An Adjournment Debate was held in Stormont last week around the issues of the cuts to the hours in the Downe Hospital Accident and Emergency service.
Down News has included an extensive section of the dialogue of the debate from Stormont in order for everyone to fully understand the complexity, and some would argue the simplicity, of the issues.
The debate was introduced by Chris Hazzard MLA (Sinn Féin) who along with other County Down MLA’s has supported the Down Community Health Committee’s campaign to have the full service restored to a 24/7 hour consultant led A&E.
Attending the debate in the public chamber with Unison officials Marion Ritchie and Sonia Graham, Eamonn McGrady, Chairman of the Down Community Health Committee, said afterwards: “This is the second debate in a few months at Stormont over the Downe Hospital A&E. The message from the campaigners and the public itself to our local MLA’s has been conveyed strongly to our health Minister Edwin Poots on both occasions.
“We yet have to see real change happening to get our 24/7 consultant led A&E service at the Downe Hospital. The Minister has expressed his desire to see this happen yet the xa0South Eastern Trust continue to focus on a recruitment policy that has not produced any doctors suitable to turn this situation round for the Downe A&E. We are concerned as information we have and evidence from other medical centres suggests this may in fact be achievable.”
[caption id="attachment_49538" align="alignleft" width="390"]
Unison officials Marion Ritchie and Sonya Graham pictured with Eamonn McGrady, chairman of the Down Community Health Committee, on the steps of Parliament Buildings at Stormont before the Adjournment Debate on the Down Hospital A&E Minor Injuries Unit.[/caption]Mr Hazzard opened the debate at Stormont and said: “Since the news broke at Christmas that the future of emergency care at the Downe looked bleak, an active and coherent community campaign has been to the fore in mobilising opposition.xa0 Approximately 1,000 people attended three public meetings in Downpatrick, Ballynahinch and Newcastle, where, by and large, political representatives spoke in unison against the cuts.
“Indeed, in the past couple of weeks, the Minister was presented with a petition of more than 20,000 signatures of those local people who are opposed to the current status of emergency care and to the direction of travel of the trust’s vision for the future of emergency care at the Downe Hospital.”
In addressing the Health Minister directly, he said: “Last month, you stood in the House and spoke of your anger and deep disappointment that the trust had taken a decision to downgrade the status of emergency care at the Downe.xa0 You gave assurances that you would challenge the trust, the Health and Social Care Board and, indeed, the Department.xa0 You outlined that you would challenge the trust to manage the consequences of such closures and said that the South Eastern Trust had, indeed, given you assurances that the additional numbers at the Ulster Hospital would be managed successfully.
“Yet the Ulster Hospital continually fails to meet patient admissions targets, with more than one in four patients forced to wait for more than 12 hours.xa0 If the Ulster Hospital cannot manage current numbers, why should the people of Down accept that they will receive the appropriate care in the future?xa0 Indeed, when we look at the experiences of changes at the Mid-Ulster and Whiteabbey accident and emergency departments, we see that those led to serious problems at Antrim and Causeway hospitals as a consequence.
Secondly, you outlined that fresh efforts would be made to secure medical staff for the Downe.xa0 Those efforts have, of course, proved fruitless.xa0 Or have they?xa0 Many of us contend that the process is designed not to secure additional permanent doctors.xa0 Indeed, when you consider that the recruitment agency that is used for such a venture is called Locumotion, surely it is questionable whether the motivation for securing full-time permanent doctors exists at all.
“At the last public meeting in Newcastle, we listened to a recruitment expert describe the process of sourcing professional doctors throughout Europe.xa0 He talked of the cultural challenges in adapting to a new workplace that are easily overcome and said how, with the appropriate support and guidance, emergency doctors from around Europe or further afield can integrate into our local hospitals. xa0The same recruitment expert had just hired more than forty full-time doctors from Romania for positions in hospitals in the Midlands and Drogheda.
“If those doctors are good enough for the people of Drogheda, why are they not good enough for the people of Downpatrick?
“Finally, you tasked the Trust and the Health and Social Care Board with bringing forward detailed plans for the future of emergency care at the Downe, coupled with an implementation plan.xa0 You said that such a plan would:xa0“secure confidence in the community that the best possible steps are being taken.”
“The people of Down are still waiting not just for sight of the plan but to be an active part in its formation.xa0 It is the best part of six months since the current crisis transpired in the weeks before Christmas.xa0 We need to see productive engagement on the road ahead.xa0 Just as the Education Minister put out to public consultation plans to reform the schools funding formula or the ongoing area planning process, so, too, any plans to reform or alter healthcare provision in Down should be open to public consultation and engagement.
“Our health and care services must be fully accountable to the public and fully transparent in all that they do.xa0 As Minister, you must enable staff, patients and the wider public to scrutinise any and all plans to reform their health service.xa0 Space must be created for honest and productive dialogue between those who use and work in the health service and those who are responsible for its delivery.
“The people of Down must be afforded the right to determine what health services are appropriate for Down.xa0 Moreover, any such reforms must be subject to the appropriate equality impact assessments.xa0 The absence of such screening thus far has been a failing of the trust and, indeed, your leadership as Minister to deliver equitable health services across the North.
“One of the fundamental aims of the health service must be to eliminate health inequalities and, in turn, to contribute to reducing social and economic inequality throughout our society.xa0 Although the people of Down undoubtedly acknowledge that specialised services cannot be provided in every town in the district, we expect appropriate emergency care services to be available at the Downe Hospital.
“As the Minister is no doubt aware, local patients and families continue to experience difficulties in the process of repatriation from the Ulster Hospital back to the Downe.xa0 In light of that, I hope that the Minister will also provide an update on the ongoing review into repatriation processes and protocols.”
Mr Hazzard also explained that linked to the issue of health inequalities and the repatriation problems is the issue of rural demographics of the local Down area.xa0 As has been outlined in previous debates, we do not have a single inch of carriageway, and existing public transport links to centralised services in the greater Belfast area are simply not what they should be.xa0 Compounding such inequalities, we also suffer the effect of over-stretched ambulance cover — cover that needs to be seriously enhanced and supported for rural areas.
“Despite the best wishes of your officials and figures within the trust, the people have been galvanised by the onset of the reductions and the downgrading of our emergency care services.xa0 We did not ask for a minor injuries unit, and we will not settle for a minor injuries unit.xa0 You yourself asked that appropriate A&E services be restored at the Downe, and we will certainly hold you to that commitment in the months ahead,” said Mr Hazzard.
Jim Wells MLA (DUP),xa0expected to be the next Health Minister,xa0responded supporting the Health Minister’s position saying: “Mr Hazzard, Mr Rogers and I attended an emergency meeting of Down District Council just before Christmas.xa0 At that meeting, Trust officials went to great lengths to explain the situation that we are in in Downe Hospital.xa0 It is not a lack of will by the Minister or the trust to have a fully fledged A&E service in Downpatrick.xa0 It is not a lack of money, unusually; there is enough money to provide for the posts that are needed.xa0 What was explained to us that night, and what Mr Hazzard and many others have to accept — they accept it privately but not publicly — is that the only reason for the situation that we are in is a lack of middle-grade doctors to staff A&E out-of-hours in Downpatrick.xa0 The facts are very simple: three issues have come together to create a perfect storm, which has made the decision of the South Eastern Trust on this absolutely inevitable.
“The first is that, on average, 50 qualified doctors leave Northern Ireland for greater experience and, indeed, greater pay and better conditions in Australia and other countries, and we could not have predicted that eight or 10 years ago.xa0 That is not unique to Northern Ireland.xa0 It happens in the Irish Republic.xa0 It is happening throughout the United Kingdom and western Europe.xa0 Mr Hazzard said that they had left the shores of Ireland; no, they have left the shores of Northern Ireland — I would never use that other phrase.
“However, it is worth commenting on the fact that other smaller hospitals in places such as Roscommon are experiencing exactly the same situation.xa0 There are not enough middle-grade doctors to man hospitals in the British Isles, full stop.xa0 It is no good saying that you should go out and advertise; you cannot go out and advertise if they are not there in the first place.xa0 Even though there are more middle-grade doctors working in Northern Ireland than there were three years ago, we still have a shortage and we cannot get them.
“Secondly, there is the issue of the feminisation of the health service, and we welcome that.xa0 It is great news, because it has allowed us to have a pool of very highly qualified, able women coming out of medical school.xa0 Indeed, the majority of those coming out of medical school at the moment are women, and that is good.xa0 However, the problem is that women demand a different type of working rota from men.xa0 They demand, and quite rightly demand, flexible working, and they demand time off to look after children and for other caring responsibilities.xa0 They take career breaks, and the trusts are absolutely right to facilitate anyone who asks for that, whether they are male or female.xa0 However, the vast majority are female.xa0 That makes it much more difficult to ensure coverage at our A&E hospitals.
“Thirdly, A&E cover at weekends and at night is becoming a very, very unattractive option for any grade of doctor, whether they are junior, middle grade or consultant, and we as a society have to accept that.xa0 As the facts have recently shown, 80% of those who present themselves at A&E in our hospitals at weekends in Northern Ireland are under the influence of alcohol.xa0 The abuse, the violence and the insults that our medical staff have to take, particularly on a Saturday and Sunday night, are absolutely dreadful.xa0 When middle-grade doctors have a choice, particularly if they are women, they make the choice that they prefer not to have the abuse, the insults and the violence; they prefer to work ordinary daytime shifts.xa0 Therefore, it is becoming much more difficult to get people to cover for those shifts.
“Compounding that in the Downpatrick situation was the fact that one doctor from South Africa, who had worked a huge number of hours, decided, quite rightly, to go back to his home country for a well-earned rest.xa0 That was granted, and the result was that the rota collapsed.xa0 Locums were not obtainable, and the staff were not there.xa0 So the South Eastern Trust had absolutely no option before Christmas but to close A&E at weekends.xa0 The fact is that, had it not done so, it would have been acting illegally.
“At the time, the Minister said, quite rightly, that he was appalled by the situation and would do everything that he could to rectify it, but not even he can produce middle-grade doctors out of a hat.
“There are options, such as trying to attract doctors from Europe.xa0 I know that at least one professional in south Down is trying to pursue that option.xa0 However, there were difficulties with the previous attempt to do that.xa0 There were problems with language and experience.xa0 However, every effort is being made to resolve this position, and every attempt is being made to ensure that we can rectify it.xa0 I think that we all hope that this is temporary.
“We have a wonderful new hospital in Downpatrick.xa0 It is a fantastic facility, but, unfortunately, since the day and hour that it opened, various forces have acted against it.xa0 I want to see that building completely utilised and packed to the rafters with patients enjoying first-rate care.xa0 Rather than simply making cheap party political points leading up to 22 May, as many political representatives in Down district are doing, you should understand the facts of what is happening and rally together to help the Department to ensure that we get the staff that we need to keep the hospital up and running.”
Séan Rogers MLA (SDLP), speaking in favour of the hospital campaigners’ position of a full 24/7 A&E for Downpatrick, explained that thexa0newxa0minor injuries unit was established on 1 March to lessen the impact of the temporary weekend closure of the emergency department at the Downe Hospital. xa0He said: “I would like to stress my admiration for the nurse practitioners who work at that unit.
“They offer a wealth of skills and experience and, at present, deliver an excellent service to the people of south Down.xa0 However, it cannot be ignored that that is no substitute for what is needed in the area:xa0 a fully operational accident and emergency unit.xa0 Unfortunately, the needs of local communities in south Down are not being met, and we cannot ignore that.
“On 11 February, Mr Poots stated that ‘The first elements of the provision of health and social care are safety and quality … If it falls short, it will be a matter of real concern to all of us. — [Official Report, Vol 91, No 8, p33, col 1]’
“We are all in this together, and we have been elected by our constituents to voice their concerns and raise the issues that affect them.
“The BBC ‘Spotlight’ episode, ‘The State of Emergency’, shown on 12 February, flagged up too many warnings about the state of our A&E units, once again fuelling the public consensus that there needs to be an operational A&E in Downpatrick to lessen the stress on A&E’s in Belfast.
“The minor injuries unit is a polit scheme and will be evaluated in three months from its beginning.xa0 I speak on behalf of my constituents when I comment that I hope that the evaluation is not three months too late for anyone who has had to wait an unnecessary length of time on an ambulance trolley or in a hospital bed.
“We need to start doing things differently.
“The problem has been well articulated:xa0 there are not enough middle-grade emergency doctors, and there is no local solution that can remedy that within five years.xa0 The solution is that we need to recruit from Europe and further afield.xa0 There are suitable doctors out there with the right basic skills that could be enhanced to the required level, but they need training and development to operate effectively.
“There are recruitment businesses that can find suitable doctors abroad, but some exploratory work needs to be done.xa0 Precisely how many doctors do we need?xa0 What are their training needs?xa0 Who will train them?xa0 What retention strategies will be employed?xa0 What will the costs be?xa0 Minister, I urge you to take up the challenge:xa0 form a small project team that can carry out the scoping exercise, but, in the process, do not reinvent the wheel.xa0 Hand this over to an international medical recruitment specialist — Mr Wells mentioned that we have one in South Down — who can form this team.xa0 Scope it out, and I can guarantee you that, in three months’ time, he will be back with solutions on your desk.”
In addressing Minister Poots directly, Mr Rogers said: “The answer to Downe A&E and, indeed, to A&E generally, lies in recruiting the right person in the right way with the right skills and having the processes to develop the team.xa0 If we or the trust imagine that only doctors from the UK and Ireland can grasp the role of an A&E doctor, we are deluding ourselves.
“We should be selling the whole package of living and working in Northern Ireland, in places such as St Patrick’s country, with our schools, beautiful countryside and cheaper housing.xa0 We should be looking at alternative contracts that meet the needs of our people.xa0 We have the opportunity to work with well-trained doctors who may not have the desired UK experience but have the right basic skills and are able and willing to learn and be trained.
“You are the Minister.xa0 You have said that you want A&E to be restored at the Downe. You lead from the front:xa0 take up my challenge of establishing this little project team, then we will all begin to think differently, and it will be better for us all.”
UUP Leader Mike Nesbitt also joined the fray in the hospital debate and said:xa0″We oppose the down-scaling of the emergency department in Downpatrick, just like that at Lagan Valley. It is hoped that the minor injuries unit, which opened at the start of last month, will mitigate the impact.
“However, the unit will still be open only from 9.00 am to 5.00 pm at weekends.xa0 So the point stands that, after 8.00 pm during the week and 5.00 pm at weekends, there is no service, emergency or minor injury.xa0 I am not opposed to change across our hospital but in these circumstances, we simply disagree with the Trust’s decision.
“The Trust said that it was experiencing difficulties in maintaining sufficient medical staffing in the unit, but what efforts were really being made to sustain the existing services? xa0If doctors feel that working in emergency departments is not for them, as Mr Wells articulated, what is being done not only to rectify that but to retain, retrain and upskill nurses to fill the void?
“I am sure that the Minister, in his remarks, will express his concerns about the reductions in the Downe and tell us that he hopes that they will be only temporary.xa0 However, let us look briefly at what happened in Lagan Valley Hospital, when emergency services there were first reduced to daytime and weekends in summer 2011.xa0 At the time, staffing concerns were given, and we were again assured by the Minister that the decision was only temporary.xa0 Nevertheless, and despite his public statements at the time, the opposite has happened, with the services being further reduced at the end of last year.
“I have every confidence in the staff working in the minor injuries unit at the Downe.xa0 I am sure that they are doing their utmost to make it safe and to offer an efficient system, but I am also sure that even they would say that it still falls some way short of the previous full emergency service.”
“I have been told previously that, following the downscaling of services and with the introduction of this minor injuries unit, the Downe Hospital will be linked more closely with the Ulster Hospital.xa0 The reduction in services was, conveniently for the Minister, announced in the mouth of Christmas and implemented days after new year, and it will have already placed greater pressures on the Ulster.
Mr Nesbitt citedxa0that only 69% of patients attending the A&E at the Ulster Hospital are being treated and discharged or admitted within the four-hour target. xa0He added: “Of course, the Minister does not need to be reminded that the target is 95% not 69%.xa0 Were he in England, no doubt he would long ago have been hounded out of office.”
Caitriona Euane MLA (Sinn Fein) supported Chis Hazzard’s position and added: “We have seen a litany of cases where there has been no support for the Downe Hospital.xa0 We hear the excuses and we see the wringing of hands about there not being enough doctors or people attending when we know that one reason why is because of memorandums that were put in place about ambulances and various A&E departments in Belfast.
“There have been ongoing changes to emergency care at the Downe Hospital without public consultation.xa0 There was no equality impact assessment and there was a complete and utter failure to plan for the future.xa0 We heard Mr Wells talk of the failure to recruit sufficient doctors, and, yes, Minister, you have failed to recruit doctors.xa0 You have failed.xa0 You can dress it up and you can pretend that somehow we cannot get doctors, but you are the boss.xa0 You are in charge.xa0 Can you imagine John O’Dowd or I when I was in Education not being able to recruit principals?
“For young people, places to study medicine are rarer than hen’s teeth.xa0 Young people want to go into medicine:xa0 what has the Minister done about that?xa0 If we do not have enough doctors, if he cannot get doctors, why does he not do something about the thousands of young people across this island who are doing aptitude tests and studying day and night so that they can enter medicine?
“Our doctors and consultants are paid well and that is fine, but the Minister’s job is to ensure that their contracts are such that they have to work in various hospitals.xa0 It is not good enough that doctors can say that they will work here but will not work there.xa0 It is the Minister’s job to ensure that the system works, and, frankly, this is not working under his watch.
“So, the MInister has a job which must be done. The Minister has over half the entire Executive Budget, but what is he doing?xa0 He is squandering it on unnecessary court cases.xa0 We had a debate about equality earlier.xa0 He is squandering it.xa0 He has no money for x, y and z, yet he has money to fight discriminatory court cases.
“This is not leadership.xa0 We are going from crisis to crisis, and there is a failure of leadership by this Minister.xa0 Really, he needs to take control, but he should not be taking control at the expense of the people in Down.xa0 That hospital was built because of a Sinn Féin Minister, and it was approved because of a Sinn Féin Minister, Bairbre de Brún, who stepped up to the plate.
“The people of Down are being failed by this current Minister, and it is not good enough.”
Fearghalxa0McKinney SDLP Health Spokesman said: “I listened with interest to Mr Wells diagnosing the whole situation.xa0 For months now, we have been saying that the issue needs to be resolved by, first, diagnosing the problem.xa0 Mr Wells gave us a range of problems.xa0 He said that there are three big ones linked to others as well, creating what he described as the perfect storm.xa0 There is the fact that 50 qualified doctors leave in a year.xa0 There is the feminisation, he said, of the health service, and the fact that A&E cover is unattractive and beleaguered with constant and ongoing alcohol-riddled problems.xa0 Then there are the additional issues of locums not being available and the issue of one particular member of staff.xa0 Apart from that one last issue, what links them all?xa0 I will tell you:xa0 they are all long-term problems that nothing was being done about.
“Therefore I am grateful for this xa0DUP perspective, but what happened?xa0 Did the Department or the trust do anything about these long-term problems?xa0 They did not.xa0 They pitched up shortly before Christmas and shut the unit down.
“The issue is also about public confidence. xa0The Downe Hospital is an excellent facility with excellent staff.xa0 However, when an A&E unit has its services restricted in this way, it undermines confidence.xa0 It no longer becomes a tangible front door for services.xa0 The erosion of services at Downe is regrettable, and the introduction of a nurse-led unit, although welcome in the short term, will not answer all the problems.xa0 The Minister has admitted that because, on the day when he was presented with the 20,000 signatures, he explained that he would like to see different answers.xa0 At the time, he said that it was the wrong decision, just as, ultimately, he said the Northern Trust’s shutting of nursing homes was wrong.
“What we are saying is that there needs to be more strategic thinking around all these problems.
“I am delighted that the Member for South Down is able to bring some knowledge that at least there has been thinking around this and some analysis of what the problem is.xa0 However, we need longer-term strategic thinking at departmental and ministerial level to resolve these particular problems.
We have seen, for example, how stripping services from a hospital becomes a slippery slope, and we have seen it in Omagh.xa0 We have to hope that what happened there in the removal of services does not ultimately happen in Downe.xa0 I commend the work of the Down Community Health Committee, which has been so proactive in lobbying for the full restoration of A&E services at Downe Hospital. xa0So the will is there ; the strategy is not.
NI21 deputy leader Mr McCallisterxa0has also campaigned xa0for the full restoration of services at the Downe Hospital and said: “I am hearing today from both Mr McKinney and Mr Nesbitt a warning on the dangers of when you start to strip those services out, about what is left. xa0Once you take away certain services, there is an element of draining the confidence from that hospital.xa0 Mr Nesbitt said that it can almost become a self-fulfilling prophecy.
“Once you take away certain services from that hospital, you change its very nature.xa0 You change what it was meant to be, which was an enhanced local hospital, move it away from that status and downgrade it.xa0 Ever since, literally, the day and hour it opened, the battle has been about maintaining services at the hospital.xa0 One of the biggest disappointments for me is that, nearly three years ago, there was a great debate about changing from a consultant-led A&E department and moving to a GP-led model.xa0 That was supposed to take the Downe Hospital off the radar in some of the cases in A&E.xa0 That would have safeguarded Downe, even throughout the whole ‘Transforming Your Care‘ policy debate and the Minister’s target of reducing the number of A&Es across Northern Ireland.
“This was taking the Downe Hospital off the radar; it would secure it.xa0 That almost goes to the heart of why people across Down district, the South Down constituency, and, indeed, parts of the Strangford constituency, have lost confidence in the Minister and in the trust.xa0 They have lost confidence because they keep getting told: ‘It is a pilot scheme’; ‘It is temporary’; ‘This will not happen’; ‘We are just trying this’; and “If this is successful, it is going to secure it for the long term.’ xa0We heard that and, two or three years on, we are back having the same debate again.xa0 They are back saying, ‘We cannot maintain it the way it is and we are going to downgrade it.xa0 We are going to close it at this part of the day and open it at that.’ xa0There is no confidence left and that is the key problem.”
“Let me pick up on some of what Mr Wells said about the shortage of doctors.xa0 I, too, accept that there is a problem there; but, next month, this Minister will have been in post for three years.xa0 Are we any further on in developing proper workforce planning or in recruiting and retaining doctors?xa0 Are we any further on in looking at how we should rotate doctors and make sure that they keep up their skills?”
A great argument for smaller hospitals is that you can keep up the doctors’ skill sets by rotating them around different parts of the hospital.xa0 Can we even rotate doctors between Trusts?xa0 Can we look at all the options to make this work and give people the confidence to buy into some of the changes?xa0 Quite frankly, confidence in the Minister and in the Trust is at an all-time low.xa0 People are just not buying into it.”
Mr Poots (The Minister of Health, Social Services and Public Safety) was under fire from all sides and rsponded during the debate at Stormont saying that the temporary reduction in the opening hours of the emergency department at the Downe Hospital was the subject of an previous Adjournment debate on 14 January. xa0He said: “I also made a written statement to the Assembly on 18 March, providing an update on the progress of actions in relation to emergency departments in Northern Ireland.xa0 That statement includes details of the steps I have taken to manage the consequences of the temporary changes in the Downe and Lagan Valley hospitals, and the measures put in place by Health and Social Care to reduce the impact of the changes on neighbouring hospitals.
“I have already told the House of my deep disappointment at the South Eastern Trust’s decision to reduce the opening hours, but on examination of the facts, I accepted that, in the circumstances, there was no other option.xa0 Given the debate in January and my statement last month, the circumstances that led to the South Eastern Trust’s decision and the action that has been taken since then have been made clear.
“It was not down to money, as Mr Hazzard or Mr Rogers would have you believe, and it was not down to policy. Let us get the facts out and not try to mislead or deceive people.xa0 The fundamental reason that led to the South Eastern Trust’s decision is that the Trust was unable to recruit middle-grade doctors in emergency medicine or to source enough locums to sustain the rota.xa0 Therefore, the safety of the people in South Down would have been compromised.xa0 That is the reason — no other.
“In view of this, and in the interests of ensuring patient safety, the trust had no alternative but to take action to manage that risk.
“A recruitment drive in January by the South Eastern Trust for emergency department staff for all its hospitals attracted applications from consultants and emergency nurse practitioners but none for the middle-grade doctor posts that were needed for the Downe Hospital.xa0 The shortage of emergency medicine doctors is a regional one, not a local one.xa0 There is no quick fix for the shortage of those key medical staff.xa0 However, I have taken a number of steps, which I will say a bit more about later.xa0 Perhaps I might cover in that what Mr McKinney wants to ask about.
“I referred to contingency arrangements being put in place to reduce the impact of the temporary changes on neighbouring emergency departments.xa0 It is equally important that steps are taken to minimise the impact on local people.xa0 Local arrangements were, therefore, put in place to minimise disruption to patients.xa0 For example, there were GP direct admissions to the Downe and Lagan Valley hospitals, thus avoiding the need for some patients — indeed, quite a lot of patients — to go to an emergency department.
“There was also early repatriation of patients from other hospitals to the Downe and Lagan Valley hospitals.xa0 Additional ambulance provision — I hope that Mr McCallister is listening — was also put in place to improve emergency responses for life-threatening and critical cases. xa0He can update himself with the Ambulance Service, which will be very accommodating at any time.
“Another measure concerns the topic of this debate.xa0 That is the weekend minor injury service, which was introduced at the Downe Hospital from 1 March.xa0 No one is suggesting that the minor injury service at the Downe Hospital can replace an emergency department service.xa0 It is, by definition, a service that treats minor injuries and, therefore, cannot treat people suffering from serious injuries or critical illness.xa0 The South Eastern Trust has made it clear that the service has been introduced to help to mitigate the impact that the temporary weekend closure has had on local people.xa0 It is not providing a substitute for it.
“It is an excellent service.xa0 I know that Mr Nesbitt made it clear that he did not want it, but it is an excellent service.xa0 Minor injury units play an important role in urgent and unscheduled care services, treating people with a variety of injuries that are not major or life-threatening.xa0 They are typically staffed by emergency nurse practitioners, who are experienced nurses with specialist training and experience that allow them to work independently to treat minor traumas.”
Mr Poots added: “There are seven minor injury units across Northern Ireland, excluding the weekend service at the Downe.xa0 They are particularly valuable in rural areas, where people might otherwise have to travel a considerable distance to an acute hospital emergency department.xa0 Examples are the Tyrone County Hospital’s urgent care and treatment centre in Omagh and South Tyrone Hospital’s minor injury unit in Dungannon.
“In 2012-13, there were 83,000 attendances at minor injury units, representing 11·7% of all emergency care attendances.xa0 Almost 100% of patients who attended minor injury units were treated within four hours of arrival.
“The minor injury service at the Downe has proved effective in its first month.xa0 In March, there were 210 new attendances.xa0 That represents 210 people who did not have to travel to one of the neighbouring emergency departments or wait until the Downe emergency department opened on Monday morning.xa0 On average, there were 44 attendances each weekend in March, compared with 100 attendances when the emergency department was open at weekends.
“So, I am sure that those 44 people each weekend were glad of the service, even if Mr Nesbitt did not want it.
The Minister added that the opening hours of the minor injuries service in the Downe Hospital are based on the hours during which the majority of minor injury-type patients attended the emergency department when it was open at the weekends.xa0 Collected evidence he said suggests that the majority of patients attend during the daytime on Saturday and Sunday, with the majority of attendances relating to sports-related injuries, particularly on Saturday and Sunday afternoons. xa0When this is combined with the enhanced arrangements for direct GP admissions when the emergency department is closed, which, on average, is around eight each weekend, xa0a substantial amount of emergency care activity is being retained in the Downe.xa0 The South Eastern Trust has indicated that the level of attendances is just under 80% of the volume before the temporary change.
Health Minister Poots continued: “It is important to recognise that this is about the people of Down, first and foremost, and almost 80% of the people are availing themselves of the service that is available to them in a satisfactory manner.xa0 That was important because I asked the trust to take interim measures while it sought to obtain more doctors, and a very clear effort has been made to deal with that.”
Demand for emergency services tends to fluctuate, so monthly figures must, therefore, be used with caution.xa0 However, there were 1,467 attendances at the Downe Hospital emergency department in March 2014 compared with 1,675 in March 2013.xa0 That represents 200 fewer patients.
“I was deeply and profoundly disappointed when I received the news that there was a proposal to close the facility at weekends.xa0 That was not something that I supported, and I have made that very clear to the trust’s chiefs.xa0 It is, therefore, something that I wish that they would turn around, and I have made it very clear to them that I have an expectation that they will turn it around.
“The weekend minor injuries service is not a substitute for the emergency department, and I have asked that fresh efforts are made to secure medical staff for the site.xa0 I understand that the South Eastern Trust intends to advertise again in the near future and that it is also continuing to work with recruitment agencies, and I recognise that increasing the number of emergency medicine doctors cannot be left solely to individual trusts.xa0 It requires a regional and national approach.
“I have engaged with the College of Emergency Medicine to explore options to improve emergency medicine as a career choice.xa0 I have also met the British Medical Association to consider solutions to current medical staffing issues in emergency medicine.xa0 I have also corresponded with the Secretary of State for Northern Ireland and the Home Secretary on the impact of the delays in progressing immigration relating to international recruitment, because, in many instances, we have identified doctors who want to come to work here, but by the time the immigration process is completed, the vast majority will have found jobs and gone elsewhere.
Locally, my Department will be carrying out workforce planning activity at all levels for the medical workforce, including undergraduate intake levels.xa0 Specialties where there are currently shortages, such as emergency medicine, are being given priority.xa0 Negotiations are also under way nationally to agree a new junior doctor contract and a consultant contract.xa0 That is unlikely to solve the medical staffing issues in the emergency department, as the Downe relies on experienced middle-grade doctors, but it is essential that we work to ensure that, in the future, we have an appropriate level of emergency doctors at all levels.
I know that some people fear that changes to the emergency department might lead to the downgrading of the Downe Hospital.xa0 That is absolutely not my intention.xa0 The Downe Hospital is a prime example of how an enhanced local hospital can operate at the centre of a network of secondary, primary and community services.xa0 The Downe Hospital has links with specialist acute services in the Ulster Hospital and with primary and community care services in the Down area.xa0 It houses GP out of hours practicesand community health.xa0 It is looking at new ways of working in line with Transforming Your Care, which envisages closer working relationships with secondary care.
“As I said before, I do not want a reduction in emergency services at the Downe Hospital, and we will do what we can to recruit further doctors to ensure that we can provide the service that the people in Down want.”
The Adjournment Debate at Stormont ended as it had begun. A number of MLA’s had spoken about the serious issues, and the Minister was left in no doubt about the deep public concerns. But hanging on everyone’s lips was “Will anything happen to make this situation at the Downe Hospital better?”
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