Before I call the Minister, I remind Members that they must be concise in asking their questions and that long introductions will not be allowed.

Thank you, Mr Deputy Speaker. I am making a statement on the launch of the public consultation on the hospital reconfiguration framework document, which is entitled 'Hospitals — Creating a Network for Better Outcomes'. I am pleased to have the opportunity to share the framework document with Members today in advance of the imminent launch of a 16-week consultation period. That will commence tomorrow and will run until 21 January 2025.

I am aware that some people tend to promote the belief that there has been no clinical involvement or engagement with health service front-line staff on the development of the framework. That is simply not the case, and I want to set the record straight. It is not something that civil servants have simply cooked up with no outside input. 'Hospitals — Creating A Network For Better Outcomes' has been co-produced with the trusts and the Public Health Agency (PHA), which have involved a wide range of clinicians in the process, as well as senior managers and chief executives. Furthermore, during July and August of this year, my officials carried out an extensive pre-consultation exercise that involved engagement with all the royal colleges, as well as with trade unions and service users. The feedback from that very useful pre-engagement exercise has been incorporated into the final draft of the document, which is presented to the House today.

At its heart, the work is about how we can improve the sustainability of hospital services and, ultimately, provide an assurance that none of our acute hospitals will close. The draft framework aims to describe our acute hospital system. Its underlying principle of local provision where possible and central where necessary is key to the document. A fundamental concept is that of an integrated Northern Ireland hospital network. Within that network, each hospital has been identified as part of a particular tier, combining to form an interdependent network. The types of hospitals described in the framework are local, general, area and regional. That network approach will ensure a brighter and more secure future for all our hospitals.

I want to be clear in the message that this is not about cutting costs or closing hospitals but about managing change in a controlled way and demonstrating the benefits, which have to be better outcomes. We will continue to need every square inch of our hospital estate. It is about showing everyone how each hospital fits into the network, determining what the most valuable role for each one to play is and delivering the best outcomes for patients.

To embed sustainability and resilience, taking account of our workforce, safety considerations and advances in modern medicine, it is simply not possible to deliver all services in every hospital. It is already the case that different hospitals have different services available. The network approach will ensure that people can still get the right treatment in the right place by the right person, even if it is not necessarily in the hospital closest to their home. I recognise that there are difficult judgement calls to make around that. My view is that patient safety must always come first. When hospitals have lower patient numbers, that can create significant issues for professionals working in key specialties. They include the rota and on-call pressures inherent in smaller clinical teams, as well as an insufficient case mix to support specialisation, training and skills development. Those issues inevitably have consequences for recruitment and retention, adding to the challenges of maintaining services. That, then, potentially compromises patient safety and often leads to poorer patient outcomes.

We have seen in recent years a number of examples where changes have been made as a direct result of service collapse rather than planned improvement. Research shows that the vast majority of people — in fact, in the region of 80% — say that they are willing to travel for elective care in order to receive treatment from the best and most skilled experts as quickly as possible. However, I recognise, of course, that there are some for whom any additional travel will be a cause for concern. That is why a section on patient travel is included in the draft framework, setting out the supports available for the public.

It is important to note that 'Hospitals — Creating a Network for Better Outcomes' will not itself reconfigure any specific services; instead, it provides a strategic context and structure for future reconfiguration decisions. It is underpinned by a number of existing service reviews and strategies, which were clinician-led and developed in partnership with those who use the services. Future reconfiguration decisions will continue either to come from regional service reviews or to be trust-led. I am committed to ensuring that such decisions include appropriate engagement with, for example, staff, service users and the local community.

In closing, I encourage Members to take the time to respond to the consultation and make their views known. As I encourage Members to look on our hospitals as a network, in the same way I encourage them to regard this statement as one of a series about reform of healthcare delivery that will come in the coming weeks. I commend the statement to the House.

Minister, I acknowledge your statement. We have had Bengoa, 'Developing Better Services', 'Transforming Your Care' and, today, it is 'Hospitals — Creating a Network for Better Outcomes'. The document, in its summary, details the why, how, what, where and when. We already know the why and the what. There are scant details on the how, and, given that the where is controversial, I can understand why you have omitted that.

When will you publish a concrete timescale that will detail the changes and when they will be implemented that is measurable and accountable? Failing to provide that just gives the impression that this will be yet another document that will lie on a shelf and gather dust without delivering any real change.

I thank the Member of the Opposition for his comments and his question. I can say to him that this will not lie on the shelf and gather dust. Indeed, some Members have suggested that the Bengoa report from 2016 has, over the past eight years, sat on the shelf gathering dust, and that is not the case. There have been some movements on foot of that Bengoa report. I think of day procedures and elective care and how we are trying to separate elective care from emergency operations. That is a sensible way forward. In my closing remark, I asked Members to think about this as one of a series of statements that are coming. Professor Bengoa will be back next week to, as I put it, reboot that report, not to write a new one, because the challenges remain as they were in 2016. <BR/>I intend to publish in the forthcoming weeks a three-year plan that will cover the rest of my time as Health Minister, if I am spared to work through to May 2027. I have made it clear that I want to see a regional attitude towards breast screening services. We will continue to deliver that at pace. I have talked about my initiative, which I am calling "Live Better", to tackle health inequalities. That is due to be launched in the forthcoming weeks. In association with that, I will look at some of the social determinants of health inequalities. I think of, for example, tobacco and vaping. We will be hand in glove with the UK legislation on that front. I am considering minimum unit pricing for alcohol, because it is clear that, if you go into the most deprived areas, you see the worst impacts of alcohol abuse.

I say to the Member that a lot is happening. I cannot give you a step-by-step time frame, but I am moving at pace to deliver better outcomes for patients, service users and the staff who deliver healthcare.

I welcome the Minister's statement. As he knows, we have been waiting for it for some time. It is a positive step forward, and I welcome that he has said that there will be engagement with a range of people.

The draft framework states that it will require:

"a five-year strategic delivery plan."

Will the Minister therefore confirm that the key performance targets will be based on patient, clinician and, importantly, nursing and healthcare staff experience as well as focusing on securing better outcomes? We need that breadth of knowledge to deliver the framework properly and ensure that we achieve what it sets out to do.

I thank the Chair of the Committee for her welcome and her comments. I am, of course, not a clinician; I have no medical or clinical qualifications. As Minister, I see myself as an enabler of change. Recently, I was in both the Causeway Hospital and the Antrim Area Hospital. As the Member knows, the Northern Health and Social Care Trust is consulting on the future of general emergency surgery provision and the potential that it may move from the Causeway Hospital down to Antrim. In its consultation document, the trust has made clear its preferred option, which is the one that I have just articulated. However, when I met the clinicians at Antrim Area Hospital, they made it clear that it was an imperative for patient safety and delivering better outcomes. So, yes, I will be guided by clinicians, surgeons, allied health professionals (AHPs) and nurses.

There is also a need to consult the local community, because all healthcare is not just personal but local. For example, for most of my adult life, my nearest hospital has been the Ulster Hospital. Of course, I feel an affinity for the Ulster more than I would for the South West Acute Hospital (SWAH), Altnagelvin Area Hospital or Daisy Hill Hospital. I have to get over that affinity and wishing for every service that I need to be delivered at Dundonald and recognise that it is in my best interests, once we have the areas of specialty, to travel a little further for a procedure. Having said that, I know that people who are prepared to travel for a procedure want the aftercare as close to home as possible. That is the principle underlying my thinking.

I thank the Minister for his statement. He will be well aware that, as we go out of the Chamber, there will be misinformation about what goes on underneath hospital roofs. I welcome that he has confirmed that no acute hospital will close. Can he confirm, as, I am sure, he will, that the plan will stabilise services and attract workforce to rural hospitals such as the SWAH, where it can be difficult to attract a workforce? Will he reassure the public that transport links, which I have raised with him before, will be developed as part of the programme of work? Missed appointments cost the health service as well.

I thank the Member for her comments. No acute hospital is, in any way, in danger; in fact, some of the proposals, such as the one to separate emergency from elective surgery, will secure their future.

On the first point about attracting workforce, interestingly — well, you will be the judge of that, but I found it interesting — I went up to Altnagelvin a few weeks ago to visit some of our international colleagues who have come here. They go into the centre at Altnagelvin to learn about the processes and procedures that we use in hospitals that may be different from what they are used to in India, Afghanistan or wherever their country of origin is. The interesting thing for me was asking them whether they preferred to be at Altnagelvin in Derry/Londonderry or at the South West Acute Hospital in Enniskillen. There was a variety of answers. Those who came from big cities in India tended to say that they preferred Altnagelvin because it is in the city of Derry/Londonderry, whereas others whose origins were, perhaps, more rural preferred Enniskillen. It is possible to think about imaginative ways in which to tackle those workforce challenges and not just simply buy into a narrative that a rural hospital will not attract a workforce. It may be more challenging, but I accept and rise to that challenge.

The Member made a very important point about transport. It is all very well for me to say that I am prepared to travel to Antrim, Londonderry or Enniskillen for my procedure when I have many family members with cars who would be more than willing to take me there and bring me back. I have been working with other Ministers — the Minister for Infrastructure and the Minister of Agriculture, Environment and Rural Affairs — to look at community transport arrangements and how to provide transport for those who do not have ready access to it. I am also thinking about the Northern Ireland Ambulance Service (NIAS), which has a voluntary driver scheme. That scheme took a bad hit to its numbers because of COVID. The NIAS is working hard to get the pool of drivers back up. We need to be imaginative. For example, I think of church networks: it strikes me that people who regularly go to church may be the sort of people who have the kind of community interest that might lead them to think about becoming community drivers.

The issues that the Member raised are very much on my radar. They are valid and need to be addressed.

I thank the Minister for bringing this long-awaited statement to the House. In the third paragraph of the statement, Minister, you state that you want to put to rest the belief that there was no engagement or clinical involvement. I am glad that that engagement took place, following the Committee session in which we pressed the Health Department on the lack of engagement.

I welcome the reconfiguration framework. Now that we have an overall strategic framework from which all the decisions on this will flow, when will we see more decisions and actions being taken, having evolved from the framework?

In headline terms, that sequence starts with the announcement in the Chamber today. Professor Bengoa will be at a half-day conference in Belfast next Wednesday afternoon. I will be interested to hear the detail of his remarks on whether he feels that his report from 2016 is still valid — I believe that it is. He will also reference some developments that have taken place globally over the past eight years and perhaps encourage us to take the next steps. After that, as I said, I will publish the three-year plan that will cover the rest of the mandate.

Out of that, we will have to get down into the weeds of what we mean when we talk about which hospitals deliver which services. I assure Members that we will go out to public consultation on every one of the potential moves, because that is the right thing to do. That is why it will not be possible to do it in a year or in the remainder of the mandate, and that is why I am talking about a five-year plan. We have to bring people with us, and I do not mean just the clinicians and everybody who works in healthcare, important as they are. We also want the community to come with us. Sometimes, when we say that we will change services, people think that they are losing a service from their local facility without being reassured that something better will come in its place. For example, you may separate emergency and elective surgery in one hospital in order to make that hospital a centre for excellence in elective surgery, which would be a bit better for securing its future.

Sorry, I wandered off topic a bit. There will be a series of announcements, and, while they might not please the Member, they will certainly give her the opportunity to respond.

I thank the Minister for his statement to the House. He acknowledged that, in a better-structured network, some patients may have to travel further for their procedure. Following on from Deborah Erskine's question, can the Minister give a commitment that he and his Department will do all that they can to make the case for adequate provision of accessible and reliable public transport for patients who require it?

An increased focus on centres of excellence for elective care will mean that some patients will be asked to travel further for non-emergency procedures. I refer to the 2023-24 health survey for Northern Ireland, in which approximately 80% of respondents indicated that they would be prepared to travel within Northern Ireland for a routine procedure or operation, if that meant that the waiting time would be reduced. Similar questions were asked by the Age Sector Platform, and over 80% said that they would be willing to travel further if there were benefits such as reduced waiting or procedure times and a lower risk of cancellation.

As the Member suggests and as Mrs Erskine made clear, there needs to be accessible and reliable public transport for patients who do not have access to private vehicles, particularly the elderly and the vulnerable. In that regard, flexible appointments, especially for those who are travelling a greater distance, would also be important.

I thank the Minister for his statement. Action 7 states:

"Consideration to be given to moving suitable activity out of ... Regional Centres into Area Hospitals."

Can you give us some sense of what those activities might be? Is there an estates plan? As I have outlined before, Craigavon Area Hospital is bursting at the seams. People died during COVID because the hospital did not have the space to keep them separated.

I do not want to be prescriptive or overly prescriptive at this point in the process. I will stick with what I have said. There is huge logic in trying to separate emergency surgery from elective surgery, because, if you are on a waiting list for planned or elective surgery, the length of the list does not really matter. If you have been given the appointment, it is frustrating to get a phone call early that morning to say, "I am sorry. The theatre is in use for an emergency procedure. The anaesthetist, the surgeon and the theatre nurses have all been taken up, and your surgery is cancelled". Those are the sorts of things that I am talking about. We need a logical redistribution that means that we are more productive and more efficient in what we do.

You asked about Craigavon Area Hospital. My goodness. I was there a couple of weeks ago, and the last area that I visited was the emergency department. It was not edifying to see so many people in the corridors outside the emergency department being fed. When you want to access healthcare, dignity is really important. Far too many patients feel that they lose their dignity because of overcrowding, particularly in emergency departments. That was late August, by the way. One of the emergency department consultants said, "I think this is the start of the winter pressures". We have to box clever and use the whole of the estate.

I am not the expert, I am not a clinician, and I am not a medical professional who can say how we should do that, but we need to look at the network. It is important to get people thinking of networks. People tend to think of the local hospital as being "it". Once we can do that, we can have a good, mature debate about who does what.

I thank the Minister for his statement. We have waited a long time for the paper. I am grateful for it, and I take your word that it is the start of a process. However, on reading it last night, I found that it is a series of high-level principles rather than any detail on how we will proceed. A number of questions arise about that. You said this morning that there would be further papers: that is really important, but we need further papers that focus on the principles that you outlined in this one.

You also said that service reviews would be trust-led: I worry about that, because my experience of trusts is that, at the moment, they will not and cannot cooperate with one another. How do you expect them to cooperate on service reviews and sharing resources? Will you ensure that each of those is led by a consultation?

First of all, I get it. You have waited a long time for the document, and, to a certain extent, perhaps, it is a little frustrating that it has only high-level principles. However, that is the logical sequence by which to roll out the nitty-gritty of reform. It is not just reform of hospitals; it is reform of how we deliver health and social care more generally.

There will be consultations — I can guarantee the Member that — on all the changes, but I said that they will either be trust-led or led regionally by the Department. I note that the Member said that the trusts are struggling to cooperate. I have to say that that is not my sense of things. I know that they were set up under the Thatcherite idea of, if you have competition, you drive down price and get a better bang for your buck, to use that expression. I suppose that there was a temptation, when going into the role, to say, "Why do we need five geographic trusts, and why can we not just have one Northern Ireland-wide body?". I do not think that that is worth the effort, but I said to the chairs, chief executives and financial directors of the trusts that I expect them to cooperate and that, in my mind, they are one trust. I think that they have been increasingly showing an ability to cooperate and collaborate rather than compete, but that is a work in progress, and I will certainly try to keep the pressure on to get further collaboration and cooperation. The big issue for me across those trusts is productivity, and I assure the Member that there have been some frosty enough conversations on that issue.

I welcome the Minister's statement. We all know that reform of the health service is long overdue and has stalled due to the political instability in this place. The Bengoa report was in 2016, and it described a "burning platform". We should have been eight years into a 10-year programme of reform, but, instead, we have let it burn and burn.

The Minister mentioned that there has been clinical involvement in this document and this consultation, and I believe that there was a pre-consultation over the summer involving stakeholders. I ask the Minister to outline some of the feedback that was received from that and how that has fed into the document that will be given to the general public.

I thank the Member for his question. All the royal colleges were involved, and all the chief executives and the trusts were involved. Indeed, a couple of weeks ago, I was at the headquarters of the South Eastern Trust and met the chairs of all the arm's-length bodies that are involved in delivering healthcare. Therefore, extensive consideration has been given to this plan.

The big challenge that has been faced by, for example, the people who represent the five geographic trusts is, "What does it mean for me and my service?". One of the most important exchanges in the feedback has been my sense that they need to collaborate and cooperate more deeply and that they have to address the issue of productivity. If you talk to the clinicians, they will tell you about the barriers that prevent them being more efficient and more productive, and then, when you speak to the management, you maybe get a better sense of what management perceives to be the barriers to delivering that efficiency and productivity.

The one thing about healthcare that I discovered very early in my tenure is that there are so many moving parts. You can see one moving part and say, "Well, if we do something here, that will be really productive and positive", but there will be three or four other moving parts that might say, "Well, if you do that, you will have a negative impact on me". Those are the sorts of conversations that we have been having.

Ultimately, as, I think, I said in my very first remarks in the Chamber as Health Minister, everybody wants reform, but everybody has a different idea of what reform should look like. As we go forward, I know that people will object to this proposal or that proposal, but that is the value of the consultation. I am certainly happy to discuss offline with the Member some more detail, if he is interested in the specifics of the feedback.

Members, I remind you all about long introductions and that long conclusions should not be used to replace long introductions.

[Laughter.]

I thank the Minister for his statement. Can he provide the details of what factors will be considered in the assessment of local hospital sustainability to meet the future needs of our population?

I thank the Member for her question. If I understood her correctly, she is talking about local hospitals. As I said, I think that, by and large — 80% at least — people are willing to travel for a procedure if they feel that they are going to a centre of excellence. I have said before that, if your local hospital does the procedure that you need once a week but that, by travelling a bit further, you can get to somewhere that does it 10 times a day, five days a week, you are more likely to want to go to that centre of excellence. The local hospitals will deliver the aftercare. I want aftercare to be delivered as close to the home as possible. That, primarily, is where I see a role. It is about delivering day-to-day, non-acute services. There is so much that local hospitals can do; they should be in no doubt about their short- and medium-term future.

I welcome the statement today as well. It is reassuring that none of the acute services is going to be closed during or after the process. Will the Minister assure us that each acute and local hospital will be utilised to its full potential? Far too often, when we see a change coming, we can see the gaps that will be left. That leaves the hospital not being utilised to its full potential, which then creates problems with the retention and recruitment of staff, as we have seen in the South West Acute Hospital (SWAH).

I thank the Member. I can offer that guarantee; we need every square inch of our hospital estate. The next challenge, having put hospitals into four tiers, is to determine exactly what services are offered by which hospital. That is a fairly significant piece of work, but, if it is approached with logic, it should not take that long to get to where we want to be. I assure the Member that I want every hospital to do whatever it is doing to the best of its ability, and to be recognised as such by the community that uses that facility.

I thank the Minister for his statement today. I look forward to working with him for the benefit of patients and staff from right across Fermanagh and South Tyrone. As he will recall, I recently joined him on a visit to the South West Acute Hospital. I was glad that he was able to see at first hand the potential that it has. Following on from the comments from the Member who spoke previously, will the Minister give a commitment that today's framework will help to better utilise the capacity that exists in SWAH?

I thank the Member. SWAH is a very good example of separating out emergency and elective care. It has become an elective-care centre of excellence in Enniskillen. That works really well. It gives an assurance to the staff and healthcare workers who are based in the SWAH that they have a really sustainable future and a worthwhile role to play in delivering as part of the network of our Northern Ireland hospitals.

I thank the Minister for the statement. I go back to the questions from Colin and Nuala earlier. I know that it is really hard to set specific definitive timelines at this stage because, obviously, it is an early phase of the process, but when do you foresee the proposals for reconfiguration going out to the public? The consultation closes in January 2025. Do you foresee that happening in 2025, or are we talking 2026, or later?

I thank the Member. I understand the nature of the question. It is going to be a rolling programme. For example, as I indicated, officials in my Department have been liaising with officials in the Department of Health and Social Care in London about the Tobacco and Vapes Bill. It is our intention that whatever legislation is brought in for England will apply here in Northern Ireland. I would love to see a smoke-free generation as soon as possible. Smoking is one of the social determinants of health inequalities. I am sure that the Member will join me in hoping that we can tackle that.

I have talked about minimum unit pricing of alcohol. We, as a Department, have already consulted on that. I am at the early stages of discussing with officials how we take that forward. It is something that I hope to bring to the Health Committee. I apologise for missing my slot last week due to illness. I think that it is something that the Committee and the Department can work together on. That will not have to wait until January and the end of the consultation. I want to go ahead with trying to see whether we can get agreement on minimum-unit pricing for alcohol.

Officials have been told to press on urgently with work on breast cancer screening. I want to get as soon as possible to the point at which every woman can go online and have control over her own appointment. If she wants the earliest available appointment, wherever that might be in Northern Ireland, she should be able to click a button and book herself in for that. If she would rather go local, even if it means waiting a bit longer, that is her choice, and I want her to have that choice. Those things are part of a continuum. It is not that we will get to the end of January and a whole series of initiatives will come. I am doing every one of those as quickly as I can.

Thank you, Minister, for your statement. From the Alliance Party's engagement with the sector, it is clear to us that the Royal children's hospital needs to be a regional hub and funded as such through the proper commissioning of services. Will the Minister confirm that that is his intention, so that it can be a centre of excellence for children across Northern Ireland? Has he engaged with clinicians in the hospital? If not, will he do so?

Sorry, Deputy Speaker. Which hospital?

The children's hospital.

Are you asking whether it can be a centre of excellence? Are you talking about the Royal Belfast Hospital for Sick Children?

Yes.

Sorry, could the Member repeat the question? I did not quite catch it.

Clinicians at the Royal Belfast Hospital for Sick Children are telling us that it needs to be a regional hub and funded as such, so that it can be a centre of excellence for children across Northern Ireland. I am trying to ascertain whether the Minister's intention is for it to become that and to be funded accordingly and for services to be commissioned.

I am sorry that I missed the question the first time.

It is my understanding that, in many ways, it already is a regional hub. Certainly, it is my intention that that is the case going forward. Certain services, like percutaneous endoscopic gastrostomy (PEG) treatment, are only available at the Royal.

Minister, the document is largely made up of principles, and there are lots of principles to commend. One thing that is not mentioned in the statement is the cross-border context. Hospitals such as the South West Acute Hospital are already in a real-life network, but they could be in a theoretical network that includes hospitals in Sligo, Leitrim and Cavan. There is already a cross-border healthcare context. There is also an aspiration and a vision to maximise that. What will you do to properly maximise the cross-border potential for services at, for example, Daisy Hill Hospital, Altnagelvin Area Hospital or SWAH to ensure that those services are best used by people on both sides of the border? What will you do to ensure that we maximise the possibilities of cross-border healthcare provision?

I thank the leader of the Opposition. I think that I have said in the House — I have certainly said it at the North/South Ministerial Council and also at the North/South sectoral forum — that I have no political or ideological objection to cooperation with the Government of Ireland on healthcare delivery. In fact, it makes an awful lot of sense. Indeed, going back 15 years, the development of the breast cancer unit at Altnagelvin was based on a cross-border business model. SWAH was also built on the basis of cooperation across the border.

I have had two meetings, which, to my mind, were very useful, with my counterpart, Stephen Donnelly, the Minister for Health in the Government of Ireland. We talked about certain issues, including the need for a mother-and-baby unit. We discussed paediatric pathology, and we are making great advances on those terms. I know that a lot of Members have made clear in the House that it is far from ideal that we ask parents to fly or transport themselves to Alder Hey Children's Hospital in Liverpool. I hope that we will be able to offer an all-island solution on that. There is another initiative, which I will not mention at the moment but about which I am very excited. Mr Donnelly equally sees the benefit of an all-Ireland approach in this area.

Thank you very much, Minister. As someone who lives in and represents a rural constituency, I was glad to hear the rural transport notion being picked up. What other engagement will the Minister have with rural communities to make sure that their issues are heard fully and understood by the Department in the transformation process?

The consultation that I have had so far has been with the Minister of Agriculture and the Minister for Infrastructure. Officials have gone away to look at community transport and at how we might provide transport for people who do not have ready access to it.

If the Member is asking me whether I have plans at the moment to go out personally and consult in rural areas, that is not the case. However, I encourage Members to encourage people, particularly in rural communities, to respond to the consultation, because I want to know what people's concerns are.

It is all very well saying that 80% of people have said that they are willing to travel for a procedure, but that means that 20% have not responded that positively. In the survey, 16% said that they were not particularly keen on the concept. If we are to deliver a health service for all, which is our obligation, we need to understand why that 16% are not buying into the concept. I am more than willing to engage with the Member on how we might consult in the way that she might intend.

I thank the Minister for his statement. I very much concur with some of the frustration in the Chamber. We have would appreciated a wee bit more substance. It was my understanding that the co-chaired work streams, looking at the four types of hospitals, were looking at defining what was going where.

My question picks up on that asked by my colleague Sian Mulholland. You talked about the 80% of people who are willing to travel for elective care. We know that there will still be reservations for people with a suspected stroke or heart failure. Will you take forward a communications strategy to look at where there are serious concerns about the time required for travel?

I thank the Member for her question. I will acknowledge her frustration, but I gently suggest that she might be more frustrated had I not brought the statement to the House today.

As for people having to travel, particularly in an emergency situation, I am working to the concept that no type-1 emergency department is going away. Emergency departments will still be there. The principle is stabilising patients as soon as possible and then getting them to the best place for their procedure. That is the way to go, with, as I have said, aftercare being delivered as close to home as possible.

I thank the Minister for his statement. A section titled "Patient Travel", setting out supports available for the public, is included in the draft framework. The Minister's predecessor had committed to a review of the hospital travel costs scheme, a review that, in the absence of Ministers, seems to have ended up on a shelf. I have raised the particular problem that the scheme makes no provision for the parents or families of sick children making long and frequent journeys, whose suffering and stress is compounded by financial hardship. Will the Minister update us on the review of the hospital travel costs scheme?

I thank the Member for his question. I can only tell him that it is under review. I encourage him to respond to the consultation by making that important and valid point.

I thank the Minister for coming to the House today. Over the years, Causeway Hospital has seen a gradual running down of its services. It lost its maternity unit to Antrim Area Hospital and is in the midst of a consultation on future general surgery at the site. There are lots of fine words in your statement, Minister, but what my constituents in the north end of North Antrim really want to know is this: will your proposals result in the removal of any of the cuts made to date? Will you take the opportunity to spell out your future plans for Causeway Hospital?

I thank the Member for his question. Causeway Hospital will remain a key element of the hospital network in Northern Ireland. Separating emergency surgery from elective or planned surgery, as I have said on a number of occasions, makes great sense for the people who access hospitals. The Member should have no fear about the future of Causeway Hospital. When I visited it a few weeks ago, I found there to be hugely positive energy amongst the staff and a great appetite for going forward together.

If we are to reform health service delivery, we will have to make changes. As I have said, I understand that, for many people, the National Health Service — Health and Social Care (HSC) here — is not just personal but deeply local. It is people's local GP surgery and their local hospital. I am as guilty as anybody of thinking that, but we have to think a bit more broadly if we are going to be more productive and more efficient and deliver those better outcomes.

I thank the Minister for his statement. Can he give an assurance that action point 5 is not a case of his Department putting a proverbial gun to the head of the population of the Causeway region that only when they accept the removal of emergency general surgery at Causeway Hospital will it be designated as an elective hub?

I thank the Member for the question. I encourage him to speak to the clinicians whom I spoke to at Causeway Hospital and at Antrim Area Hospital about the future.

That concludes questions on the statement.