treat the victims of IRA and Loyalist terror, yet we have a Minister who is also given the duty of attempting to economise. For their own purposes, Central Government are willing to lay out up to £200 million on the bloody Sunday inquiry, and perhaps another £50 million to £100 million on some of the additional inquiries that are being called for. That money and other money could be used for Unionist patients, Nationalist patients and all other patients in Northern Ireland.
If we want to get the Health Service right; if we want to get our priorities right; if we really care about the welfare, economic well-being, health, and education of the people of Northern Ireland, we will have to return to real democracy, instead of a partnership between a terrible form of democracy and terrorism.
Mr Davis:
A previous speaker mentioned that this subject has been visited many times. The topic of waiting lists has been raised in the Assembly since the Executive took office. All Members have grave concerns.
It must be accepted that the Minister cannot be blamed for a historical problem that has been with us since direct rule. However, the Minister should remember the sign on President Truman's desk, which stated: "The buck stops here". Waiting lists are now the Minister's ultimate responsibility, and it is up to her to provide a solution.
Last week we were told that waiting lists were at their highest level ever. That is not acceptable in a society that should pride itself on the care of those who are in ill health and who face long periods of pain and discomfort because the structures are not in place to treat them. In March 2000, over 47,000 people were awaiting elective treatment - an increase of more than 11,000 in the four years from 1996. Only last week the Minister confirmed that the figure had risen to over 54,000 by the end of June 2001 - an increase of 4·3% since March.
There has also been a huge increase in waiting times. Between 1966 and 2000, the numbers waiting for treatment for 18 months or more increased from 632 to 5,200.
The Minister has set targets for the reduction and elimination of those unacceptable figures. That is to be welcomed, but there is currently no clear indication that those targets can and will be met.
In many cases, the elderly are suffering. They are the greatest users of health care resources. That is the nature of the problem, and it will always be so. However, it is unfair that those who have been the backbone of society in the past are now suffering because of the problems of the present. The long wait to deal with matters such as cataracts and joint replacement is a scandal that must be addressed quickly.
Northern Ireland is short of specialist surgeons in orthopaedics and neurology, and the departure of even one surgeon from these specialities can cause a crisis. Over the years, the system has received additional money, but the position does not appear to have been greatly improved. It was reported in May that there was a delay of nine months even to get on to the waiting list in some specialities. It was also reported that there was a wait of nearly two years for what are described as non-emergency operations. All of that reflects badly on the current system.
Much of the problem is historical. The drive by the Conservative Government towards market economics in all aspects of society - especially in health - was ill-judged and ill-thought-out nonsense. We are paying for that folly now because we have a system that was introduced with cost-cutting priorities rather than health care factors in mind.
There has been a problem with the number of medical staff, and the long lead-in periods required for training new staff have not helped. These matters, and others, will take time to sort out. Demand for health care will always be on the increase. People are living longer, and their health care costs increase as they grow older. The birth rate is falling, and that, along with other factors, means that the costs will fall upon the narrow band of those in employment.
We must look closely at the entire health care system. It is notable that in some European countries almost twice as much of the gross domestic product is spent on health care than is spent in the United Kingdom. Northern Ireland is tied to United Kingdom spending levels, but the Minister must find the means, regardless of those financial restraints, to deal with an urgent and growing problem. Pressure is mounting on the system, and the limited projected spending increases per head of the population to the end of this decade will only exacerbate the situation, with Northern Ireland falling further behind comparable United Kingdom regions.
I support the motion. I have no doubt that this issue will be a recurring theme for a long time to come.
Mrs Courtney:
I support the motion and congratulate my Colleague Mr McGrady for proposing it.
Members have already spoken about the dramatic increase in waiting lists that may have cost people their lives. Figures recently released by the Department of Health, Social Services and Public Safety confirm that increase. A comparison of the quarter ending June 2001 with the quarter ending March 2001 shows that the total number of patients waiting has increased by 4·3%. Over the year, comparing the end of June 2001 with the end of June 2000, the total number waiting has increased by 9·5%. Over the past year, therefore, the total number of people waiting for a hospital bed has increased by almost 10%. More than 54,000 people are waiting for treatment. That is not good enough.
We must ask how many people have suffered or have died while waiting to undergo treatment. How many family members' lives have been affected while patients wait for vital surgery? I appreciate the fact that the Minister of Health, Bairbre de Brún, is in the House today. There is an onus on her to explain the reasons for these appalling figures and the high rise in waiting times.
I accept that the growth in the numbers awaiting elective procedures must be seen in the light of the overall increase in pressure on our hospitals. However, only last week the chairman of the Western Health and Social Services Board stated that the staff at Altnagelvin Hospital are near breaking point as they push themselves to retain high standards of service with inadequate resources. That is repeated in hospitals throughout the Province. There is no point in attempting to reduce waiting lists at the expense of the health of doctors, nurses and health professionals, who are stretched to the limit.
The Minister states that work is already underway to address the problem of waiting lists. Although I accept that that is the case, waiting lists will never be reduced without adequate resources. There is no point in appointing extra consultants in specialist areas, such as orthopaedics, if the resources are not in place to employ staff such as theatre and intensive care nurses, orderlies and other professionals who are necessary to provide back-up. At present, there are many examples in our hospitals of consultants being appointed as a cosmetic exercise because of public pressure. As other members of staff are not available, and theatre space is at a premium, consultants already in post must hand over operating sessions to allow the new employee to work. That is not acceptable. To make such appointments only fools the public and does not help the situation. The Minister must be made aware of that.
I agree that there has been historic underfunding in the Health Service. However, if we are ever going to make a serious attempt to cut waiting lists for elective surgery we must listen to the staff who are continually under pressure. They are the same people who are expected to work long hours because, for example, they have to cover sick leave. More money must be found to pay for extra staff. There is no point in a hospital owning a magnetic resonance imaging (MRI) scanner or a computerised axial tomography (CAT) scanner if the staff are only available during office hours - 9.00 am to 5.00 pm. Hospitals need to provide a 24-hour service - emergencies occur at all times.
In the Royal Group of Hospitals we can see the serious consequences of not having back-up resources. Cardiac operations have been cancelled because there have not been enough intensive care beds. A complete re-evaluation of the system must be undertaken. I support what my Colleague, Dr Hendron, said about changing the management structures. We must look seriously at that issue.
Our waiting lists are currently the worst in the United Kingdom. We must make a concerted effort to ensure that the next quarter's report shows considerable improvement on the most recent one.
Mrs I Robinson:
It is with great concern and a degree of frustration that we find ourselves debating this important issue. The fact that the topic of waiting lists for elective surgery has reached the Chamber should illustrate the serious nature of the issue and the urgent need for action. On quarterly and annual comparisons, inpatient waiting lists have increased by 4·3% and 9·5% respectively. The total number of people on the waiting list has increased by 2,251 since March 2001.
Rather than witness an increase in the quality of service, the past few years have seen the NHS and health care provision undermined and reduced. The figures released in the Department of Health, Social Services and Public Safety's monitoring returns are cause for grave concern. The number of people waiting for inpatient and outpatient treatment in Northern Ireland has increased considerably. They have not only risen since the last quarter; in comparison to this time last year, in some cases, they have increased dramatically.
One of the most worrying aspects is the number of patients who are termed "excess waiters". There are people who are seeking inpatient treatment and have been waiting more than 12 months for cardiac surgery and 18 months or more for other specialist treatment. The increase of 15·8% for that group since last year is alarming.
It is particularly worrying that the Eastern Health and Social Services Board is responsible for 60% of the inpatients who are waiting for treatment, and a staggering 78% of those who are classed as "excess waiters". Of course, statistics are always susceptible to being twisted and massaged to suit one's own point of view. In this case, however, the figures do not require any artificial enhancement.
3.15 pm
The statistics prove that this issue must surely be addressed. The doctors, nurses and other staff servicing the NHS are under serious pressure, and we must pay tribute to all those who are doing their best to carry out their duties.
However, it is obvious that the Department of Health, Social Services and Public Safety has failed to address the problem. It is now time for the Department to look seriously at the considerable problems that exist. The published figures show that, without an increase in the financial support given to the NHS by the Government, the service will eventually have more people waiting for treatment than are actually receiving treatment. If the necessary and resolute action to address the problem is not taken now, the service will continue to deteriorate.
Therefore, it is essential that sufficient funds are provided so that local services can meet demands for surgery. We must do all in our power to maximise what health care provision we have left.
I am sure that most, if not all, MLA's receive a heavy mailbag of letters from their constituents every day imploring us to use our good offices to enable loved ones to get appointments with consultants. Worst of all, we often receive complaints outlining how loved ones would still be alive if they had been able to access services in time.
It is an utter disgrace that, to date, we do not even have the money in place to start the building of the new cancer hospital at the Belfast City Hospital site - especially when we consider that cancer is our number one killer, claiming more victims than strokes or chest and heart illnesses. Meanwhile, Belvoir Park Hospital has to cope with huge waiting lists and run-down hospital equipment. Unless we take the bull by the horns and dismantle the four boards and 19 trusts, this top-heavy structure will use up much-needed revenue.
The NHS needs additional, financial assistance. This Administration, like all new Administrations, takes the easy option of blaming the previous incumbents for the failures and inadequacies of the system. In Northern Ireland, the message is that any shortcomings are due to previous direct rule from Westminster. It is only a matter of time before this bluff is uncovered. Three years have passed, and we have still not addressed the problem of bureaucracy, much less any other problems. I support the motion.
Mr Molloy:
Go raibh maith agat, a LeasCheann Comhairle. We all agree that waiting lists have escalated over the last number of years. This trend started about 30 years ago. We need to rectify that situation. No one can stand over the long waiting lists or waiting times.
We reject the Hayes review as it has failed to deal with the problem sufficiently. It has failed to deliver any new or imaginative thinking in relation to hospitals or acute care facilities - particularly in rural areas.
However, we also have to examine the root of the problem. Like Iris Robinson, I would like to see a restructuring of the boards, but the Hayes review does not address that problem. Replacing four boards with three, or 19 trusts with a greater or fewer number of trusts will not solve the problem of bureaucracy in the system.
I agree with Mrs Robinson that each Administration blames the previous one. However, we can clearly point the finger of blame at the last Conservative Administration, which many Unionists propped up. That Administration ran down the entire Health Service over many years. There are Unionist MPs in the Chamber today who stood by over the last 30 years and allowed the Health Service to be run down by Margaret Thatcher and others in the Conservative Administration. It is quite clear as to when we fell into this rut; and we have a right to point the finger at those who are to blame.
Research also shows that other European countries, particularly the Twenty-six Counties, have reduced the problem of waiting by putting enough money in place to ensure a proper service. While all parties in the Chamber agree that we need to reduce waiting lists, we also need to agree that one of the ways to do that is to provide adequate funding for the service. We need to ensure that we have a proper service in the future. It cannot be done by people pointing to cancer services, hospitals and other services and saying that the proper money has not been put in. The money can only come from the Chamber and from the block grant - it cannot come from anywhere else.
We have missed out on opportunities under the present British Administration. They have made announcements on health every time they needed a perk for an election or for some other issue. They have put large amounts of money into the Health Service in England to eradicate problems there, but we have not got our fair share of that money. The Barnett formula has failed to deliver and failed to follow need in this particular situation. We have not got a fair share of the distribution of the money. While Mr Durkan announced a 7·2% increase in the health budget last year, in Scotland it was 12%. In England, £1 billion was invested to improve primary care. That is money being allocated for a particular reason, and if we had received our fair share we would have at least had an extra £35 million to put into the Health Service.
We need to put our money where our mouths are. The test here is whether the Executive have a collective decision-making process. Where will all the parties actually stand when the Minister of Finance and Personnel asks where they want to allocate money to? It is recognised by most parties that an injection of money is required by the Health Service. We need a collective voice today. We want the Health Service to be a priority in order to get the bulk of this year's Budget. We want to ensure that the Health Service can provide the proper health care facility that we all want and that we all talk about. We have to meet the needs of that service, and it will only happen if we have a collective decision in the Chamber and in the Executive.
We can lay the blame and pass the buck, but at the end of the day the buck will stop at the Executive and the Assembly. The Assembly needs to be satisfied with the budgets when they come here to be approved. The Committees scrutinising the whole process need to be satisfied that enough money is going into the Health Service to allow the Minister to deal with the problem. We also need to be able to trace that money. I accept that there are certain question marks over where the money allocated to the boards and trusts ends up. I hope that the Assembly gives a very clear message to the Minister of Finance and Personnel that we want to prioritise health in the new Budget.
Mr Savage:
There can be no doubt that a waiting list crisis exists in the Health Service. Only yesterday, in answer to a question from my Colleague, the Member for Fermanagh and South Tyrone (Mrs Carson), the Minister told the House, in a document deposited in the Library, that the Southern Health and Social Services Board had a waiting list of 228 for hernia operations, with 32 people waiting more than a year. I noted that 5 patients had been waiting more than two years. With mounting disbelief I went on to read that, across the Province, 26 people had been waiting for a hernia operation for more than two years.
I mention hernia operations because, as the Minister knows, I am currently dealing with such an issue for a lady constituent from Lurgan who has been waiting for more than two years. I suppose she is one of the Minister's statistics. She was placed on a waiting list in October 1998 and is still waiting, with no date for the operation having been set. In fact, her consultant informs me that she is still fourteenth on the list. This lady is more than a statistic. She is suffering daily discomfort and pain, to the extent that her quality of life is severely curtailed. That is the reality of waiting lists - pain and suffering.
Further searching of the Minister's document showed that approximately 20 people had waited for more than two years for knee replacement operations, and some of the figures that were supplied yesterday, including those for heart bypass operations, were provisional. That word may be appropriate for the Minister, but it is not appropriate in a written answer to an Assembly question about a major public service. Such data should be readily available because it enables the public to judge the service they are paying for.
I urge the Minister to give serious consideration to a suggestion by my colleague, Dr Adamson, that patients who have waited for a long time be treated in European hospitals. That happens in Great Britain, where patients are transferred to France and Belgium, and it is no more expensive than treating them here.
Insufficient capacity causes long waiting lists. Hospitals in Europe have more capacity, so why not transfer long-wait patients there for treatment? After all, we are all Europeans, so why not give people the choice of going to Europe or, if they prefer, wait here on the long list.
The Minister's paper also shows that people in Northern Ireland have a significantly longer average waiting time than people in England and Scotland in two out of four key areas. In Northern Ireland the average wait for a cataract removal is 227 days, compared with 119 days in Scotland. In Northern Ireland someone needing a knee replacement operation has a waiting time of 234 days, compared with 105 days in Scotland.
There appears to be a serious shortfall in specialisms, and I ask the Minister when and how that will be addressed. It gives me no pleasure to point that out, because I have nothing but the highest regard for the doctors and nurses who are so dedicated to our Health Service. However, the Assembly has a right to demand a better performance from our Minister when addressing the glaring issue of hospital waiting lists.
She has been in office for approximately three years, and that is just a little longer than a constituent of mine has been waiting for her operation. However, a further extension of the accident and emergency unit in Craigavon Area Hospital will open soon, and I give the Minister credit for that. It will help to alleviate some of the problems confronting that area.
I know the Minister takes the problem very seriously, but if something is not done to alleviate the situation, it will get out of hand altogether. I support the motion.
Madam Deputy Speaker:
There are two further Members to speak, and I ask both to curtail their contributions to two minutes.