Northern Ireland Assembly
Tuesday 22 January 2002 (continued)
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Mr Agnew: The late Canon Hugh Murphy conducted a service at the cemetery. Dr Ian Adamson was also there. Presbyterians, Free Presbyterians, Anglicans and Roman Catholics attended the service. However, my lasting memory is that two councillors from Down District Council laid the wreath - one was a Nationalist and one was a Unionist. The Nationalist was a member of the SDLP and the Unionist was a member of the Ulster Unionist Party. The Nationalist was a member of the Ancient Order of Hibernians; the Unionist was an Orangeman. The Nationalist put on his Ancient Order of Hibernians collarette; the Orangeman put on his Orange collarette, and together they walked to the memorial to the men of the 16th (Irish) Division to lay the wreath. That is a lasting memory that I will have of all of the journeys that I have made to the Somme battlefields. I welcome the conciliatory note in the House, and we should never forget that people of all races, all religions, both sexes and every walk of life lost their lives during the Great War. We talk about the 5,500 men who lost their lives, or who were wounded during the first two days of fighting at the Somme, and we should never forget the supreme sacrifice - the Somme took the lives of about one million people. However, many more millions - perhaps as many as 10 million - lost their lives in the Great War. Although I would never consider myself a pacifist, a visit to the Somme battlefield would be the one thing that might tip me over the edge towards pacifism. The deaths on those battlefields were such a terrible waste of human life, such a dreadful sacrifice. We hear much about lions being led by donkeys - that may be true. However, we must remember the supreme bravery and sacrifice of the people from Ireland, North and South. 12.45 pm I fully acknowledge the difficulty that Nationalists have with 1916 for all sorts of political reasons that intermingle in the Ulster story. We cannot ignore the fact that people from all communities and walks of life, North and South, lost their lives during the Great War. We should never forget their supreme sacrifice. In the aftermath of the war, we were told that the French had given land over in perpetuity to be used as cemeteries in Picardy, Flanders Field and Belgium. That land was to be a resting place for those who had lost their lives during the Great War, so that subsequent generations could visit and pay homage to them. I have a problem with the issue of "in perpetuity"; it must be resolved, and perhaps this is the ideal opportunity to do so. If that land was granted in perpetuity, why are we faced with the problem of the closure of the Chaulnes area in Picardy, where many soldiers lost their lives in particularly horrific circumstances? Those lives were not necessarily lost to enemy weaponry and warfare; many died in a very simple way. The soldiers wore heavy packs on their backs and the ground in that area had been churned up through the ravages of war. As a result, those soldiers, weakened by war, underfed and undernourished, sank to their knees in the mud and fell to the ground face down. Many of them drowned in a sea of mud in an area close to where it is proposed that the third airport for Paris be built. I support the motion and congratulate my three Colleagues for tabling it. We must never forget the supreme sacrifice made, not only by Ulstermen and Irishmen, but by soldiers and people from throughout the free world. That supreme sacrifice has guaranteed freedom and democracy. We must always remember that. Mr Foster: I support the motion. The issue is emotive, and it is important to Northern Ireland, Ulster, the whole island of Ireland and far beyond. I have been to the Somme battlefields on several occasions to pay tribute to those who fought and died. The remains of an uncle on my mother's side still lie in France, and I have two other uncles who returned home from that terrible scene. I say to Mr John Kelly that this issue is not about "isms"; it is about citizenship, then and now. Shortly before Christmas it was brought to my attention that the French Government planned to build a third airport for Paris, which was to be situated in the Somme area. As a result, I wrote to the French Embassy in London and to the Commonwealth War Graves Commission to establish the facts and register my opposition to such a plan, if indeed it were the case. It goes without saying that I oppose any move to disturb the final resting place of the many thousands of Ulstermen, from both traditions, who made the ultimate sacrifice in the first world war, and who lie there side by side. They died in defence of freedom and by their actions helped ensure French liberty. It would be an outrage if the French Government were to permit any interference whatsoever with these graves at this particular time. As regards local interest, there is greater regard in the Republic of Ireland now than ever before about the first world war. There are numerous associations there, and I am friendly with several people from the Royal Dublin Fusiliers Association who are thirsting for information about the first world war and are working hard to learn about what took place - who fought, who died and who gave their lives. I have received replies from the French Ambassador and the Commonwealth War Graves Commission. The Ambassador has assured me that the French authorities "have the greatest respect for the graves of those who fell on French soil", and he sought to clarify several points. He said that even though a decision has been taken to build a new airport in the region, the exact location has not yet been decided and consultations are under way into a number of factors. He promised that "proper consideration will be given to the existence of military cemeteries", and pledged that "all possible measures will be taken to protect the cemeteries." Further to that, he said "if it should prove necessary to remove some of the graves, extreme care would be taken to treat all human remains with due respect and dignity and rebury them, if so required, at an appropriate and accessible location.the cost would be borne by the French Government." Ambassador Bernard said that the French Prime Minister had given a firm commitment that before the final decision is taken there will be consultations with all interested Governments, especially Her Majesty's Government. He concluded by saying that the French authorities and public "respect and honour those who gave their lives for our common freedom". The Commonwealth War Graves Commission said that it was aware of the concern caused by recent media reports, but took the view that "until the proposals and their implications are clear, the suggestion that Commonwealth War Graves will be disturbed is mainly speculation". Significantly, the commission did point out that the area around Chaulnes, chosen for the airport, was mainly a French area of operations and considered that few Commonwealth war graves would be affected. However, while my primary concern is about the graves of those Ulstermen who fell, I would still be concerned if the last resting place of the men of any nationality were placed at any risk. That is vital. The commission said that it was seeking further clarification and would make strong representations should there be any proposal to disturb the graves. It also pointed out that the French Government have, in the past, avoided the need to disturb war cemeteries when similar developments have taken place, notably the TGV fast rail link. It said that it has no reason to believe that the French will act differently in this instance. I therefore propose that the House should monitor the situation, offer support to the Commonwealth War Graves Commission and continue to press the French authorities to live up to their promise that "the French Authorities and public respect and honour those who gave their lives for our common freedom". In conclusion, and in memory of those who served and died, I will paraphrase General Douglas MacArthur when he referred to soldiers in another campaign. We did not know of the dignity of their birth, but we must respect the sacrifice and glory of their death and their last resting place. I support the motion. Mr Deputy Speaker: One more Member will speak, and then Dr Adamson will wind up the debate. Rather than stop the debate and return to it after lunch, I am extending the time to allow Dr Adamson to speak. Mrs Courtney: I support the motion, and I congratulate Dr Adamson, Mr Foster and Mr Ken Robinson, for bringing it to the House today. We have had a detailed explanation of the history from our two historians, Dr Adamson and Mr Agnew, so there is very little for the rest of us to say regarding the historical context in which the Somme is regarded. The proposed site is in the middle of a first world war Somme battlefield, and the new airport will involve clearing a large area and possibly disturbing the graves of many Irish, British and Commonwealth soldiers. If the plan is realised and the war dead are disturbed, it will be widely opposed, for it has already been said that more than half a million soldiers were killed at the Battle of the Somme between July and November 1916. The remains of at least 25 British soldiers and 41 Commonwealth soldiers will have to be exhumed and reburied if the airport gets the go-ahead. The residents of Chaulnes oppose the scheme and say that the airport will dishonour the memory of the thousands of first world war soldiers who are buried in the area. The people of Ireland, North and South, irrespective of their religious or political backgrounds, regard burial grounds as sacred and, therefore, agree that the plan should be opposed. The Battle of the Somme in particular has great significance for the people of the North, both Unionists and Nationalists, and there has been real acknowledgement of the part played by the Irish regiments in both wars. For that reason I know about the monument at Thiepval, which was first brought to my attention years ago by Ian Adamson. For the same reason, after many years of planning, two politicians from very different backgrounds, Glen Barr from my city of Derry and Paddy Harte from Donegal, a member of Dáil Éireann, collaborated in taking a team of young people to ensure that there would be a permanent monument to the war dead at Messines in Flanders, which was officially opened by Queen Elizabeth, the queen of England, by President Mary McAleese and by the Belgian king. That was a real watershed, which showed how the world wars, and those who gave their lives in them, are regarded by people, North and South. The monument was opened by these three very prominent people, together with the relatives of the young men who had their short lives ended far away from home. For that reason we must oppose the plan to put an airport through the Somme battlefield. We must respect the memory of the dead and acknowledge the hurt that will be caused if the development proceeds. Like Dr Adamson I have also been lobbied by relatives, and at the end of last year I met with the deputy burgomaster of Messines and related the concerns of many people to him. He assured me that he shared our concerns and would bring them to his council and support our opposition to the plan. For that reason I am very happy to support the motion, and I hope that it gets the full support of the House. Dr Adamson: I thank everyone who has contributed to the debate. My co-proposers, Ken Robinson and Sam Foster, made several interesting points about Chaulnes and the Somme. Ken Robinson said that the land was given in perpetuity, which is true. The displacement of war graves must be opposed, or it will become an acceptable fact of life. Ken Robinson did, however, say that the French Government gave due sensitivity to the building of the TGV fast rail link, and perhaps that sensitivity will be seen in Chaulnes as well. But what if Verdun had been proposed as a site for an airport? Surely that could never have been considered in France. Ken Robinson thought that the Chartres region might be a much more appropriate alternative. Danny O'Connor, who accompanied us to the Somme last year, spoke of his relatives and of the 16th (Irish) Division's memorial at Guillemont. Of course, the whole area is a cemetery, which stretches as far north as Belgium, where the Island of Ireland Peace Park now exists in Messines. Annie Courtney spoke of that area, which was developed by Glen Barr and Paddy Harte through the auspices of the two Governments. Although the Irish Government could perhaps do more to acknowledge the first world war, they have already done a lot for the development of the Island of Ireland Peace Park. Frazer Agnew spoke of Wytschaete near Messines, where our old friends Harold McCusker and Canon Murphy came together at the wonderful ceremony that we had there. Jim Shannon was quite distressed about the problem that surrounds the area. His Colleague, Gregory Campbell showed us that our colleagues at Westminster are completely involved in the issue. Westminster, this Assembly, the local councils and our European colleagues all have a part to play in preventing any desecration of sites in France. 1.00 pm Mr Campbell spoke of the great role of the Royal British Legion. The Royal British Legion has accompanied our Somme Association to France on every occasion, and has done much to help the veterans of the first and second world wars and other conflicts. We join Jim Shannon in urging the Foreign Office to take a strong attitude toward the French Government in this respect. John Kelly spoke of the problems that Nationalists have because of their feeling of exclusion. I hope that that feeling will eventually die out. On our first visit to the Somme we visited the grave of Willie Redmond - brother of John Redmond - who was really too old to fight in the first world war. When Willie Redmond was wounded with the 16th (Irish) Division, he was brought to a local first aid camp by members of the old Ulster Volunteer Force (UVF). The rights of small nations were very much a focal point for those Nationalists who went to France, because of the invasion of Belgium. I take great heart that Tom Hartley, a Sinn Féin councillor on Belfast City Council, now takes people round the first world war sites in the Belfast City Cemetery and Milltown Cemetery. Mrs Eileen Bell has been one of the most loyal supporters of the Somme Association and has been to the sites in France several times. She spoke of her hope that the Irish Republic would take more notice of the first world war. She also spoke of another issue that will loom large in the following weeks and months - the development plans at Ypres, where the proposed motorway goes right through Passchendaele, where so many people fell. She gave a plug to the Somme Heritage Centre between Bangor and Newtownards, where you can see whole episodes of the first world war from both Unionist and Nationalist perspectives. Norman Boyd said that the proposed plans were distressing. He hoped that the Commonwealth War Graves Commission would firmly oppose the plans. I feel that it will. We have been in frequent contact, and it promises to press the point completely. We must never forget the sacrifice that those men and women made in the first world war. My friend, Sam Foster, has accompanied us regularly to France over the years - first as a councillor and then as an MLA. He spoke about the increasing knowledge in the South of Ireland about the first world war, and in particular the work of his friends, the Royal Dublin Fusiliers Association. I went to the Dublin Civic Museum to see its presentation a year ago. It was remarkable; the place was packed. I have also visited Drogheda to see the cross-border co-operation apropos the first world war that exists in that city. There is consensus in the House, among both Nationalists and Unionists, for this proposal, which I am glad of. In Helen's Tower at Clandeboye there is a poem by Alfred Lord Tennyson, which is perhaps the best poem written about Helen's Tower. It reads: "Helen's Tower here I stand The memorial room of the Ulster Tower at Thiepval has, carved in gold around each of the walls, the first four lines, only slightly altered to make them a fitting tribute to those other sons - the sons of Ulster and the sons of Ireland - who together passed through "Doomsday fire" for their king and country or for the rights of small nations "Helen's Tower here I stand Their name liveth for ever. Thank you for supporting this motion. Question put and agreed to. Resolved: That this Assembly notes the intention of the French Government to build a new airport in the area around Chaulnes in Picardy to serve Paris and requests the UK Government to consult closely with the French Government to ensure that due respect and honour are paid to the graves of those who gave their lives in the two world wars. The sitting was suspended at 1.06 pm. On resuming (Mr Deputy Speaker [Sir John Gorman] in the Chair) - Health Crisis in Hospitals2.00 pm Mrs I Robinson: I beg to move That this Assembly calls on the Minister of Health, Social Services and Public Safety to take immediate action to address the health crisis in our hospitals. I wish to make it abundantly clear from the outset that the motion is in no way intended as an attack on, or criticism of, the dedicated people who work hard and with professionalism at all levels of the National Health Service. Indeed, it is because of the pressures faced by the doctors, nurses and support staff in the National Health Service and, in turn, the negative impact on patients in Northern Ireland that the DUP sought the opportunity to debate the matter. I pay tribute to all Health Service employees for the continued loyalty to their vocations despite the serious conditions in which they work. It is certainly not the pay and conditions, or the stress-free environment that encourages them to keep working in the Health Service. Without their dedication, the current crisis would be one hundred times worse. The Dickensian state of our Health Service shows no sign of improvement. Each time the issue is debated in the Assembly or elsewhere, circumstances have inevitably become more serious, and the crisis deepens. Some have described the current crisis as a "meltdown" of the National Health Service. We are certainly heading that way. Every possible index of the state of the Health Service illustrates clearly that deterioration, through the long waiting lists, the long hours worked by junior doctors, the number of trolley waits and the lack of community care packages. I note, sadly, that the Minister of Health, Social Services and Public Safety decided not to take up the genuine offer from Dr Peter Maguire, the chairman of the Northern Ireland Junior Doctors Committee of the British Medical Association, to shadow him at Craigavon Area Hospital. Had she done so, she would surely have had confirmed to her at first hand just how bad things are becoming. It does not get much worse for the National Health Service when we consider the disgraceful acts of violence that took place at Altnagelvin Hospital at the weekend. That mindless and thuggish violence shows that National Health Service employees are under pressure from all conceivable quarters. I am sure that the House will want to record its disgust at that violence and the extra pressure that it creates for staff and patients at Altnagelvin, as it has done in other hospitals in the past. It gives me no pleasure to state that every aspect of the Health Service, including staff morale, service provision and public confidence, reflects the same depressing reality that a crisis is upon us. Each time the National Health Service in Northern Ireland is examined and debated, we get the same vacuous response from the Minister of Health, Social Services and Public Safety. It amazes me to this day that she repeats the same old rehearsed excuse. How many times have we heard the line that it is the fault of the Tories? It is almost as if the last five years of new Labour had not happened. We cannot continue to blame the Conservative party for all our woes. We must look closer to home for some of the blame. We have to face up to the fact that a local Minister has been in charge of health for approximately three years, but rather than there being even a slight improvement, things are getting worse than they ever were under direct rule. Under direct rule we made the justifiable complaint that unaccountable Ministers were making decisions without consultation. However, we now have a local Minister who has consultations but who never makes any decisions. That must be addressed if we are going to stymie and turn around the decline in the Health Service. At present the Health Service is rudderless - it has neither direction nor any real strategic plan. The Department of Health has spent the vast bulk of its time reviewing the problems with the Health Service while delivering little guidance on how to move forward effectively. The Department, it appears, is permanently in review. I noted with interest the Minister's article in last Thursday evening's edition of the 'Belfast Telegraph'. She mentioned at least four reviews and strategies that have been commissioned by the Department of Health - the acute hospital review, the cardiac surgery review, the comprehensive review of health and social services workforce planning and the preparation of a regional strategy. While those areas need serious attention, one cannot help but feel that the Department and, in particular, the Minister are hiding behind continual reviews instead of bringing before the Assembly a firm and attainable blueprint of the way forward for the National Health Service. Much has been made of the lack of adequate funding for the Health Service in Northern Ireland. I am sure that the word "underfunding" will be mentioned many times today. Such is the importance of funding, or rather the lack of it, that I have personally raised this issue on numerous occasions, both within and outside the Chamber. The disproportionate and unfair nature of the Northern Ireland health budget, compared to that of our counterparts in the rest of the UK, is such that only the term "second class" befits the way in which the British Government treat us. Northern Ireland has higher levels of need and demand than our English counterparts. We need to bear in mind the expenditure that is lost to the Health Service as a result of paramilitary punishment beatings and shootings. Those broken bodies require emergency treatment, months of nursing care and, in many instances, rehabilitation. Just think what we could have done with the millions of pounds that have had to be set aside because of that unacceptable behaviour. We expected that funding would be, at least, matched with the rest of the United Kingdom. However, not only do we get less, but future increases show that we receive demonstrably lower funding allocations than England. If we were to receive the same rate of increase as England over the next few years, we would see the striking disparity between Northern Ireland and England. Had we matched their rate, we would have gained £83 million last year, £138 million on top of the draft Budget proposals for 2002-03 and £214 million more than the indicative allocation for 2003-04. Northern Ireland is desperately underfunded by comparison with England and Wales. If our Health Service is to turn the corner, we must have fair, proportionate and immediate financing of the service in Northern Ireland. Moreover, it is vital that the money that is currently apportioned to health here be wisely used. The Health Minister has a budget of over £2 billion. That is a good deal of money, but various interested parties have rightly queried whether that money is being used to best effect. The Assembly must address that. Areas of the Health Service are being dangerously ignored. There is no mention in the 2002-03 Budget of the proposed new cancer hospital at the Belfast City Hospital site. We ignore the issue of cancer at our peril; we need to bear in mind that cancer will overtake heart disease as the number one killer in the UK in the next few years. Therefore, I call on the Minister to pull out every stop to ensure that funding is secured for this centre of excellence for the treatment of all variants of this dreadful disease. Last year, 31% of eligible women had not had a cervical screening test in the previous five years, and 28% of women aged between 50 and 64 had not had a breast screening test in the previous three years. If we had had that additional money, proper health promotion campaigns could have educated our people, and many more lives could have been saved. Currently, cancer patients often have to wait too long to see a specialist: this delays diagnosis and treatment, causing anxiety and distress. Often people have no choice but to travel to Belfast for treatment instead of being treated locally, and this adds to their stress. The absence of haematologists in the Western Board area forces patients to travel to Belfast. Last year's resignation of a radiologist at Antrim Hospital caused delays in diagnosis. Attracting and keeping qualified staff remains difficult. Better financial support across the service would benefit many needy people. Surely it is time for a radical overhaul of the direction that is being taken by the Department and its Minister. Members would agree that after three years in the post, the Minister must do more than say "I know what must be done" - of course, I refer to the title of her article in the 'Belfast Telegraph'. It is not good enough that she should merely admit that she knows what has to be done. People in Northern Ireland demand to know what will be done, and when. Members are fully aware of the seriousness of the crisis. One does not have to be a member of the Committee for Health, Social Services and Public Safety to encounter health issues. Members in my party receive, day and daily, complaints and queries by letter, phone or in person about the state of the Health Service. In my constituency of Strangford, I have seen, more often than I care to remember, the frequent problems and deadly effects of the growing burden on the service. Some Members may have read in the 'News Letter' recently the terribly sad and disturbing story of a disabled constituent of mine who suffered from numerous illnesses. His wife and son are also registered as disabled. In October my constituent became sick - to such a degree that his family called for an ambulance, which took him to a local hospital. He was told that it was just his arthritis acting up and was sent home without further treatment. Over the next four weeks his condition worsened and on numerous occasions he begged to be taken into hospital for proper treatment. During the following weeks he was taken to hospital a further seven times by ambulance, and each time he was sent home. Such was his pain that the poor gentleman had to sleep sitting up at night because he felt suffocated when he lay down. A local community worker came to hear about his situation and advised him to go immediately to the hospital and demand a more thorough examination. He did this on Tuesday 6 November. On the same day, after numerous tests, he was told that he had no more than 24 hours to live. Tragically, the gentleman died the following day. His family are now left without a husband or father, all because of the pressure on staff and the lack of time to deal with him adequately. That tragedy symbolises all that is going wrong with our Health Service today. Many Members could probably relate as sad a story. I spoke recently to a radiologist from Belvoir Park Hospital who informed me that the machinery had broken down, yet again. That resulted in the cancellation of appointments and a backlog of patients who did not receive their treatment. In some instances seriously ill patients have been sent home from hospital due to the pressures on the system. The words of Dr Peter Maguire reflect a sad reality "We are on the road to nowhere. The Health Service is in tatters, and we must get our act together." These words are an accurate description of the state of our Health Service. In getting our act together, the Minister must tackle the issues that strongly affect public confidence. One such example is the offer of an MRI scanner to Belvoir Park Hospital by the Friends of Montgomery House. That offer must be accepted, as to do otherwise would be criminal. I ask the Minister to undertake to find the necessary running costs to ensure the maximum use of this scanner by the patients at Belvoir Park Hospital. She must recognise that her framework on waiting lists has failed to deliver. 2.15 pm The Minister's review of acute services has run into the sidings and is far too costly. Her plan to abolish GP fundholding seems to have more to do with politics than patients. One has to ask who will be the losers from the lack of an appropriate scheme that would take account of the advantages gained through GP fundholding. The Minister was advised in the House that if circumstances such as an epidemic of the flu virus arose, the Health Service would face chaos. That did happen, and over 100 beds in four hospitals had to close because of a viral gastro-enteritis bug. As a result, the waiting time in Craigavon Area Hospital was 36 hours, and non-emergency surgery had to be cancelled. Such problems are arising across the Province, and those waiting to be admitted to hospitals are being told that emergency-only treatment is available. I wait with interest to see how many patients were waiting to be admitted to hospital at the end of December 2001 - those figures are not yet available. In the light of the situation, the Minister needs to act in the following ways. First, it is time that the Minister listened to and respected the views of the Assembly's Committee for Health, Social Services and Public Safety. She has failed to do that so far. It is time that she laid aside her own politicking and concentrated on health matters. Next, she needs to lay before the Assembly a commonsensical and realistic blueprint that will reflect the concerns of Members and the public. A firm grip needs to be taken on the £2 billion that is being spent by her Department. Instead of attacking the trusts, the Minister needs to get her Department into shape, and if that means downsizing and streamlining it, so be it. The Minister needs to take a serious look at the number of boards and trusts and take the necessary steps to reduce their number. She needs to bring her recommendations to the Assembly's Committee for Health, Social Services and Public Safety with a view to getting an agreeable working plan that will allow real money to be released to the Health Service. It is time that the number of administrative bodies and quangos were cut, so that money could be released to front- line medical services. It is only when the Minister and her Department resolve to tackle the issues in a determined manner that we will be able to build a better service. The current crisis will deepen if these issues are not tackled. Elected representatives cannot stand idly by and allow that to happen. We owe it to Health Service staff and to the patients across the Province to build a strong and durable health system. I call upon the Minister and her Department to provide vision and leadership to achieve that goal. If that necessary leadership is lacking, they will be judged accordingly. There is much to be proud of in our National Health Service - many good and dedicated people make the best of a bad situation to provide a caring service. Members will agree that a root-and-branch change to the current set-up is vital for everyone's sake in Northern Ireland. I call upon the Minister of Health, Social Services and Public Safety and her Colleague the Minister of Finance and Personnel to seek an immediate meeting with the Chancellor of the Exchequer, Mr Gordon Brown, and press him for equality of funding for Northern Ireland. It is no longer acceptable that this country should continue to be treated less favourably than other areas of the UK. Just imagine the service that we could have if there were agreement on its future direction, and the means of achieving that goal, and if proper and adequate funding were found to finance it. I urge Members not to allow the debate to become yet another in a long line of health debates. If we do not act now, who knows what the service will be like when the next debate is heard. I strongly urge Members to support the motion. The Chairperson of the Committee for Health, Social Services and Public Safety (Dr Hendron): I welcome this important debate, which has been initiated by Mrs Iris Robinson. Prior to making my main comments I will mention the money for the MRI scanner for Montgomery House. I have written to Mrs Christine Lynch about that scanner and about the fantastic work that is being carried out, and I hope that the Minister can find the funding for it. I appreciate the fact that the Minister is present for the debate. The chaos in the Health Service cannot go on indefinitely. Patients waiting on trolleys and the war-like zones in our major accident and emergency departments have to be sorted out. Patients are not cattle, to be cast aside until beds become available. The magnificent hospital staff, the doctors, nurses and allied workers, can no longer be taken for granted. "Meltdown" would be the appropriate word to describe the state of the Health Service if it were not for the dedication and resilience of the front-line workers, who are tired, frustrated, overworked, underpaid and whose perception is that they are undervalued. My colleagues on the Committee for Health, Social Services and Public Safety and I have visited several accident and emergency departments to see conditions at the coalface of health delivery. The Minister, Ms de Brún, has inherited a situation in which the health status of the population is one of the worst in Western Europe. Although over 41% of the Budget goes to the Health Service, there is still considerable underfunding here by comparison with England, Scotland, Wales and other countries in Western Europe. There is a crisis in orthopaedic and cardiac surgery. The level of staffing and facilities available for trauma and orthopaedic services here is the lowest of any NHS region in the UK. Waiting times for the treatment of fractures are appallingly long. Some people have had to wait for a week for treatment of fractures of the neck or the femur. When I was a medical student I was taught that such fractures required emergency treatment within 24 hours. Waiting lists are growing. The latest figure was that 56,700 people are awaiting treatment. Recently, I was in Craigavon Hospital, as were several colleagues, and I watched young professionals and others work on the front line. Although there is a major problem with funding, I got the feeling that there ought to be more co-ordination of services between boards and trusts. Therefore, last Wednesday I proposed to the Committee the immediate establishment of an emergency task force, representative of doctors and nurses who work in the accident and emergency departments of our main hospitals, and senior administrators. I am pleased to say that the proposal was carried unanimously. Members will note that I have called this a "task force" - not a review that will go on indefinitely. The task force will encourage a collaborative approach to accident and emergency services at operational level. It will join together the experience of key clinicians and senior nurses working in the acute hospital front-line service. It will produce its initial report within weeks. There is a clear need for close work at operational level and for integrated planning at strategic level. There must be a more meaningful co-ordination of emergency services across the four boards and the relevant trusts. I could cite many examples, but I want to concentrate on two of them. First, the Causeway Hospital sometimes buys services from the Eastern Health and Social Services Board, when, perhaps, it could buy from the Western Board, which is not under the same pressure. Secondly, beds are sometimes available at Daisy Hill Hospital in the Southern Board, while Craigavon Hospital is bulging at the seams. There may be reasons for that that I am not aware of, but those facts were pointed out to me. The current day take-in system between the City Hospital and the Royal Victoria Hospital should be replaced as soon as possible by a system of continuous take-in for general emergencies. There is great sympathy towards that idea in both hospitals. The Eastern Board, if not the Minister, should implement that. Each hospital should receive admissions from its local population and only those emergencies that require the specialist services provided only by the staff of each hospital. Capacity issues must be addressed urgently. Priority should be given to hospitals that are consistently unable to provide enough beds for the general emergency treatment of local populations. For example, there have been great pressures on the Ulster Hospital and the Mater Hospital. The ability of hospitals to cope with emergency admissions depends on the ability of their primary care and community services to avoid unnecessary admissions and ensure timely discharge. However, the Minister is about to impose new structures on primary care. On 1 April 2002, the system of GP fundholding will be replaced by local health and social care groups. It is important to note that 90% of healthcare is delivered at the primary care level. Primary healthcare is available 24 hours a day, 365 days a year. A year ago, on behalf of the Committee for Health, Social Services and Public Safety, I successfully introduced an amendment on the continuation of GP fundholding in an effort to ensure a seamless transition to the new structures of primary care. That seamless transfer has not taken place. The new groups will be committees of the boards. Instead of moving towards a primary care-led Health Service, as was envisaged by the Prime Minister, Tony Blair, we are merely giving more power to the boards. We are going to get a top-down rather than a bottom-up Health Service. A golden opportunity to give the long- suffering people of Northern Ireland the first stage of a top-class Health Service is being missed. The British Medical Association has been making that point about primary care for some time - this is a golden opportunity, if we have not already missed it. This is a once-in-a- lifetime opportunity to get primary care right. Primary care is the base of the triangle. If you cannot get primary care right, you cannot get other services right - in particular, secondary care and hospitals. We want to deliver a robust, patient-focused, responsive and truly integrated service to local communities, in which the patients come first. However, it seems that we are introducing, instead, another layer of bureaucracy under the control of the boards. I appreciate that this is a complex subject. I am not in the business of "bashing" the Minister or anyone else. However, I am in the business of doing my work as the Chairperson of the Committee for Health, Social Services and Public Safety. As someone with long experience of primary care, I believe that what is proposed for 1 April 2002 will cause massive problems across Northern Ireland. Health professionals say that to me. The Minister recently met regularly with many people, such as Dr Brian Patterson, the chairperson of the General Practitioners' Committee (NI) of the British Medical Association. To ensure success, primary care groups should be driven from the bottom-up. Primary and secondary care services are independent, though neither can be looked at in isolation, as Maurice Hayes pointed out. His remit was acute hospitals. However, the Committee persuaded him to examine primary care also, because you cannot consider one without the other. The British Medical Association has sent to all Members a circular in which it makes some points about primary care. It says: "It is important that proper foundations are laid at the beginning if not to miss a major opportunity to create the most effective primary care system, which would complement and help alleviate the pressures in secondary care services." Significant extra funding must accompany a new integrated, collaborative approach to healthcare provision, if we are to bring about the necessary improvements across the community and hospital settings. Northern Ireland has higher levels of deprivation than Great Britain. However, historically, it has received lower funding for health services. During the 1990s, while expenditure on health and social services in Northern Ireland grew by 35% in real terms, the growth in England amounted to 57%. The figures from the comprehensive spending review for 2001-02/2003-04 highlight a deteriorating situation. Given Northern Ireland's well-documented poverty and historical lack of investment in health, it is unacceptable that it should not enjoy at least a pro-rata increase in line with that in Great Britain. We have an opportunity to get primary care right. The people of Northern Ireland deserve the very best, and that is what they should get. 2.30 pm Mr Deputy Speaker: Many Members wish to speak. Each Member will have eight minutes. Rev Robert Coulter: I too support the motion and am glad of the opportunity to pay tribute, as Mrs Iris Robinson did, to the loyalty, dedication and professionalism of those who work in all levels of the Health Service. The Chairperson of the Health Committee outlined the complexity of the problem. There can be no quick fix for it. As I said yesterday, it will take the very best co-operation among us all to look at the situation and to work together. We should not try to score any points at any level for ourselves. Rather, we should look at the tremendous problem in the Health Service and work together to rectify it. The debate gives us the opportunity to express the concerns of those who are worried about the situation, particularly those who are on waiting lists, those who are waiting to see a consultant and those who are beginning to lose hope that, when they are called, it will be in time to do anything about their problems. One can only begin to imagine the concerns in the mind of someone who has been told that he needs a critical cardiac operation immediately, only to be told by a consultant that the operation cannot be performed for another year or 18 months. His family are concerned about his condition. He rises every morning wondering whether it will be his last day on earth. He is waiting for a message to come, but he knows that it will not come in the immediate future. Similarly, one can only imagine how someone with a cancerous tumour feels when he is told that he cannot have an operation for many months. As Members of this House, we must take that situation on board. We must critically examine the system wherein people are unable to have the treatment that they long for and require. The problem is not centred on hospitals alone. When Dr Hayes began to consider his brief, we told him that the problem of acute hospitals could not be viewed in isolation - the entire system must be looked at. I am glad that Dr Hendron pointed out that if we do not get primary care right, then every other part of the system will be wrong. Without repeating the eloquent comments made by the Members who have spoken, several points must be made. There should be directed finance at the critical points of the Health Service. If finance is not directed, it will become, as I said to the Minister of Finance and Personnel, "confetti currency". It will blow in the wind and disappear. There will be no way to have accountability. It will not be possible to trace finance through the system. We should look at the contracts of those who work in the system. Doctors are one example. Hospital start courses for junior doctors are not in line with the take-up for postgraduate doctors. I am told that hospitals will employ doctors only on a one-year contract, because the hospitals must pay for doctors for the first three years. Therefore, after completion of a one-year contract here, doctors go to seek work across the water, in England or elsewhere. If we are to keep our doctors, that system must be changed. The contracts must be examined. Consultants' contracts should also be examined. Much of the problem is that people are either waiting to see a consultant or are waiting for the treatment that the consultant has prescribed. The existing contracts need to be reviewed and revised. The training of nurses and the retention of nursing staff should also be considered. Recently it was my privilege to attend the graduation ceremony of the nursing faculty at Queen's University, Belfast. It was impressive. One reason for that was the number of young people who, despite the difficulties in our Health Service, are coming forward to take up a career in that service. However, the stress they will face, the conditions in hospitals and the lack of morale among people already working in the system will result in many of those young people, after a very short time, going elsewhere to pursue their careers. Buildings are outdated and equipment needs to be updated. But the most debilitating effect on those who work in our health system is caused by the apparent lack of decision by those who control it. I said in a previous debate that decisions are needed in the short term, not more consultations and more blame. If that "mind change" could be achieved - so that instead of blaming one another, each of us could contribute in our own way and could work together to the betterment of our system - decisions could be made in the short term to benefit those who are currently concerned and worried. To be told "Yes, we are consulting" is not much comfort to someone lying on a trolley in a hospital corridor. That person wants action, not words. I support the motion. |