I beg to move
That this Assembly expresses its grave concern
about the future of primary care services in Northern Ireland and
calls on the Minister of Health, Social Services and Public Safety
to take prompt action to allay the serious concerns of the
professionals and staff working in health and social services
about the arrangements for local health and social care groups.
The debate is about the future of primary care
services in Northern Ireland. The Prime Minister, Tony Blair, and
successive Secretaries of State have told us that the Health
Service should be primary care led — it should be led from the
coalface: from the bottom up; not from the top down. The former
direct rule Minister, John McFall, produced a document some time
ago called ‘Fit for the Future — a New Approach.’ It was
addressed to the New Northern Ireland Assembly, and it expressed a
vision of health and personal social services as a single
integrated service centred around primary care.
The needs of people were to come first, and the
needs of organisations were to come second. The proposed new
groups are to be committees of the health boards. I welcome the
end of fundholding because of the inequities in the system.
However, the four health boards have been around for years,
carrying out the commissioning for non- fundholding practices, and
they have not succeeded. We are moving backwards rather than
I unequivocally support the setting up of new
primary care groups, with multidisciplinary teams working
together. However, the guidelines should have been issued a year
ago — certainly, at least 10 months ago. Our vision for primary
care should be similar to that in England — empowering
front-line staff to use their skills and knowledge to develop
innovative services, with more say in how services are delivered,
and empowering patients to become informed and active partners in
We understand the massive financial constraints
on the Minister and the Department of Health, Social Services and
Public Safety and I am aware of the recent report by the Northern
Ireland Confederation for Health and Social Services (NICON),
which covers the four boards. One of the points that it made was
that an extra £100 million per year is needed, in real terms,
over the next 10 years to bring the service up to an acceptable
level. I accept that there has been a legacy of underfunding over
many years. However, a 7·2% increase for the health budget was
announced in October 2000; £17 million was allocated in November
2000; £14·5 million was allocated in January; and a further
£18·5 million was allocated in February. In total, the budget
available for 2002-03 will be over one third — 37% — larger
than the budget when the Minister took office. That is an increase
of £687 million.
There are huge pressures on primary care
professionals. I must refer to the waiting lists, which everyone
is currently talking about. I accept that there have been 20 years
of underfunding, and I appreciate the efforts that the Minister
has already made. We have the problem of the cancellation of
outpatient clinics. We have so-called bed blocking — I do not
like that term, but we all know what it means. I am aware of the
Minister’s framework for action on waiting lists announced in
September 2001 and the boards’ comprehensive waiting list plans
and quarterly monitoring reports. Indeed, I think that there are
also bimonthly meetings. However, if there were one board instead
of four it might be easier, and we might get more uniformity of
services across the North.
On 20 February, the Minister announced the
establishment of 15 new local health and social care groups, and I
will quote from her press release at that time. Commenting on the
high degree of consensus among stakeholders in establishing the
new groups, the Minister said
"I hope this will point the way to a
continuing focus on partnership, co-operation and shared
objectives, which will be crucial for the new Groups to fulfil
their full potential."
I accept that, but there was not consensus
among stakeholders on the option that the Minister chose. In the
same press release the Minister said
"The experience of the five Commissioning
Pilot Groups has shown that GPs and other primary care
professionals working together in groups have improved the
provision and quality of local services."
I agree with that statement, and I would have
thought that the new primary care groups would be based on such
pilot groups. However, Dr Harold Jefferson, chairperson of the
successful Lisburn commissioning pilot, said in a recent letter to
"I am deeply distressed and disgusted at
the present plans for the local health and social care groups.
What is to be their function?"
Dr Jefferson goes on to make the point that
although we are told that the groups are developing from the
commissioning pilots, they bear scant resemblance to these
On 1 March, the director of primary care in the
Department of Health, Social Services and Public Safety replied to
Dr Jefferson. In his letter the director blames the Assembly,
because it voted last year to delay the ending of GP fundholding.
However, Mr Speaker, you and Members know that the purpose of the
amendment was to facilitate, and ensure that the Department
brought about, a seamless transition into new primary care
structures. Over a year has passed, and we do not have any such
transition. The director also said
"We have always believed that a timescale
for setting up the new groups is achievable, provided that there
is appropriate commitment, co-operation and goodwill from all
However, there is total commitment and goodwill
from all the professionals in primary care.
The problem lies with the Department, which
seems to have wasted almost a year. It is inexcusable that the
guidelines for new primary care arrangements have not been
introduced in the last nine or 10 months. I have heard
explanations from the Department about finance and personnel. It
can juggle the figures in whatever way it likes, but the fact is
that at least 10 months have been wasted. The guidelines must have
been ready a year ago, and I do not see why they were not
announced long before they were.
Mrs Hilary Herron of the Royal College of
Nursing (RCN) sent a submission to the Assembly’s Health
Committee, expressing the disappointment of RCN members. The RCN
referred to the amendment tabled a year ago and the fact that
seamless transition is now impossible. The RCN also stated
"Frontline primary care nurses have not
had an opportunity to voice their opinions regarding the guidance
on the constitution, governance and accountability
Front-line nurses who work at the heart of the
community should be represented in the group.
In its letter of 19 February 2002, the Northern
Ireland Board of the Royal College of Midwives made various
points, one or two of which I will quote
"We were profoundly dismayed therefore to
find that the midwifery profession is not even mentioned in the
recent Guidance Circulars, there is no recognition of midwives as
primary care professionals, there is no provision to have
midwifery representation on the Management Boards of the proposed
new Local Health and Social Care Groups."
The Royal College of Midwives also stated
"Although the Minister in her announcement
of 12 October 2001 indicated that there had been ‘broad support’
for the preferred model proposed in ‘Building the Way Forward in
Primary Care’, the Royal College of Midwives, in common with
most other professional organisations in Northern Ireland,
including the Royal College of Nursing and the British Medical
Association, did not support the proposal to establish LHSCGs as
committees of the existing Health and Social Services Boards,
seeing this as adding another layer of bureaucracy to an already
‘top-heavy’ structure for health care provision".
Dr Brian Patterson of the General Practitioners
Committee (Northern Ireland) of the British Medical Association
Northern Ireland also wrote on 1 February 2002 and made many
points. I will not repeat all that group’s concerns except for
two, which I will quote:
"lack of detailed guidance across the
board bearing in mind LHSCGs are due to go live in 8 weeks’
"no details of timescale as to when LHSCGs
will be empowered".
All Members will have seen that letter, so I
will not quote anything more from it.
The Northern Ireland Multi-Disciplinary Primary
Care Forum stated
"We see proposals that still have no clear
vision or commitment. They create, in the words of one civil
servant, a set of new bureaucratic quangos."
It goes on. The Northern Ireland Public Service
Alliance (NIPSA) quoted two aspects of deep concern:
"fair protection for GP fundholding staff.";
"inadequate public consultations about the
Department’s guidance on the composition and operation of the
proposed Local Health and Social Care Groups."
In relation to the first point, I am aware of
the redeployment centre in the Central Services Agency. I have had
telephone discussions with the relevant person there. I hope it
works out, but I have doubts about it.
The bodies that wrote in totally supported the
new groups, as we all do. They do not, however, make any reference
to delays. Correspondence was also received from Prof Salmon,
Chairperson of the Northern Ireland Trust Nurses Association, from
the Directors of Nursing in the boards and from the Association of
Directors of Social Services, whom we met last week. There were
also a couple of other groups. We all support the local health and
social care groups, but it is a question of how the groups are set
up and why the guidance was not given long ago.
The Minister appeared before the Health
Committee on Wednesday 6 March to discuss the health budget and
primary care. We were pleased that she did, and it took several
hours to cover both subjects. At the meeting, reference was made
to the Committee meeting on Wednesday 27 February, when
representatives of the Royal College of Nursing, the British
Medical Association GPs’ Committee and the Royal College of
Midwives attended. Those bodies requested a meeting with the
Minister. Members will have a copy of a letter dated 19 February,
signed by Dr Brian Patterson, Mrs Hilary Herron of the Royal
College of Nursing and Mrs Breedagh Hughes of the Royal College of
Midwives, in which they expressed extreme worries about the
situation. Those three groups represent many front-line staff,
and, therefore, the Health Committee advised them that they should
seek a meeting with the Minister. At the Committee’s meeting
last Wednesday, we were told that no such request had been
received. I subsequently found out that a letter, signed by all
three representatives, was handed in at Castle Buildings on
Tuesday afternoon. I am not suggesting that the Minister knew
about that, but the letter was handed in.
I strongly support the primary care groups. We
will be in big trouble if we do not get primary care right,
because it is the basis of the whole Health Service. Everyone
concerned must be involved in meaningful dialogue.
I welcome the end of fundholding, and I
sincerely want the new primary care groups to succeed. We have had
a golden opportunity for change. Perhaps it is not too late. The
people of Northern Ireland deserve the best; it is now up to the
Minister and her Department to achieve that.
The time limit for this debate is two hours. As
one might imagine, many Members wish to participate. Therefore, in
order to facilitate as many Members as possible, I am imposing a
limit of six minutes on all contributions, except those of the
Minister and the mover of the motion.
My background is in community child health,
although I trained as a general practitioner. I am acutely aware
that early diagnosis has become increasingly important, due to
recent advances in drug therapy and the potential gains from the
modification of risk factors. In most areas of medicine early
diagnosis assists the GP, as it permits the formulation of a
management plan, which obviates much of the later crisis
intervention. Family practitioners remain the central core of the
provision of support and co-ordination in medicine, which benefits
both patients and carers.
I am not a member of the Committee for Health,
Social Services and Public Safety, but I keep in close contact
with my Colleagues on it. The Department’s consultation paper,
‘Building the Way Forward in Primary Care’, had many positive
features that can be readily supported. The proposals were
outlined in section 6 of the document, following an analysis of
five models or options in the previous section. This is the model
described as option 3, evolving into the option 4 model. Both
models involve the creation of multidisciplinary care groups to
serve populations of between 50,000 and 150,000. Option 3 proposes
groups that would be mainly advisory, while option 4 proposes
groups having devolved commissioning budgets.
If any approach is to be successful in
developing the agenda for change in health and social care and
developing the full potential of primary care, we must clarify the
concept of primary care to include health, social and community
care. It is inevitable, and highly desirable, that closer working
relationships with community trusts will develop, and, eventually,
integration can take place between the new local health and social
care groups as equal partners.
Adequate resources will need to be prioritised
to allow the new groups to flourish. Important areas include
training and managing support and resources for infrastructure and
programme development. The costs involved in information and
communications technology (ICT) development are considerable, but
essential if desirable quality improvements are to be realised.
Much will depend on the overall resource
allocation to health and social care. If the allocation is
inadequate, no amount of innovation or efficiency will be able to
deliver the required outcome. Northern Ireland should aim to have
at least the same resource per capita as any other region in the
United Kingdom — preferably a sum that fully reflects the
additional needs of our population.
Option 4 might not be an end in itself, but it
is a firm foundation for further developments in integrated health
and social care delivery. The Department has said that it must
ensure that the right structures are in place and that the right
policies are pursued in order to achieve the Executive’s
strategic priority of working for a healthier population. However,
we must not become bogged down in bureaucratic wrangling when the
real war is against disease, social injustice and the inequalities
in health and well-being for a large section of the population.
The motion does not argue for the retention of
GP fundholding. Indeed, the argument is not about the merits or
demerits of GP fundholding, which, as it is currently constituted,
is dead in the water. Those who wish to rehash arguments over that
issue have lost the plot, or at best they want to deflect
attention away from the real issue that the motion is concerned
A recent newspaper report about the discontent
over the circumstances surrounding the ending of GP fundholding
exemplifies all that is wrong about the way in which the Health
Service is run in Northern Ireland. It is one thing to remove GP
fundholding, but it is quite another to turn back the clock by 10
years without any understanding of what will replace it, or
without the implementation of a replacement that will fit in with
the improvement of the Health Service. That is not only sheer
incompetence but official ignorance under the guise of skill.
(Mr Deputy Speaker [Mr Wilson] in the Chair)
In its wisdom the Assembly gave the Minister
and the Department a year to come up with clear plans that were
properly resourced and carefully set out, and which could be
supported fully by the Committee for Health, Social Services and
Public Safety and the primary care sector. Instead, the Minister
was aggrieved when the Assembly delayed the ending of GP
fundholding for another year. That was a wise decision. There was
no replacement on the table, under the table or outside the door.
There were not even mirrors. It is now one year later and —
surprise, surprise — the issue is not much further forward. It
is little wonder that professionals are distraught and angry. The
seamless transition is non-existent. The Minister has angered just
about everyone who is involved in the delivery of services.
Doctors, nurses, midwives and a host of other professionals are
extremely angry at the latest botch-up by the Department.
What has been happening? Since the issue was
last debated in January 2001, little has happened. In the past few
weeks, however, there has been some activity. The Department
issued a press statement on 16 October 2001. Impressively, it took
from January 2001 to October 2001 to come up with that. The
statement was followed by a circular on 14 December 2001. There
was no consultation or negotiation before, during or after those
events. It is an attempt at change by uninformed, incompetent
diktat. It is clear that if the Minister had spoken to
professionals, she would simply have exposed her own ignorance.
The Minister promised the Assembly that when GP
fundholding was replaced, all would be well. All is not well, and
worse still, there will now be a gaping hole where once was there
were clinicians in operation. That is hardly the most brilliant
piece of leadership. There is chaos, uncertainty and, at best,
mere cant. It is unacceptable that just a few weeks before the
changeover nothing concrete is in place. Perhaps everything is
supposed to happen over the next couple of weeks, as if by magic.
Furthermore, there is no blueprint. Neither the Health Committee
nor the Assembly has been presented with the finalised blueprint
for primary care, a blueprint that should have been debated and
voted on by the Assembly. That would show professionals where
things are going. How the Minister can continue to make piecemeal
changes without a plan is beyond the comprehension of any rational
The Minister, the Department and those who work
in the primary care sector do not know where things are going. Not
once has there been a simple outline of how the removal of GP
fundholding, in the absence of any specific transitional scheme to
finalised agreed arrangements, will improve either the quality or
quantity of care. There has not been one piece of hard, factual
data. The Assembly is entitled to hear how the removal of GP
fundholding will improve the quality and quantity of care to
patients in the absence of a transition to finalised arrangements.
Where are the hard, real, factual data?
On 17 January 2001 it was recorded that the
Chairperson of the Health Committee expressed the strong view of
the Committee that GP fundholding should cease only when the
Department could make the planned seamless transition to an agreed
Amazingly, we are no further on today. Those
who argued against our motion last year said that it was wrong.
One Member had the nerve to suggest that an extension would not
allow for a proper replacement for GP fundholding to be put in
place and that it ought to go immediately.
We must listen to the British Medical
Association (BMA), which wrote to the Committee for Health, Social
Services and Public Safety about the end of GP fundholding and
said that there had been no detailed guidance, no details about
timescales, no proper resources, no meaningful consultations, no
primary care development funding and no details about the
redeployment of GP fundholding staff. That is a clear vote of no
confidence on the part of the professionals. I support the motion.
Mr J Kelly:
Go raibh maith agat, a LeasCheann Comhairle.
This motion does not come before the House with the full consent
of the Health Committee. The vote was 4:3 in favour. My Colleague,
Sue Ramsey, and I opposed its tabling because of the same
misinformation that we have heard from Mr Berry. We believed that
the motion would be divisive and would not be concerned with
primary care or with the delivery of healthcare to those who need
At the Committee’s meeting last Wednesday,
Sue Ramsey and I asked for the motion to be postponed for a week
or a fortnight to allow people working in primary care piloting
commissions to address the Committee. The Committee has only heard
from groups opposed to the transition from GP fundholding to
primary care. Even within those groups, there has been marked
disagreement over the way forward.
I thought that the Committee’s function was
to bring the Minister before it to address its concerns about
primary care and to ask people working in that sector to give the
Committee their views on the transition from GP fundholding to
primary care. That did not happen. There was no consensual
discussion from those representative bodies in favour of primary
care. Their point of view was not heard. The only point of view
that the Committee heard came from those who were ostensibly
opposed to the introduction of primary care. The Royal College of
Nursing, the Royal College of Midwives and the BMA disagreed among
themselves over the way forward.
It was inappropriate for the Chairperson of the
Committee, as a GP, to bring the motion to the House without
declaring his interest in the transition from fundholding to
On a point of order, Mr Deputy Speaker. If Mr
John Kelly looks at the record of the debate last January he will
see that I clearly and unequivocally stated my slight link with
primary care at that time. My position has not changed since then.
On a point of order, Mr Deputy Speaker. The
Assembly is entitled to note that the Chairperson of the Health
Committee, Dr Joe Hendron, is a GP — the world and his wife know
that. Any suggestion in these circumstances that he has any axe to
grind or that he has misled the Assembly or the Committee in any
way is quite wrong, and that should be stated.
Mr J Kelly:
The Chairperson’s vested interest in GP
fundholding was not on the record of this debate.
The House of Commons Select Committee on Health
said of the transition from GP fundholding that it would improve
patient care and the health of the population by
"putting doctors and nurses into the
driving seat and by ensuring co-operation rather than competition
within the NHS".
We support that.
The Committee’s second report also recognised
"there have been some problems with
implementation in areas where there have, historically, been
tensions between fundholders and non-fundholders and that changes
are going ahead more smoothly in areas where general practice has
traditionally enjoyed a good relationship with the health
It went on to say that all health professionals
in primary care, whether in general practice or community trusts,
were finding the pace of change quite threatening, so there have
been difficulties in England, Scotland and Wales with the
transition from fundholding to primary care. Such expressions of
doubt and concern have not just come from this Assembly, its
Committee for Health, Social Services and Public Safety and its
My colleague and I oppose this motion, because
ample opportunity was not given to practitioners in primary care
to express their views to the Health Committee. There are
difficulties, but the best way to address them is for the
Minister, the Committee and all the groups involved in the
transition to meet and discuss how those difficulties could be
solved. A more orderly method of teasing them out is by discussion
and debate. There is no doubt that primary care is the care of the
future — by all objective standards of critical analysis it can
ease tensions in the Health Service. Go raibh maith agat.
I thank Dr Joe Hendron, the Chairperson of the
Committee for Health, Social Services and Public Safety, for
bringing a vital subject to the Floor of the Assembly. I also
welcome the Minister and hope that she can help us to overcome our
We must not forget that the one-year extension
to GP fundholding brought benefits to local communities. However,
we are a few weeks away from the introduction of an entirely new
system, and I am deeply disappointed that very little is known
about how things are expected to work out. I hope we are not
experimenting with the health, and possibly the lives, of people.
Ordinary people want and expect a good local GP service, and in
general they are not interested in how it is administered.
All Assembly Members have received
correspondence from anxious people, one organisation noting that
"A year of development time has been
squandered, Assembly wishes ignored.."
This is not the first time that Assembly wishes
have been ignored, and we must act to ensure that the will of the
Assembly counts and is acted upon by the Executive and its
Ministers. The same organisation concluded that
"the opportunity to change the HPSS to
work better for the population has also been ignored.
We see proposals that still have no clear
vision or commitment. They create a set of new bureaucratic
quangos. They have no obvious purpose or goals, certainly none
that could not be achieved by existing arrangements."
In addition, the Hayes Report identifies the
need for a strong, well-organised primary care system. That does
not seem to be the aim of current policy guidance, and it
certainly will not be its outcome.
I support local primary care groups that can
and must make a difference to the health of our constituents. I
appeal to the Minister to heed the advice of medical professionals
who have years of experience and are willing to see change
succeed. There is no reason to change the system unless we are
confident that it will bring early benefits to health provision
for everyone. That must be a priority for all. I support the
Health and social care groups will improve
prospects for better services if they are developed through
meaningful engagement between professionals and service users. The
experience drawn from successive primary care pilot schemes has
shown that family doctors, community nurses, social workers and
other professionals can work together successfully to redesign and
develop services for the community. For the benefit of all, we
must grasp and exploit the opportunity to extend this concept to
people throughout Northern Ireland.
The purpose of local health and social care
groups is to give the people who work in primary care, and the
communities that they serve, more influence over the way in which
services are arranged and developed. At present, planning and
development of the services is organised through what is called
"commissioning", and responsibility rests with the four
boards. It is important that, under the new arrangements, the next
few years will see local health and social care groups gradually
taking on more responsibility for commissioning services. Most
importantly, the process must be undertaken through effective,
collective working between professional staff and community
representatives. We hope that the boards will be fully committed
to actively supporting the growth and development of these groups.
We have stressed on several occasions the
importance of how the 18 members of each group will be chosen.
When the groups become fully operational, five of the members will
be GPs, and the remainder will be made up of a range of
grass-roots health and social care professionals, including those
allied to medicine, nursing, pharmacy and social work. It is
significant that two members will be community representatives who
will promote the interests of patients and other service users.
Scotland, England and Wales are already moving
in this direction, and it is time for Northern Ireland to develop
such community groups. A balance must be struck between
representation and the obvious need to not make the groups
cumbersome. Initially, not everyone will be able to achieve
representation. We are glad that there is a mechanism to review
the situation within 18 months. Groups will be able to be
flexible, but I stress that midwives should be represented on them
— they must not be left out.
I understand the Member’s concern about
midwives. The Royal College of Midwives expressed that concern, so
I raised the matter with the Minister in the Health Committee
meeting on Wednesday. The Minister said that, in the guidance,
"nurses" is used as a generic term and does not exclude
I thank the Member for that information. That
is good news, and I hope that midwives will be included.
Real opportunities to improve services and
build community confidence and the confidence of professional
staff do not come often and must be quickly and properly grasped.
It is clear from letters that we receive that there are concerns
about the Health Service, but they can, and should, be addressed
through the normal channels. My Colleague, Monica McWilliams, as a
member of the Health Committee, will be working to allay those
Making changes to health and social services is
rarely risk free. However, it is a hugely important task that is
often wrongly perceived as presenting a threat to the stability of
existing services and to the jobs of much- valued health and
social care staff. Health and social care groups can strengthen
services — they pose no threat to the roles and jobs of
front-line staff. If anything, they maximise opportunities for
staff and provide a basis for professionals from many backgrounds
to interact more readily with patients and to tailor successfully
services to meet their specific needs.
Although we accept that the Minister should
work hard to allay existing concerns, we do not support the
motion. This is a real chance to make meaningful and constructive
change to primary care services in Northern Ireland, and we should
take that chance when we can.
I support the motion. It is public knowledge
that the Health Service as administered in Northern Ireland is
dysfunctional. The waiting lists are not only the worst in the
United Kingdom, they are the worst in Europe, and it is plain that
organisational reform of the delivery of primary healthcare is
nothing short of chaotic. What are the reasons for that? The first
reason is how resources are used, and the second is the delay in
this much-needed reform.
As Dr Hendron rightly pointed out, capital
investment in the basic infrastructure of health was underemployed
for many years under direct rule. However, that merely underlines
the failure of those who agreed the terms of devolved Government
to ensure that the underspend on capital infrastructure funding
was made good.
Having said that, resources are also being
massively reduced by a welter of bureaucratic expense under
devolved Government. Several weeks ago, I pointed out that £1·2
billion will be spent on the administrative costs of running the
11 Departments and the Assembly. Almost 14% of the block grant is
being spent on feeding the Assembly and its administrative
processes, which are a dripping roast for those who benefit from
I have been recently informed that the cost of
ministerial cars, which are provided by the Assembly and by the
Administration, amounts to £1·2 million per annum. Something
must be done about resources. We shall not receive more resources
through any increase in the Barnett formula, so they must be
obtained in other ways — and not by petty efforts such as
raising the rates by £12 million to screw many small businesses
and put them out of business when that £12 million will
cover only one third of the £36 million needed to meet the Office
of the First Minister and Deputy First Minister’s administrative
costs alone, Mr Trimble’s Department. Therefore, something must
be done about resources.
There is also the issue of organisational
reform. It is plain from correspondence to Members from the
professional organisations affected by these reforms — GPs,
midwives, nurses and other care professionals — that the
transitional arrangements for going from fundholding to the
provision of primary healthcare through local health and social
care groups is nothing short of a disaster. The Minister has
provided no guidance on the core issues. Local groups cannot
influence either the commissioning of secondary care services or
primary care development, and we have no details of the timescale
within which the groups will be able to do that other than a bare
statement in a circular.
The Minister’s statement of 16 October 2001
about groups progressing to delegated budgets as quickly as they
can demonstrate their capacity to deal with them entirely ignored
the fact that a broad spectrum of fundholders and other groups
have experience of controlling their budgets and could do that
efficiently. There are no guarantees with regard to service
provision to patients after 1 April. However, the Minister has
done something about that belatedly. The funding arrangements are
totally inadequate. In Northern Ireland the funding will be £3
per patient; on the mainland the funding is between £7 and £8
per patient. How can any form of comparable primary healthcare
service be delivered when the cost of providing that is being cut
from £7 or £8 to £3? There is also a lack of meaningful
involvement of all stakeholders in the process, and there has been
no meaningful consultation on the constitution of the groups, the
management boards or the remuneration arrangements.
In response to John Kelly, I will close by
stating that most groups are totally opposed to what is happening.
The South and East Belfast Primary Care Group had this to say:
"In February 2001, the Assembly rejected
the timetable then proposed to develop new Primary Care structures
issued by the DHSSPS. The Assembly accepted the argument that the
gap between the ending of existing arrangements on 1 April 2001
and the earliest operational date of any new proposals would be
detrimental to the provision of Primary Care services."
The Minister and her Department have wasted an
entire year and have failed to put in position any guidance,
instruction or constitutional arrangements whereby primary care
can be developed. I have great pleasure in supporting the motion.
I approach the motion and its expression of
concern for the new structural arrangements based on information
that I have received from people on the streets and in
constituency offices, including people from the medical
fraternity, and their experiences. There is enormous and grave
concern that the new structure is not even designed to deliver
better primary care and will constitute yet another bureaucratic
structure laid over an already overstructured delivery of medical
There is concern about the levels of
bureaucracy and the levels of resources that were supposed to be
available for the new development. I hoped, as did all laypersons,
that the new structure would speed up access to primary care and
contribute to shortening the much-quoted waiting lists, which are
causing increasing daily concern to people on both elective and
non-elective waiting lists. An increase over the past year of
14·5 % and a failure by the Department to achieve its set targets
and explain why those targets are not being met against a
backcloth of increasing funding are shortcomings, not least in
We must try to achieve that clarity so that we
can redress what appears to be happening, which seems to be —
and I cannot substantiate this with facts and figures — more
money chasing less effective delivery. If that is the case, it
requires an urgent and extreme remedy.
I come to the debate not from the point of view
of statistics or finance but from my experience and knowledge of
the unnecessary pain and suffering being placed on families, the
communities and the country. The relief of pain and suffering is
the objective of all medical services.
Mr J Kelly:
Will the Member give way?
No, I have just started. I will give way when I
come to something substantial that the Member might wish to query,
but I have not dealt with the generics yet.
It is correct to look at how efficiently and
effectively the Heath Service is administered, but that must be
done with the objective of achieving better relief of pain and
suffering. We cannot include in a motion such as this the
provision of care for cancer patients, because that is not primary
care - although initially everything is primary care. People are
literally dying against a backcloth of a lack of medicines and
treatments that are available elsewhere, and that is never
acceptable in a society such as ours.
Alongside that, medical professionals - GPs,
midwives and district nurses - do not know how the proposal can
work, and they do not know why it has been made. In fact, GPs have
asked the Department to explain the objective, purpose and
facilities that will drive the new structure, which will start in
two weeks, but they have not had a meaningful answer.
We have heard Members talking about a variety
of bodies - the Royal College of Nurses and the Royal College of
Midwives - who say that there has been no meaningful
consultation on their participation. However, district nurses and
midwives are primary carers. If they do not know what is going on,
what, in the name of God, are the patients going to do?
GPs are not sure about what is happening and
what will be expected from them. The new body to be set up - and
I stand to be corrected on this - will consist of GPs, who will
get an extra £17,000 a year for administration. All of the
others, midwives, district nurses and lay people, if there are
any, will get nothing. This is not an even-handed scheme that will
encourage co-operation and a better development of resources.
The BMA finds the process incredible. It says
that there is no long-term vision, no medium-term plan and no
short-term direction. It criticises the lack of information it is
receiving from the Department, information that is necessary to
achieve what, it is hoped, will be an improved system of delivery.
Mr Deputy Speaker:
Time is up.
My goodness - time passes when you are