Cross-border Healthcare

Opposition Business – in the Northern Ireland Assembly am 12:15 pm ar 18 Mehefin 2024.

Danfonwch hysbysiad imi am ddadleuon fel hyn

Photo of Colin McGrath Colin McGrath Social Democratic and Labour Party 12:15, 18 Mehefin 2024

I beg to move

That this Assembly acknowledges the daunting challenges facing our health service; laments that Northern Ireland has fallen behind the Republic of Ireland and the rest of these isles on several healthcare outcomes; understands that a solution to our healthcare challenges will not come solely through increased funding, but also through reform of our services; recognises that a key element of this will be further collaboration with the healthcare service in the Republic of Ireland; acknowledges that certain bespoke specialist services, in particular perinatal and paediatric post-mortem services, which are currently not available in Northern Ireland, could be delivered more efficiently and compassionately on an all-island basis; calls on the Minister of Health to work with the Irish Minister for Health to identify how the two jurisdictions can work together to reduce waiting lists, harmonise healthcare pay rates, and deliver bespoke specialist services on an all-Ireland basis.

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

The Business Committee has agreed to allow up to one hour and 30 minutes for the debate. The proposer of the motion will have 10 minutes in which to propose and 10 minutes in which to make a winding-up speech. All other Members who are called to speak will have five minutes.

Photo of Colin McGrath Colin McGrath Social Democratic and Labour Party

I welcome the opportunity to open the debate on cross-border healthcare. The SDLP tabled the motion with the public firmly in our minds. We are very much an ageing population, and I certainly feel that myself as the years go by. That being the case, our reliance on our health system will only increase over time, whether that be for one-off visits or for people who require more sustained and repeated care. At the heart of today's debate are two words that sum up what our approach to healthcare on an all-island basis should be: "efficient" and "compassionate". At the outset, I want Members to know that, in approaching the debate, whilst we are discussing people's ability to avail themselves of healthcare in the South, that in no way diminishes anyone's sense of national identity. Receiving healthcare in Dublin will not make those here who are British any less so.

There is nothing new about cross-border healthcare. The provision of such healthcare has been a key element of the European Union for many years. As a result of our exit from the EU, many here who had been able to avail themselves of care in the South through cross-border healthcare were worried about what the future of that provision might be. As one that does not support Brexit, our party was committed to ensuring that we minimised the adverse impact that Brexit threatened. Therefore, we were concerned about the loss of the cross-border healthcare directive in 2020. To set it in context, between 2019 and its closure, there were well in excess of 3,000 reimbursement claims for the cross-border healthcare directive at a cost of just over £15 million. The former Minister of Health, Robin Swann, then introduced —

Photo of Diane Dodds Diane Dodds DUP

I thank the Member for taking an intervention. I am always astounded that people put so much emphasis on cross-border healthcare. Will the Member agree that there is an inherent inequity in that people who want to avail themselves of that service have to provide the money up front before they can claim it back and that, even then, they may not be able to claim all of it back? That is an inequality in the whole set-up. I would like to hear the Member's views on that.

Photo of Colin McGrath Colin McGrath Social Democratic and Labour Party

I do not disagree with what the Member said, but, of course, the greatest inequity is that people are not getting their healthcare and are being forced to use their savings to pay for it up front. I want to see a system whereby people do not have to claim money back and, instead, treatment can be approved so that they can get it without having to make any payment. That would remove that inequity from the system. The bottom line, however, is that, if that system were not in place, none of them would get any treatment or relief from the symptoms of illnesses that some have been living with for a long time.

I will mention again the number of people whose pain has been alleviated. There was also the Republic of Ireland reimbursement scheme, which was introduced by Minister Swann. Between its introduction and closure, there were over 3,500 reimbursement claims at a cost of just over £21 million. If people did not have that system to invest in, they might end up going privately. If they do so, they will get nothing back. At least this way means that those who have the money can pay for the service, get treatment and claim it back. That takes pressure off the system, which will help others to avail themselves of services. It is an imperfect system, because it addresses a problem that should be resolved in a different way.

Think of the 6,500 people whose lives have been supported and improved through our capacity and willingness to work with our colleagues in the South, whether they needed a new hip, cataract removal, scans or cardiac surgery. The schemes covered a range of interventions. All those conditions, however, could be addressed through our willingness to work together through a scheme that costs a fraction of our healthcare budget. It is an efficient use of our healthcare funding. You cannot put a price on the impact of those operations. If people did not have them, the impact on their quality of life would be enormous.

It should also be noted that the second scheme that I referenced was delivered by a unionist Health Minister. It is an important point to make, as it recognises our ability to reach beyond ourselves and deliver positive outcomes for all members of the public, regardless of our own views or constitutional aspirations. That must surely be the sort of vision that we need to look for in our Government working together. Imagine if we had been without Ministers at the time of making those decisions. I am not so sure that the schemes would have been introduced. There would have just been more uncertainty. That underscores the importance of having this institution up and running so that Ministers can take the decisions that are required to provide services for the community. If we could see delivery of such a short-term scheme, which would deliver positive outcomes for the public, each of us could then consider our capacity for further joint health working with colleagues in the South. Members of the Health Committee and those beyond it know the full range of problems in our health sector. Many segments of the health service are clogged up by long waiting lists, meaning that people are not getting the outcomes that they need.

The services could provide care to women and families in some of the most emotionally charged and heartbreaking situations. I refer specifically to the perinatal and paediatric post-mortem services that we do not provide here. The absence of a paediatric post-mortem service and the fact that we still cannot access the service in the South result in many women and families having to access the service in England. While it must be said that the service puts care and compassion at its heart, I cannot help but think that it is worth exploring whether we would be able to provide the service on this island.

We must give credence to the need for cross-border working, given the increasing reach of Sláintecare in the South. That reform of services delivers positive health outcomes in the South, but it is also quickly becoming an attraction for healthcare staff from the North. I will set it in context: a primary care doctor in the North could earn around £75,000; in the South, they could earn an average of €130,000, which equates to over £100,000. Think of what could be achieved in some areas if we were to commence cross-border working to help deliver some elements of primary care as well. Meanwhile, again for context, in the past five years, we have spent well in excess of £11 million on GP locum cover alone.

As we commence the debate, I look forward to hearing Members' contributions and hope that they demonstrate a willingness to do some imaginative thinking in order to deliver positive health outcomes for all members of the public. I hope that Members across the House will support our motion, remembering that efficiency and, most importantly, compassion are at its core.

Photo of Liz Kimmins Liz Kimmins Sinn Féin

I thank the Member for proposing this important motion. It is no secret that Sinn Féin's vision for the future of healthcare is one that encompasses an all-island health service because it makes sense. Yesterday, all parties supported our motion on all-island cancer research. In discussing that, nobody disputed that that makes sense. It is the way in which we need to go.

The proposer of the motion mentioned the importance of cross-border, all-island healthcare in reducing the colossal waiting lists in our health system, with people's conditions continually worsening as they languish on waiting lists for not weeks or months but years. We have to think outside the box, which means collaborating with our colleagues across this island and sharing our resource, knowledge and expertise. In more and more conversations with individuals, organisations and professionals, it is being said, "We want to get the best care for people. We want to ensure that they get the best outcomes". I know that the Minister has said that achieving better outcomes for patients is one of his priorities. That is where we need to go, and the motion will help formalise that and emphasise how we work together.

As I mentioned in yesterday's debate, the Oireachtas Health Committee will come to Belfast next week, about which I am really excited. It is the first time that we have done that, and that in itself shows that there is appetite for the Assembly Health Committee and the Oireachtas Health Committee to work together. I hope that it is the start of something really progressive and productive. We will meet representatives from the Queen's University Centre for Cancer Research and others to look at the opportunities that exist across the island. We have a small island and a small population overall. Looking at the population in the North, I think that it is equivalent to that of a big city such as Glasgow. The potential of the resource and talent that we have across our island is huge. There is so much that we can do.

I am being parochial, but it is not surprising that I should mention my hospital, Daisy Hill, which is the only hospital between Drogheda and Portadown and serves a huge area of Newry, south Armagh, south Down and, indeed, north Leinster. It is ideally placed, as a central location, to provide healthcare on an all-island basis, and, indeed, it already does so. In many cases, for people from the South or other parts of the North, it is the closest hospital when something happens to them. Likewise, there is huge potential for our Ambulance Service, which is increasingly pressurised. I recently spoke to a family who had an emergency situation with a child and were ever so grateful to get any ambulance. We can do a huge amount of work on an all-island basis to ensure that we get resources to people at the right time so that they get the right care.

The Member who spoke previously talked about the loss of our workforce. Our health service workforce, as we have said repeatedly in the Chamber since the Assembly was restored, is the underpinning issue to be fixed to ensure that we have the right capacity to deliver services for all our citizens. We are, however, losing our workforce to the South, where there are more attractive jobs and better conditions. The Member referenced Sláintecare. Why do we not pool that resource? Why can we not work together to ensure that we provide really high-class services? That is doable, and it is not all about money. It is something that we can do if there is the will between the two Health Departments.

I agree with everything that has been said. We have so much potential because we are a small island, with the maximum distance that anybody would have to travel taking just a couple of hours.

If we work together, we can achieve so much more, and it is certainly something that I support. My party has produced a document on its vision for all-island healthcare, and I hope we can see some of that with the support of the House for this important motion.

Photo of Alan Robinson Alan Robinson DUP 12:30, 18 Mehefin 2024

Yesterday, the House considered a motion on cancer. Today, there is another sensitive issue in the Order Paper: post-mortem services for babies and children. At the outset, I sympathise with any parents who have had to walk through this highly traumatic circumstance. Few will know what it feels like, and I cannot imagine how difficult it is. I hope that all Members will be very sensitive to that fact today.

At the core of the motion is the fact that, since the end of 2018, the health service in Northern Ireland has been left without a single paediatric pathologist. All Members will agree that that is unacceptable, and I look forward to the Minister's explanation of not only what measures have been taken by the Department to recruit a consultant in this field but when that staff member will be in place.

Today, we wish to make it absolutely clear that we fully support those services, but simply exporting the issue to Liverpool or Dublin is not acceptable. However, the motion as drafted seems to just accept the fact that perinatal and paediatric post-mortem services, which are currently unavailable in the Province, could be delivered more efficiently and compassionately on an all-Ireland basis. The outworking of that premise is an acceptance that parents should travel with their baby for a post-mortem in Liverpool or Dublin. In our eyes, the status quo of a trip to Alder Hey Children's Hospital or the alternative of a considerable drive to Dublin is unacceptable.

Let us show some empathy to those in that situation. With the Liverpool or Dublin option, the parents travel with their child, but leave their crucial support network of wider friends and family at their most vulnerable time and when that support is most needed. We want to be clear that the service should be available in the health service in the Province, and we unfortunately cannot support a motion that forces parents on a journey of hundreds of miles with their loved one during a time of extreme personal trauma. The service needs to be provided by the Department of Health, and it is unforgivable that we do not have a local solution after nearly six years. We support the contention in the motion that more money is not the key to resolving the well-documented issues that face the health service today. That said, health has been prioritised by the Executive and has seen its baseline funding increase by £2 billion since 2020.

With regard to the later parts of the motion, we refer Members to the Bengoa report, which the current First Minister launched when she was the Health Minister in 2016. The 'Systems, not Structures' report by Professor Bengoa was designed to deliver the transformation the health service needs and to achieve the best clinical outcomes for people here.

In closing, I recognise and commend the work of the charity Sands. It is an organisation that supports anyone affected by pregnancy or perinatal loss and provides bereavement care and support for parents in those very difficult circumstances. We cannot support a motion that appears to accept the failure of the Department of Health to provide this incredibly important local paediatric pathology service for parents going through that traumatic experience. Exporting it is not the answer; solving it is.

Photo of Danny Donnelly Danny Donnelly Alliance

I thank the SDLP Members for tabling this motion as one of the Opposition day debates. It is good that two important health motions have come before the Assembly this week that recognise the many challenges our health service faces. We will support the motion.

It is unacceptable that we have the longest waiting lists on these islands and some of the longest in Europe. In particular, our waiting lists are significantly longer than those in the Republic of Ireland. Based on official figures from last year, twice as many people in Northern Ireland were on a waiting list for an appointment, despite having approximately a third of the population. The disparity was much larger for people waiting over 12 months: approximately four times as many people in Northern Ireland. Anything that can be done to reduce those waiting lists must be done.

One aspect of the motion that is particularly encouraging is the recognition that the transformation of our health service will not be achieved solely through increased funding but that fundamental reform is also needed. That will require difficult decisions and, more importantly, political leadership from all Members of the Assembly and the Department of Health. As mentioned, we have had the Bengoa report, 'Systems, not Structures', effectively sitting on a shelf for the past eight years due to years of prolonged political instability. Outside this specific debate, we need fundamental reform of the Assembly and its structures so that it cannot collapse again through the actions of one party, otherwise we can never commit to the required long-term planning and multi-year budgets needed for transformation.

We discussed all-Ireland cooperation yesterday in relation to cancer research, but I want to discuss such cooperation more broadly. It makes sense, from a geographical perspective, for example, that, at the North West Cancer Centre at Altnagelvin, which is partially funded by the Irish Government, approximately one third of its yearly patients are from the Republic of Ireland, mainly Donegal, which is just a few miles from Derry; otherwise, such patients would have to travel to Galway or Dublin. On the other hand, there has been an increase in the number of children from Northern Ireland receiving heart surgery in Dublin, since heart surgery services in the Royal Victoria Hospital ended in 2015. That vital network continues through cooperation with Our Lady's Children's Hospital in Dublin, which is very accessible for people in Northern Ireland. It is only a few hours in a car, bus or train.

It is important to recognise that one of the main challenges to cross-border health cooperation is the challenge posed by Brexit. Some of that relates to funding. In the short term, much of our current funding continues through PEACE PLUS, but, in the coming years, it will become increasingly uncertain as to whether equivalent UK funding is available. The loss of EU regulations and directives providing benefits in respect of cross-border healthcare is also of significance, not only on this island but across the EU. The temporary reinstatement of the cross-border healthcare directive in 2021, for one year, was a welcome step by former Minister Swann to help reduce the waiting lists. However, we need a more proactive and permanent approach to reduce waiting lists, and cross-border healthcare cooperation should be considered as a part of that approach.

As mentioned, pay rates, compared with the rest of the UK and with the rest of Ireland, remain an important issue here in Northern Ireland. We have discussed in previous debates how pay is much lower here compared with other jurisdictions. For example, in last month's debate on the motion on junior doctors' pay, it was acknowledged that junior doctors work very long hours and face the longest waiting lists in Europe for the lowest pay in the UK. It is well known that the Republic of Ireland both higher pay and fairer working conditions compared with here. As such, many healthcare workers are working in the South as opposed to working in their local health service. That is obviously not an issue in England, Scotland and Wales, and it is important that the Minister considers the specific circumstances here in Northern Ireland when addressing pay issues in any discussion of future pay settlements.

There are many opportunities for potential cross-border cooperation, particularly in relation to healthcare, but, in order to realise those, we need to confront the challenges and barriers posed by Brexit, and we will need political stability here to deliver the long-term reforms and to establish the long-term relationships needed, North/South, to improve our health service for the benefit of patients across the island of Ireland.

Photo of Steve Aiken Steve Aiken UUP

There is no doubt that our health service is facing some unprecedented challenges. Our overall waiting times position remains wholly unacceptable, and our health workers are operating under huge pressure. Similarly, major demands remain on services such as primary care, social care, dental and pharmacy.

It might seem easy to say that our health service is sliding in only one direction and that turning it around is beyond us, but neither I nor my party share that view. Even though the likes of the elective care framework has never been fully funded by the Executive, not least because of the repeated stop/start nature of this place, there has still been some notable transformation and progress made. For instance, thanks to decisions made in 2021, treatment waiting times, at least, have been falling steadily. Of course, we absolutely accept that we were starting from an appalling position and that overall waiting times are still far too long, but it is worth noting that, for those waiting for treatments, in the space of 12 months, the number has reduced by 15,000, by over 12% overall. Some very positive progress has been made for those waiting for inpatient day-case treatment in areas such as general surgery, which has seen the waiting list fall by over 20%. Similarly, progress has been made in cutting waiting times in ENT, gynaecology and urology. That shows that, where there is a clear focus and political will, any kind of progress can be made.

My party will always stand ready to utilise any and all opportunities to help patients and staff. That includes working on an all-Ireland basis when beneficial. We know that there are areas of such cooperation that currently work well and that, similarly, there are other areas that could work better. We need to recognise that it is not a panacea. There are major pressures in the Republic's health service also. It is grappling with the very same challenges that we are: poor waiting times, changing demography and the rising costs of care and treatment.

We acknowledge that a gap in pay is developing on the island of Ireland, which will raise particular challenges locally. It is not just the health service that is being impacted; it is education, a slate of other public services and private commerce. In reality, never mind not keeping up with pay in the Republic of Ireland because of the failure of the previous Executive to agree a Budget, and then the absence of Ministers even in post, our health workers have too often had to watch their pay falling well behind that of their counterparts, even in the rest of the UK. Thankfully, however, due to the work of the previous Minister of Health in January 2020, and again in February of this year, parity has largely been restored. It is essential that the Executive give a commitment to fund and maintain that. Without a stable workforce, the improvements that we want to make simply will not be possible.

Progress needs to be accelerated even further. I welcome the publication of the updated elective care framework only a few weeks ago. Unfortunately, however, the recent Budget, which was agreed by Sinn Féin, DUP and Alliance Ministers, in which the Health budget was cut by 2·3%, will greatly impact on the ability to drive through further improvements. MLAs need to be aware that, as it stands, the Executive have not provided a single penny of targeted funding to spend on tackling waiting lists. It is, therefore, totally incoherent for the Executive to try to claim, as the DUP, Sinn Féin and the Alliance Party still do, that tackling waiting lists is a priority for them. Quite frankly, it is not. At the same time, the Budget did not even meet the Department of Health's basic plea just to keep up with red-flag cancer and other time-critical treatments.

Although we welcome any further improvements that can be made through working on an all-island basis, as well as on the vital east-west basis, the reality is that the greatest potential for reform and improvement still sits with what is available on our own doorstep. To do that, we require a collective willingness.

Photo of Nuala McAllister Nuala McAllister Alliance

I thank the Member for tabling the motion, which the Alliance Party is happy to support. Since the Assembly was restored in February, we have had many discussions about the state of our health service. One thing has been clear in every one of those motions: the status quo is simply not working. That is why Alliance has been consistent and unwavering in its calls for the transformation and reform of the health service for many years. There must be a willingness to look at how services can be delivered in the most efficient way possible, with better outcomes, ultimately, for our constituents.

I understand that the Minister is new in the role and that it may take a number of weeks or months for his plans to be brought to the Assembly, but I hope that, in good time, some of those priorities will be progressed through the Assembly and the Health Committee. In particular, I note the reconfiguration blueprint. The Committee was told that that would come forward, possibly, in June. I wonder whether the Minister, in his response, will confirm whether we will see that within the next two weeks.

One thing is clear from the people who give evidence to the Health Committee, whether they are allied health professionals, doctors, nurses or anyone else in the health sector: their patients tell them that they are willing to travel for treatment. We, too, hear that from our constituents. They want the best healthcare possible, and if that means that they must travel for it, they are more than willing to do so.

We have seen the success of that in the elective care and surgical hubs. People have been more than happy to move outside their city or rural area in order to get seen quicker. A further example of how transformation can work through all-island cooperation are the children's heart services. A number of Members mentioned that. I think about that service quite a lot. A child in my family has a heart condition and relies on it. A topic that comes to mind for all parents is that their child's health is a priority, and you would be willing to travel to wherever is needed so long as it is provided by the state — well, maybe not so long but as long as it is provided by the state. That is the crux of it.

Just yesterday, as Members who spoke previously mentioned, we spoke about cooperating on an all-island basis on cancer research. The Good Friday Agreement was clear in recognising that cancer impacts everyone equally across these islands. Since then, there has been ongoing cooperation on cancer research. I hope that, in the coming months, the Minister will develop not only the policy links on that on an all-island basis but the delivery of services, because that is crucial here.

Whilst we speak of the delivery of those services, I want to touch on the cross-border directive. We need to reflect on the realities of that, because when it comes to the independent sector across these islands, we are cementing a two-tier health system. It is a two-tier health system for those who, ultimately, can put money towards their healthcare. That is not acceptable and is not something that we should rely on. I understand using it in the short term to tackle waiting lists. The Committee has heard many times from stakeholders that those who are on some waiting list for longer than three months in the Republic of Ireland are seen in the independent sector, where Sláintecare provides the healthcare. However, they actually come up here to Northern Ireland and are seen in the independent sector, where their state provides the care, so something does not quite add up there. We cannot have a cross-border directive whereby we allow people to travel only to the Republic of Ireland. If it can be done here in Northern Ireland, we should allow that too. I hope that the Minister will speak on that. Officials said that the issue would be brought back to the Committee within a number of months, so I look forward to hearing about it.

There is cross-party agreement in the Chamber that the healthcare sector cannot continue with the current status quo, that waiting lists are rising unacceptably and that patients are experiencing complications and additional harm while waiting. Also, staff are choosing to work elsewhere. We all agree that it is not acceptable in the current circumstances to see an exodus of staff every single year from the health service up here in Northern Ireland to that in the Republic of Ireland. It is crucial now that the Minister shows leadership on the issues —

Photo of Nuala McAllister Nuala McAllister Alliance

— and that all parties are willing to work together on the matter.

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

Thank you, Nuala. Minister, you are next to respond. You have around only 12 minutes. If you can do it now, well and good. If not, we can take you immediately after Question Time. It is up to yourself. There is no pressure.

Photo of Mike Nesbitt Mike Nesbitt UUP

I will wait, Madam Principal Deputy Speaker.

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin

That is your prerogative. That is fair enough. As Members know, the Business Committee is due to meet at 1.00 pm. Given that we do not have enough time for the Minister to respond, I propose, by leave of the Assembly, to suspend now. The next item of business will be Question Time, and immediately after that, the Minister will respond.

The debate stood suspended.

The sitting was suspended at 12.49 pm.

On resuming (Mr Speaker in the Chair) —