Bangor and Newtownards Minor Injury Units: Closure

Adjournment – in the Northern Ireland Assembly am 5:45 pm ar 30 Ebrill 2024.

Danfonwch hysbysiad imi am ddadleuon fel hyn

Photo of John Blair John Blair Alliance 5:45, 30 Ebrill 2024

In conjunction with the Business Committee, the Speaker has given leave to Alex Easton to raise the closure of the Bangor and Newtownards minor injury units (MIUs). I call Alex Easton, who has up to 15 minutes.

Photo of Alex Easton Alex Easton Annibynnol

At the outset, I say to the Health Minister that I in no way blame him for the closure of the Bangor and Newtownards minor injury units. My comments are not directed or aimed at him in any way but are comments of frustration and annoyance about the closure of the two minor injury units. I hope that he understands that. I suspect that, had the Minister been in place, there might have been a different outcome.

On 6 March 2023, the South Eastern Health and Social Care Trust launched a consultation to close the Ards and Bangor minor injury units. The Bangor minor injury unit had already been closed for some time due to COVID. I always said that it would never open again, despite reassurances at the time from the Health Minister that it would be reopened. How accurate my prediction was: the Bangor minor injury unit never reopened its doors. It was stripped of its equipment even before the consultation was finished.

The South Eastern Trust launched its consultation with one public meeting in Newtownards, attendance at which was booked through a complicated system, which immediately put people off going. A further two Zoom meetings with restricted numbers were held. No meeting was held in Bangor, despite it having the larger population, nor was there one for residents living in the Ards peninsula, the furthest point away. On the evening of that one public meeting, the South Eastern Trust arranged a format that meant you had to hand in questions beforehand so that it could control what was asked and by whom. So much for a fair consultation.

The South Eastern Trust proceeded to say what its plans were. Closure, with the announcement of a new minor injury unit at the Ulster Hospital site, was the only option. The consultation farce continued with the South Eastern Trust's failure to mention that the Ulster Hospital was not creating a new minor injury unit, because there already was a minor injury unit at that site. Ironically, few people knew about it. It was the world's best-kept secret. The next farce came when the new unit, which was not new, was moved into the old Ulster Hospital A&E unit, which was declared not fit for purpose by the South Eastern Trust itself.

At the public meeting, the South Eastern Trust claimed that it was closing the units as a result of the Bengoa report. That is where I have a problem. Minister, your colleague and mine, Alan Chambers, pointed out in 'The County Down Spectator' on several occasions that the Bengoa report should not be used as a reason to close MIUs; in fact, the Bengoa report does not even mention MIUs.

The consultation documents were the poorest example of their kind. It is difficult to see how any external consultee could have provided an informed response that might have affected the South Eastern Trust's decision-making process on the basis of the document. There are two main issues with the consultation documents. First, important information on the policy, background and evidence base that informed the South Eastern Trust's decision-making process was missing from the consultation document.

Secondly, insufficient assessment was done of the impact of the proposed changes on service users, including section 75 groups.

That is problematic, as the scale of the change is likely to generate different impacts across areas and population cohorts on their having access to minor injury services. The consultation did not provide evidence of the South Eastern Trust's preferred option: the replacement of the two minor injury units with an urgent and emergency care centre. That has not even got off first base and was a red herring. It could be years before it happens, if ever.

The Department of Health's 2022 review of urgent and emergency care services unambiguously states:

"Urgent Care Centres do not replace existing Minor Injury Units."

It is clear that the review was conducted on that assumption. The accompanying equality impact assessment (EQIA) was also flawed. First, it was prepared using outdated statistical information from the 2011 census. That data was superseded by results from the 2021 census, which were published between September and December 2022. The trust did not use that updated information. In addition, the disability measures used in the equality impact assessment did not accurately reflect the number of individuals with a disability in the relevant geographical areas. That was because it used a measure based on households rather than on individuals. The equality impact assessment also did not measure the different impacts of the proposals on section 75 groups. It merely listed the number of individuals falling into each category in two broad geographical areas. In fact, by the South Eastern Trust's own admission, it openly discriminated against those who are disabled in the consultation on the closure of the minor injury units.

The consultation approach to the Bangor minor injury unit was problematic. The location was shut temporarily owing to the COVID-19 pandemic, without there having been a public consultation, yet the subsequent consultation document was produced on the basis that that closure was permanent. That meant that the consultation focused primarily on the proposals to close Ards minor injury unit, with minimal reference made to the facility in Bangor. That seemed inappropriate, especially as the South Eastern Trust's preferred option would have had a greater impact on residents of Bangor, owing to the greater distances to travel, poorer-quality roads and weaker public transport links to the Ulster Hospital site. From a freedom of information request, we know that the South Eastern Trust did not even bother to contact Translink about improving public transport to the Ulster Hospital site.

The consultation also contains a number of concerning elements, suggesting a lack of understanding of the area and the issues involved. First, the South Eastern Trust consistently used a map in the consultation that does not accurately represent the area. The map shown in the consultation included the entire Newry, Mourne and Down District Council area, which has nothing to do with the South Eastern Trust area.

We therefore know that the consultation and the equality impact assessment were a farce and a foregone conclusion. Let us look at the impact on the Ulster Hospital site. We know, from a freedom of information request, that the new A&E building is smaller than the old one, has fewer beds and is too small overall. Well done to the person who thought that one up and designed it. We know that there was no new minor injury unit on the Ulster Hospital site, as there was one already there. We know that some new, additional car parking spaces were provided. Anyone going up to the Ulster Hospital, however, has to wait for a space and is often met with queues. That means frustrated patients and visitors waiting for long periods. I took my wife up there this morning because she had previously fallen and broken her hip and had an outpatient appointment. We had to wait 45 minutes to get a car parking space, so that is more evidence.

We know that, as a result of the closure, only seven members of nursing staff from the Ards and Bangor sites transferred. The rest left, so we have lost valuable staff. What do we know about the patients who were attending the Ards and Bangor minor injury units annually? We know that up to 13,000 patients a year were attending the Bangor minor injury unit. Some 10,200 patients a year were attending the Ards minor injury unit. Those stats were provided in answers to Assembly questions. Either they have not gone to the Ulster Hospital minor injury unit because they cannot stand the thought of going there and spending hours waiting or they have tried to go to their GP. GPs are not seeing patients as they did pre-COVID, however, and people do not want to queue on the phone for hours just to wait on a call from their GP.

Then, of course, some people have gone to the Ulster, adding to the waiting times, backlogs and car parking issues and putting more pressure on the Ulster Hospital site, which is not equipped to cope. It is no coincidence that the Ulster has frequently declared an emergency as a result of A&E being too busy due to the number of people attending. According to the response to a question for written answer, there were zero savings to the South Eastern Trust budget from the closure, so the question is this: why close the MIUs when, between them, they kept 22,000 people away from the Ulster Hospital site? If there were no savings, why did they do it?

We then come to the Alliance Party, which gave the South Eastern Trust political cover to close the Bangor and Ards minor injury units. Its political reps said:

"Minor injury units are not good enough and should go".

I quote two Alliance councillors, who said that the units had not been "of any use". If they were of no use, why did 22,000 people use the two minor injury units at their height?

Over 20,000 people signed a public petition opposed to the closure of the units. That was ignored, even though, in the public consultation, 80% opposed the closure. That was also ignored. What is the point of a public consultation if the public's responses will just be ignored?

The closures have achieved nothing but the creation of a bigger crisis at the Ulster Hospital site, with longer parking waiting times, overworked staff and frustration for the public. Minister, I thank you for hearing my frustrations and those of the public who, until now, have not had their voices heard. I hope that you will rethink the closure of the MIUs, because the staff did a wonderful job and took a lot of pressure off the Ulster Hospital site.

Photo of John Blair John Blair Alliance 6:00, 30 Ebrill 2024

Thank you for opening the debate. Other Members will have approximately five minutes in which to speak.

Photo of Stephen Dunne Stephen Dunne DUP

I welcome the opportunity to speak on this matter, and I thank the Member for securing the debate. I thank the Minister for his attendance. I know, Minister, that you have had a busy day, so thank you for staying with us this evening.

I firmly believe that the decision to close the Bangor minor injury unit in 2020 and, subsequently, the Newtownards minor injury unit at the end of August 2023 was the wrong choice by the South Eastern Health and Social Care Trust and the Department. The strength of feeling about the decision has been evident over the past number of years, including throughout the trust's consultation period, when over 80% of respondents spelled out their concerns loud and clear in writing, at the various public consultation events and through petitions.

When the decision was taken in August 2023, there was already significant pressure on the Ulster's emergency department (ED), with official figures stating that the Ulster's emergency department was seeing 9,000 more patients than it had done five years previously. That was prior to the decision to close the Newtownards unit and not reopen the Bangor unit. It has been eight months since the closure of the Ards MIU, and, today, the Ulster's emergency department is under extreme pressure.

I commend and pay tribute to the hard-working staff across our local health service in what are very challenging circumstances indeed. Those staff go well above and beyond the call of duty, in high-pressure environments, to provide excellent care 24/7, 365 days a year. I put on record our thanks to those dedicated staff who continue, no matter where they are, to give that commitment and dedication. That must be saluted.

The commitment, promised for 2025, to open, as a second phase, a new urgent care centre, co-located with the new ED, was a key part of the transition process and, I suppose, a way to justify closing the two well-used and valued services. We have been writing regularly to the Minister on that matter, and I trust that plans for the urgent care centre will remain on target, as it is greatly needed. I welcome the fact that work is ongoing to ensure that it opens ASAP, and I hope that that will mean very early in 2025.

There are genuine concerns across our areas about the size and capacity of the new emergency department at the Ulster. I know, from speaking to staff and even from personal experience, of the genuine concerns about the size and scale of the emergency department and about the external pressures on the site, such as the car parking capacity and the road infrastructure around the hospital estate. That road is very busy, as are the various networks in and out of the hospital. I am sure that everybody here will be familiar with the hospital. There are real issues with closing sites in the surrounding areas that we represent.

The population of Ards and North Down was over 163,000 at the time of the 2021 census, which made it the fourth-largest local government district. That was an increase of 4·5% since the 2011 census, and, with people living longer, there is even greater pressure across all our health services.

I appreciate that valuable services continue at the Bangor and Ards sites. Perhaps the Minister could spell out some of the services that are available at those sites. I visited Bangor Community Hospital around a year ago — I think that some colleagues were there as well — and it was very valuable to hear directly from the services that are still there. The message must go out that there are still services available there, including dentistry and some optician work, which are very valuable for local people of all ages.

The South Eastern Trust confirmed recently that no savings were made as a result of the decision to close the Bangor and Ards MIUs. However, there is no doubt that people in my constituency feel short-changed by the Health Department and the trust. As detailed in the public consultation, the decision was not taken to make financial savings but rather to reshape and sustain urgent and emergency care services in the Ards and North Down area. However, I emphasise that there is a genuine feeling that there has been a reduction in the service since those valuable MIUs closed their doors.

As we all know, there is significant pressure on our GPs as well.

Photo of John Blair John Blair Alliance

Will the Member bring his remarks to a close?

Photo of Stephen Dunne Stephen Dunne DUP

Those GPs continue to face challenges.

I thank the Minister for coming to the House, and I ask him to do all that he can to improve service provision for the people across Ards and North Down.

Photo of Connie Egan Connie Egan Alliance

Thank you, Health Minister, for coming to the Chamber today.

The decision to relocate the Bangor and Newtownards minor injury units to the Ulster Hospital came from the No More Silos action plan. That was clearly stated in the consultation from the South Eastern Health and Social Care Trust around the future provision of those services. The No More Silos action plan set out 10 key actions for rapid implementation to ensure that urgent and emergency care services across primary and secondary care could be improved. The No More Silos action plan was, importantly, in line with the Bengoa report recommendations. I asked the Health Minister about that in a question for written answer upon the restoration of devolution, and I was glad that he was able to clarify that.

All parties signed up to Bengoa, which stated:

"The stark options facing the HSC system are either to resist change and see services deteriorate to the point of collapse over time, or to embrace transformation and work to create a modern, sustainable service that is properly equipped to help people stay as healthy as possible and to provide them with the right type of care when they need it."

Our health service is at crisis point, and I think that we all recognise that. Our hard-working health and social care workers are going above and beyond to keep patients safe. When the Bengoa report was published in 2016, it gave us this warning:

"The Northern Ireland Executive invests annually almost £4.6 billion, or 46% of its entire budget, in providing health and social care services for the people of Northern Ireland. If costs rise as predicted, with a 6% budget increase required annually simply to stand still, then we can expect the budgetary requirement to double to more than £9 billion by 2026/27 to maintain the current system. This is clearly not sustainable".

That is a quote directly from the executive summary of the Bengoa report. We are well on our way to that warning becoming a reality.

Last week, the Northern Ireland Executive produced a Budget in which Health was allocated nearly £8 billion, which is just over 51% of the Executive's overall funds. Even with that being the case, the Health Minister has stated that it is not enough. That is in the context that Northern Ireland currently spends more per head of population on health than our counterparts in England but has the worst outcomes.

I understand that change can be difficult, but it is clear that the options in front of us for our health service are change or collapse. We simply cannot go on as we are.

My party and I will always follow the evidence when it comes to making decisions on our health service. We will not play politics with people's health and their lives. The Health Minister and the Bengoa report have called for leadership from elected representatives regarding decisions on our health service, and Alliance MLAs and councillors have not been found wanting. We have engaged with the trusts throughout the process and with consultants and doctors who work in the Ulster Hospital's accident and emergency department. Why did those who say that this should have been a decision for the Health Minister continually vote against the restoration of devolution? What was more important than health?

This week, I met a consultant in emergency medicine at the Ulster Hospital who reported on the positive impact of the enhanced minor injury unit at the hospital. The service is now open 12 hours a day instead of eight and 365 days a year instead of being closed at the weekends, as it was in Bangor and Newtownards. That, again, has been backed up by statistics provided by the Department of Health. Since opening in September 2023, the enhanced minor injury unit in the Ulster Hospital has seen over 10,000 patients and received only five complaints. Patient surveys on the service have received excellent feedback, with over 97% of patients who have used the minor injury unit recommending it.

The issues in accident and emergency care are, of course, of concern to us all, but I will take my leads from the experts who are telling us clearly that the long waiting times and backlogs of ambulances in A&E departments are due to a lack of care packages for those who cannot be discharged from hospitals, not the relocation of the minor injury units. The debate on the transformation of our health service requires leadership and following the evidence and the experts. I look forward to hearing clarification from the Minister later in the debate on some of the points that have been raised today. Alliance will support the Department of Health in transforming our health service by implementing the Bengoa commitments that all parties signed up to.

Photo of Alan Chambers Alan Chambers UUP 6:15, 30 Ebrill 2024

The minor injury unit in Bangor Community Hospital was closed during the COVID pandemic as it was considered that the nursing staff would be better deployed at pressurised inpatient hospitals. The closure was sold as being temporary, and, given the logical reasons offered by the trust, no one raised any serious objections at that point. However, when the trust announced that it would not be reopening the Bangor minor injury unit and would also be closing the unit in Newtownards, it was a different story. There was considerable public concern about that announcement, and the trust commenced a public consultation on its proposals. Many members of the public had little confidence in that process.

Those of us who, as public representatives, argued against the trust's proposals were accused of hypocrisy in that we openly supported the transformation of our health and social care systems as laid out in a series of road maps in the Bengoa report but became parish-pump politicians when local closures were proposed. There are two elements of the project that blow out of the water the distractions used by the political closure cheerleaders, who seriously misread the local public mood on the closures.

First, on more than one occasion, representatives of the trust pointed out that they had serious staffing issues coming down the line. There was a shortage of the highly qualified nursing practitioners who ran the minor injury unit. We were told that at least three of those nurses were about to retire and that replacements were almost impossible to find. They also stated that they needed more of those nurses in the Ulster Hospital. It was clear from those remarks that the closures were playing no part in transformation, as I understand it, and instead were being used as an opportunity to solve staffing issues at the Ulster Hospital.

The second point that the cheerleaders for the closures ignored was a comment by the Health Minister in a previous policy document in which he stated clearly that the creation of an urgent care centre should not mean the closure of a minor injury unit. One of the selling points of transferring the minor injury unit to the Ulster Hospital site was the promise of a consultant-led urgent care centre that would work alongside the A&E department. Where is that urgent care centre? The forecast date for its opening continues to be pushed further down the road. Would it not have made more sense to have postponed the closure of the minor injury units until the urgent care centre was ready to operate? In my view, that did not fit with the trust's immediate need to relocate the staff to the Ulster Hospital site.

I and my party have never been opposed to the reconfiguration of the health system, but it needs to be evidence-driven and clearly in the interests of patients. I was not convinced that the closures were made for the right reasons or in the best interests of the North Down public. For my party, service transformation should not be viewed as some sort of catch-all phrase or used as a cloak of convenience. For us, it is about ensuring that patients receive the best care in the best environment and within the best time frame possible. Yet, in this instance, the permanent transfer of the minor injury service to the Ulster Hospital appeared to be driven as much by challenges in recruitment as any other broader strategic decision to co-locate the service. In particular, I was concerned that moving such an important service to the Ulster Hospital site, with all its known issues of congestion, was perhaps going to make the situation even more difficult for local patients and staff, and so it has proved. The fact that it was undertaken during the absence of an Executive and functioning Assembly also meant that there was zero political oversight. It was signed off by a senior civil servant and not by a Minister.

Given the passage of time and the well-documented budgetary constraints, I suspect that the Minister has little or no scope to turn back the clock. What he can, perhaps, do is to encourage the trust to expedite the operation of the promised urgent care centre. He could also ask the trust to deliver on the promises of improved public transport connectivity.

The situation is a perfect illustration of why it is so important to have an Executive and Assembly in place to provide the political and democratic oversight that, sadly, does not exist when the political institutions are down. In conclusion, I place on record my admiration and appreciation of everyone involved in providing us with healthcare in the current difficult circumstances.

Photo of Michelle McIlveen Michelle McIlveen DUP

I thank Mr Easton for securing the Adjournment debate. He pursued this issue doggedly and relentlessly during the consultation and has continued to do so since the imposition of the decision. That decision was made contrary to the vast swathe of public opinion, which simply could not comprehend why the trust was pursuing this course of action. I thank Mr Easton for his efforts in fighting this, including organising a petition that was signed by thousands of local residents. I also put on record my support for the health professionals, who are working in incredibly challenging circumstances.

I was present at a strictly controlled public consultation event in Newtownards that was run by the South Eastern Trust. Questions had to be submitted in advance, and, perhaps coincidentally, the majority of the questions that were drawn out came from Alliance Party reps, the Alliance Party being the only party that supported the trust's proposals to close the MIUs. That party's position was not remotely reflective of the feeling in the area.

A number of local people who attended were deeply frustrated at what seemed to be a fait accompli, which is what it evidently became. They could not understand why local services were being taken away and moved to east Belfast. We heard from the trust that it was to improve services and outcomes. That seemed strange, because, in the Chamber on 22 November 2021, Minister Swann said:

"The trust is confident that patients receive an effective service and has received some positive feedback on the service at Ards minor injuries unit. It is nurse-led. Emergency nurse practitioners provide expert advice to ensure that clinical practice and patient care is delivered to the highest standards." — [Official Report (Hansard), 22 November 2021, p25, col 2].

If it was not for higher standards, since the highest standards were already being delivered, it must have been about making savings. However, in answer to questions for written answer tabled by Mr Easton, the Minister has said that there are no savings.

The Alliance Party claimed that the decision to close the MIUs in Newtownards and Bangor was as a result of Bengoa. Despite being repeatedly told by others that that was not the case, the Alliance Party has insisted on that fallacy, taking the opportunity to criticise other parties for saying one thing in relation to supporting Bengoa and doing another when it came to local services. I ask the Minister to take the opportunity to reiterate what he said in his answers to those questions for written answer and to make it clear that the decision around the MIUs had nothing to do with Bengoa.

The trust also indicated that, in order to establish an urgent care centre at the Ulster Hospital site, it needed to close the two MIUs. Yet, in 2022, the Ulster Unionist Party health spokesperson, Alan Chambers — I am glad to see him in the Chamber — wrote a letter to the 'News Letter', criticising Paula Bradshaw MLA. In that letter, he stated:

"if Paula wishes to read the final urgent care policy that was signed off by Robin Swann in March last year she will see on page 42 that it categorically states 'it is important to note that Urgent Care Centres do not replace existing Minor Injury Units.' That is a mere statement of fact, and one which is a [sic] accurate today as it was 12 months ago. Given that fact there is no contradiction in supporting the retention of a local minor injuries facility."

Does the Minister stand by the comments of his party colleague, who, of course, was quoting the Minister?

If care in MIUs was of the highest standard, the decision to close was not a result of Bengoa, there were no savings to be made and there was no need to close the MIUs to deliver the urgent care centre, will the Minister take steps to reverse that decision? It has placed care further out of the reach of my constituents in Strangford. Those constituents have to stand outside in the cold and rain at 8.00 am just to get on a list for a call from a GP. Some travel from Portavogie and Portaferry to go through Newtownards and then battle with congestion at the Dundonald bottleneck to run the gauntlet of trying to find a parking space at the hospital site, and some are constituents with disabilities who, when the final move is made to co-locate the urgent care centre with the emergency department, will be further disadvantaged by the chronically bad parking arrangements at that site.

The decision did not enhance the care of the constituents of Strangford or North Down; it enhanced the care only of those in east Belfast. No justifiable reason has ever been given for the decision to remove that important and well-used local service. Trust reports will never factor in —

Photo of John Blair John Blair Alliance

Will the Member bring her remarks to a close?

Photo of Michelle McIlveen Michelle McIlveen DUP

— those patients who decide that it is too much trouble to travel to the Ulster Hospital site and the impact that that might have on them in later life. Complaints and compliments are no real measure of the unnecessary inconvenience and upheaval that the decision will cause.

Photo of Andrew Muir Andrew Muir Alliance

I speak in the Adjournment debate as an Alliance Party MLA for North Down. It is important that we are able to discuss the issue. We were not able to for two years, because the institutions were not sitting. It is not lost on me that the person who secured the Adjournment topic is one of the people who voted consistently against the restoration of the institutions, which would have allowed us to consider these matters. However, we are where we are now, and we are able to consider the matter in front of us.

I will be relatively brief because I do not want to delay Alex from his campaign launch in Bangor tonight. It is an important issue for the Assembly, and I recognise that the DUP has handed over its slot for the Adjournment debate to Alex.

The easiest thing that the Alliance Party could have done would be to join the protest lines and vote on the motions on the matter in the council, but we did not. People have to ask themselves why we did not. The easiest thing would have been to go with the flow and not have ourselves criticised in this Adjournment debate or in council. The reason is that we believe in transformation. If we cannot do transformation of that nature in an area that covers, essentially, the distance between Newtownards and Dundonald, which is approximately 5 miles, what hope do we have of achieving the true transformation that is required in health and social care? <BR/>Some people will say —.

A Member:

Will the Member give way?

Photo of Andrew Muir Andrew Muir Alliance

Sorry; I will just continue.

Some people will say, "But this was not Bengoa. It is not in line with No More Silos", but, in a meeting on 15 March 2023, the previous permanent secretary in Health confirmed to health spokespeople from all parties that the proposed change was in line with Bengoa and No More Silos. Whilst other people have contributed towards it, the people whom I will be guided by on the issues are doctors and medical experts. I have immense respect for the staff who work in Health and Social Care (HSC). It is an immensely challenging job. I have the utmost respect for them. I know them personally. They are family and friends. My mother worked in the NHS for decades. I will declare that, and I am proud of the service that she gave.

We owe it to them to take the difficult decisions, but we have not travelled the journey that we need to travel on transformation in Northern Ireland. When we go to the UK Government and argue for additional funding, our inability to do transformation in Northern Ireland is cast back at us, and rightly so, because the waiting lists in Northern Ireland are the longest in the whole of the United Kingdom, yet we are spending, arguably, the highest amount on health and social care. Therefore, we need to do transformation. We need to be able to take the difficult decisions. Members say that people were not happy about the position that we took, but I got involved in politics to take difficult decisions. It is easy to stand at the protest lines on these issues.

I recognise the concerns about the emergency department at the Ulster Hospital, and I hope that Alex's wife has a speedy recovery. I know the pressures around this, but the solution is not to oppose change. It is to be able to face up to that and support people in their positions. I recognise that there are concerns around the consultation, but nothing is perfect in this. We could have been debating this for two years. We could have had a Health Minister in position to take a decision, but that was denied. It was denied by the DUP, Alex Easton and Jim Allister, so there is the responsibility when it comes to accountability issues with this.

I conclude by saying that we owe it to Health and Social Care to take the difficult decisions, show leadership and be able to walk the walk, not just talk the talk.

Photo of John Blair John Blair Alliance 6:30, 30 Ebrill 2024

Before I call the next Member, I caution Members that if they take an intervention, time constraints mean that additional time may not be allocated to them.

Photo of Nick Mathison Nick Mathison Alliance

Before I begin my remarks, I want to find the one point of agreement that we have had, which is that we should all pay tribute to our Health and Social Care staff, particularly those working in emergency medicine and unscheduled care. They are doing a fantastic job in very difficult circumstances across Northern Ireland, but I think that that may be the only point of agreement that we have reached in the debate.

Before I look at my prepared remarks, I will pick up on a few things that were mentioned in the debate. Mr Easton suggested that the minor injury unit at the Ulster was in some way contributing to the delays and the backlogs and the difficulty of moving patients through the emergency department. It is my understanding that, if anything, the minor injury unit is actually reducing the number of patients attending the ED and getting clogged up in that system.

I also want to pick up on a comment by Michelle McIlveen that seemed to conflate services at the old minor injury unit and what a GP provides. I suggest that the conditions for which you attend your GP do not require services that you expect to receive at a minor injury unit, which is for broken fingers, dislocated shoulders and those sorts of conditions. I do not imagine that those would require queuing at your GP's surgery, so I am not sure where that comparison was being drawn. I also want to pick up on a comment from Stephen Dunne, who suggested that this was not about saving money but about improving the patient experience. I agree with that, and I know that no change in service is ever perfect from day 1, but, in my view, this minor injury unit is about providing an enhanced service for the least sick patients who do not need to be in an emergency department.

Last year, the trust took the decision to change how minor injuries were treated in the Ards and North Down area. We got confirmation that the old Bangor MIU would remain closed and that the Newtownards site would close, moving all minor injuries treatment to the Ulster Hospital. As already referenced, the new service that is available at the Ulster brings an enhanced offering for patients. There are longer opening hours — 70 hours-a-week access rather than the previous 40 — and a service that is seven days a week, 365 days a year. That is a significant improvement on the five-days-a-week service that previously operated on the other sites. As far as I am concerned, this represents a planned change to locate a service in a setting with access to the expertise that can treat minor injuries and to clinicians who can provide care in more serious cases, should it be required. There is also access to scanning and imaging equipment and a consultant-led team, should the condition be serious enough to require it.

As I referenced, the new service was designed to reduce attendance at hugely stretched ED services and improve the flow through the system for the least sick patients. I agree that all services need time to be fully evaluated and to bed in, but it appears to me that the new MIU is performing well. We have customer satisfaction rates at around 98%. We have patients accessing more streamlined care. I have heard from clinicians working in the service that many can be discharged home from the MIU to return the next day for a scheduled attendance, with scan or X-ray results provided. Those are patients who would have been waiting in the ED for hours and hours, possibly through the night, to receive those results. I know which service I would prefer. In March, 3,500 patients were seen in the MIU, just over 2,000 of them by nurse practitioners and 1,500 by other medical staff on site. Typically, those were more complex cases that could not have been dealt with in Bangor or Newtownards and would almost certainly have had to be redirected to the Ulster Hospital anyway.

I acknowledge that all of this is said in the context of an ED service at the Ulster Hospital and across Northern Ireland that is under huge pressure. None of us doubt that. The patient experience is unacceptable in many emergency departments, but the trust is clear, and I take the same view, that that patient experience in ED is not to do with the closure of MIUs. It is about a hospital system that is not functioning. It is about patients who cannot get discharged because there are no domiciliary care packages, and it is about an Ambulance Service that is struggling to offload patients because of clogging in the system. We need to be brave enough to take the decisions to tackle those problems with our creaking systems. What is not required is the undoing of planned change and the reform of how we deliver what is a fairly small element of treatment in the area. Not small to the people who need it but, as my colleague Andrew Muir said, small in the scale of the health service.

These are the kind of planned changes and reform that we need to be encouraging and supporting as elected representatives, not blocking. I urge my colleagues across the House from North Down and Strangford to get behind the transformation agenda. As we do hope to see the urgent care system developing —

Photo of John Blair John Blair Alliance

Will the Member bring his remarks to a close?

Photo of Nick Mathison Nick Mathison Alliance

— at the Ulster Hospital again, I welcome that and hope that Members will support it.

Photo of Colin McGrath Colin McGrath Social Democratic and Labour Party

The beauty of an Adjournment debate is that you can never work out where it is going to go in the politics and messages that were previously relayed.

Obviously, I am not from the North Down and Ards area. I am part of the South Eastern Trust area, and I am just surprised that I am not here talking about closures to Downe Hospital, which has been the norm over the past 20 years when it comes to discussions about the South Eastern Trust. On this occasion, it is with relief for my area that we are talking about somewhere else. Maybe being just one step back from what is happening on the ground, and from maybe the more upcoming political agendas that there may be, I can understand and appreciate the difficulties of people not liking change. People do not like it when a service is closed and taken away. As I say, we have had plenty of experience of that.

I have some sympathy, I suppose, for the residents of Bangor, which is quite a distance away. Maybe slightly less sympathy for those in Newtownards because, when it comes to the removal of services from Downe Hospital, I would love if there were just four or five miles on a dual carriageway point-to-point to connect me from one service to the other. Where I can understand that there are difficulties in understanding this for people from Ards and Bangor is that the nature of this is minor injury units. The thing is, they can quite often be provided locally and quite close to where people are. It is that lack of understanding as to why you have to travel 10 miles or a number of miles to be able to get what are some of the most basic health interventions.

I understand and agree with the whole process of transformation. I am certainly supportive of transformation on a wider, greater, bigger basis, but we desperately need to see that road map. We need to know where we are going, because if we know where we are going, there is a better chance that people will get behind it and support it. When we look at an issue such as the closure of minor injury units, or the changes that there have been at other places such as Lagan Valley Hospital and Downe Hospital, we do not know what the overall road map is. We know just that we have services that are being taken away but do not know what it is going to be part of in the greater scheme of things. That is a challenge for the Department and the trust, but it is one that I would love to see them being able to stand up and do. If we can get that sense of transformation, you know that you are losing service x but that it is going to be replaced nearby and is going to be a better service and you, in return, will also get something different in your area. In that way, we can keep patients and staff happy and keep the public on board.

Unfortunately, the process has been a little bit like others. We feel that the service is being closed down but that no accommodation has been made for additional traffic and car parking. We know that staff are being moved and are not necessarily that happy about it. We know that consultations can often be loaded — that is the nature of them — but people who go into such a process feel aggrieved if it does not go the way in which they want it to go.

I would like to see a greater road map for a transformation that we can be part of. The medical experts are out there, and it is critical that we listen to them. I sometimes worry, however, because, from what I remember them saying 20-odd years ago, if we were to talk about taking on board proper medical evidence about hospital services in Northern Ireland from those qualified to give it — I have said this before — we would end up with a super-duper hospital on stilts in Lough Neagh with six roads, one leading into each of the counties. Everybody would be able to access it, all the services would be under one roof and nobody would be at a deficit as a result. That, however, is not the reality. We are trying to retrofit the system that is there. I appreciate that the trust has its difficulties. I would love to see it be able to deliver locally that which it can deliver locally but also provide a much better system if it has to centralise it.

Photo of John Blair John Blair Alliance

Thank you to all the Members who contributed to the Adjournment debate. I call the Minister of Health to respond.

Photo of Robin Swann Robin Swann UUP

Thank you very much, Mr Deputy Speaker. Before I get into my substantive response, I will pick up on some of the comments made by Members, because it is important to provide clarification before I respond to the debate.

Miss McIlveen and Mr Chambers used quotations attributed to me from press releases or other documents, I can assure them and the House that I stand by what I have said in the past. I do not change my mind or perform U-turns just because something may be popular or seen to be the right thing to do.

I will address a wider comment, which I am attributing not just to Ms Egan or Mr Muir in today's debate, in order to dispel the easy line that is often used that, in Northern Ireland, we spend more per head on health than any other country. Compared with England, Scotland and Wales, that statistic proves to be right, but, in 2022, the Northern Ireland Fiscal Council stated that we spend:

"broadly the same as in the North West and North East of England."

When spend is broken down regionally, there is therefore not the disparity that some try to portray when they say that our system is overfunded. On where we stand on that matter, the Northern Ireland Fiscal Council also stated in 2022:

"health spending in NI has previously been broadly in line with relative need."

I thank the Member for securing the Adjournment debate and providing an opportunity to address an issue that concerns a key change and improvement to unscheduled care in the South Eastern Health and Social Care Trust. The consolidation of minor injury services on the Ulster Hospital site represents what I have been told is an improved service for the residents of the Ards and North Down Borough Council area. At the Ulster Hospital, patients have immediate access to a service that is open longer hours, with a wider range of diagnostics. More importantly, the minor injury service has been secured for the long term, with the appropriate skills in place and training for staff. In addition, the unit is now consultant-led, whereas the smaller units were led by specialist emergency care nurses. I will expand on that later. Although the decision was taken by the permanent secretary, under the Northern Ireland (Executive Formation etc) Act 2022 — Members have highlighted the fact that the decision was made in the absence of Ministers, when this place was not functioning — I have been assured that the correct processes were followed in making that decision.

I have been informed by the South Eastern Trust that the main drivers for implementing the new model included increased demand for unscheduled care, staffing challenges, substandard facilities and the need to optimise staff skills and expertise. Above all, the trust was facing a strong risk that it would have to react suddenly to the inability to provide minor injury services on the two sites in the very near future. To mitigate that risk, the trust's decision to transfer those services to one site was aimed at ensuring that unscheduled care services for the population of Ards and North Down remained safe and sustainable for the long term.

I have been informed that, in the consultation document, the trust cited difficulties in the recruitment and retention of staff at the minor injury units. Officials in my Department and the Public Health Agency sought additional information from the trust about its position and were advised that there had been ongoing recruitment drives for emergency nurse practitioners (ENPs). Prior to the consultation exercise, the most recent recruitment drive had been in autumn 2022. While that was successful in appointing a number of candidates to the trust, none of the successful applicants was interested in taking up a permanent position at the Ards minor injury unit. That is most likely because working as part of a multidisciplinary team, as would be the case in emergency departments, is an attractive proposition for emergency nurse practitioners because of the extended scope of practice and greater opportunities for nursing management experience that it offers. At the close of the consultation period, 40% of the posts were outstanding in the emergency nurse practitioner workforce. Two of the posts were filled by other trusts' ENPs on a supplementary basis.

The trust has advised that, on average, since 2018, 20% of the ENP workforce has been unfilled at the Bangor and Ards MIUs. As I mentioned, the trust reported that ENPs had a reduced scope of practice at a stand-alone unit and that that was a contributory factor in its recruitment difficulties. In recent years, bank ENPs have supported the operational rota at Ards MIU. However, the six retired bank ENPs who had been available in previous years to secure the service have been reduced to two, meaning that the historical reliance on bank staff was no longer possible.

A further major issue for the trust that, I was informed, was affecting services at Ards minor injury unit was the condition of the estate in which the service operated. The building needed major investment or replacement to continue providing the service. In the absence of any immediate capital funding, the trust was faced with the prospect of temporarily closing or relocating in the short term, while awaiting capital investment, in order to effectively manage the risks that were present. Even if the facilities at Ards Hospital were renovated, the volume of demand versus the available space would also be likely to present challenges on the current site. Likewise, the facility in Bangor is limited in space and would struggle to meet further demand if that were the operational alternative.

The public consultation on the future of urgent and emergency care in Northern Ireland, which was mentioned, was launched in March 2022, and the consultation findings report was published in October 2022. The report concluded that there was broad support for the proposals outlined in the public consultation, which included three strategic priorities: creating an integrated urgent and emergency care service; capacity, coordination and performance; and a regionalised approach to immediate care.

The move to consolidated minor injuries services on the Ulster Hospital site met priority 1, which was to create that integrated urgent care service. My Department, along with the South Eastern Trust, is still committed to providing better urgent and emergency care services and recognises the need for reform to address the many challenges in the healthcare system, which that move seeks to do. I have confirmed that all the relevant procedures were followed in making the decision. Having identified significant challenges and the need to make a service change, the chief executive of the South Eastern Trust notified my Department in December 2022 of the trust's intent to change the model of care that it provides to residents of Ards and North Down. That, like all significant service change, is a requirement under the Department of Health's policy guidance on roles and responsibilities.

In January 2023, the trust received approval from the Department to commence a public consultation on the matter. The consultation outlined nine options, with a preference to move the minor injuries service units to the Ulster Hospital site. The consultation commenced in February 2023 with trust board approval for the statutory 12 weeks, and it ended in May 2023. I have noted Members' concerns about the consultation period, but I was advised that, during the consultation period, the trust held three public events: two online and one in person. The events had 121 attendees, 388 responses were received, and 642 local groups and 460 organisations were informed. As has been mentioned, a petition of over 19,000 signatures against the move was also received. The trust's findings and associated mitigations were publicly presented in a feedback report released in June. During the summer period, the trust's board approved the preferred option, and the trust's chief executive wrote to the Department requesting approval to transfer the services. A number of clarifications and queries were addressed by my officials in the Department and the Public Health Agency before the findings were submitted to the permanent secretary. Having carefully considered the proposal and the consultation outcome, the permanent secretary, in the absence of an Executive, wrote to the trust's chief executive at the end of August to approve the changes under the Northern Ireland (Executive Formation etc) Act 2022. As a result, the minor injuries services transferred to the Ulster Hospital site on 6 September 2023.

Mr Deputy Speaker, that is the update that I have.

Photo of John Blair John Blair Alliance 6:45, 30 Ebrill 2024

I thank the Minister for that response.

Adjourned at 6.50 pm.