MLA's Debate Downe Hospital A&E Cuts At Stormont

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  South 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 befote the Adjournment Debate on the Down Hospital A&E Minor Injuries Unit. 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.  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.  You gave assurances that you would challenge the trust, the Health and Social Care Board and, indeed, the Department.  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.  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?  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.  Those efforts have, of course, proved fruitless.  Or have they?  Many of us contend that the process is designed not to secure additional permanent doctors.  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.  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.  The 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.  You said that such a plan would: “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.  It is the best part of six months since the current crisis transpired in the weeks before Christmas.  We need to see productive engagement on the road ahead.  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.  As Minister, you must enable staff, patients and the wider public to scrutinise any and all plans to reform their health service.  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.  Moreover, any such reforms must be subject to the appropriate equality impact assessments.  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.

dn_screen“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.  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.  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.  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.  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.  We did not ask for a minor injuries unit, and we will not settle for a minor injuries unit.  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), expected to be the next Health Minister, responded supporting the Health Minister’s position saying: “Mr Hazzard, Mr Rogers and I attended an emergency meeting of Down District Council just before Christmas.  At that meeting, Trust officials went to great lengths to explain the situation that we are in in Downe Hospital.  It is not a lack of will by the Minister or the trust to have a fully fledged A&E service in Downpatrick.  It is not a lack of money, unusually; there is enough money to provide for the posts that are needed.  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.  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.  That is not unique to Northern Ireland.  It happens in the Irish Republic.  It is happening throughout the United Kingdom and western Europe.  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.  There are not enough middle-grade doctors to man hospitals in the British Isles, full stop.  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.  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.  It is great news, because it has allowed us to have a pool of very highly qualified, able women coming out of medical school.  Indeed, the majority of those coming out of medical school at the moment are women, and that is good.  However, the problem is that women demand a different type of working rota from men.  They demand, and quite rightly demand, flexible working, and they demand time off to look after children and for other caring responsibilities.  They take career breaks, and the trusts are absolutely right to facilitate anyone who asks for that, whether they are male or female.  However, the vast majority are female.  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.  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.  The abuse, the violence and the insults that our medical staff have to take, particularly on a Saturday and Sunday night, are absolutely dreadful.  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.  Therefore, it is becoming much more difficult to get people to cover for those shifts.

dn_screen“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.  That was granted, and the result was that the rota collapsed.  Locums were not obtainable, and the staff were not there.  So the South Eastern Trust had absolutely no option before Christmas but to close A&E at weekends.  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.  I know that at least one professional in south Down is trying to pursue that option.  However, there were difficulties with the previous attempt to do that.  There were problems with language and experience.  However, every effort is being made to resolve this position, and every attempt is being made to ensure that we can rectify it.  I think that we all hope that this is temporary.

We have a wonderful new hospital in Downpatrick.  It is a fantastic facility, but, unfortunately, since the day and hour that it opened, various forces have acted against it.  I want to see that building completely utilised and packed to the rafters with patients enjoying first-rate care.  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 the new minor injuries unit was established on 1 March to lessen the impact of the temporary weekend closure of the emergency department at the Downe Hospital.  He 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.  However, it cannot be ignored that that is no substitute for what is needed in the area:  a fully operational accident and emergency unit.  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.  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:  there are not enough middle-grade emergency doctors, and there is no local solution that can remedy that within five years.  The solution is that we need to recruit from Europe and further afield.  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.  Precisely how many doctors do we need?  What are their training needs?  Who will train them?  What retention strategies will be employed?  What will the costs be?  Minister, I urge you to take up the challenge:  form a small project team that can carry out the scoping exercise, but, in the process, do not reinvent the wheel.  Hand this over to an international medical recruitment specialist — Mr Wells mentioned that we have one in South Down — who can form this team.  Scope it out, and I can guarantee you that, in three months’ time, he will be back with solutions on your desk.”

dn_screenIn 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.  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.  We should be looking at alternative contracts that meet the needs of our people.  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.  You have said that you want A&E to be restored at the Downe. You lead from the front:  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: “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.  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.  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?  If 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.  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.  At the time, staffing concerns were given, and we were again assured by the Minister that the decision was only temporary.  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.  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.  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 cited that only 69% of patients attending the A&E at the Ulster Hospital are being treated and discharged or admitted within the four-hour target.  He added: “Of course, the Minister does not need to be reminded that the target is 95% not 69%.  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.  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.  There was no equality impact assessment and there was a complete and utter failure to plan for the future.  We heard Mr Wells talk of the failure to recruit sufficient doctors, and, yes, Minister, you have failed to recruit doctors.  You have failed.  You can dress it up and you can pretend that somehow we cannot get doctors, but you are the boss.  You are in charge.  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.  Young people want to go into medicine:  what has the Minister done about that?  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?

dn_screen“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.  It is not good enough that doctors can say that they will work here but will not work there.  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?  He is squandering it on unnecessary court cases.  We had a debate about equality earlier.  He is squandering it.  He has no money for x, y and z, yet he has money to fight discriminatory court cases.

“This is not leadership.  We are going from crisis to crisis, and there is a failure of leadership by this Minister.  Really, he needs to take control, but he should not be taking control at the expense of the people in Down.  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.”

Fearghal McKinney SDLP Health Spokesman said: “I listened with interest to Mr Wells diagnosing the whole situation.  For months now, we have been saying that the issue needs to be resolved by, first, diagnosing the problem.  Mr Wells gave us a range of problems.  He said that there are three big ones linked to others as well, creating what he described as the perfect storm.  There is the fact that 50 qualified doctors leave in a year.  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.  Then there are the additional issues of locums not being available and the issue of one particular member of staff.  Apart from that one last issue, what links them all?  I will tell you:  they are all long-term problems that nothing was being done about.

“Therefore I am grateful for this  DUP perspective, but what happened?  Did the Department or the trust do anything about these long-term problems?  They did not.  They pitched up shortly before Christmas and shut the unit down.

“The issue is also about public confidence.  The Downe Hospital is an excellent facility with excellent staff.  However, when an A&E unit has its services restricted in this way, it undermines confidence.  It no longer becomes a tangible front door for services.  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.  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.  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.  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.  We have to hope that what happened there in the removal of services does not ultimately happen in Downe.  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.  So the will is there ; the strategy is not.

NI21 deputy leader Mr McCallister has also campaigned  for 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.  Once you take away certain services, there is an element of draining the confidence from that hospital.  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.  You change what it was meant to be, which was an enhanced local hospital, move it away from that status and downgrade it.  Ever since, literally, the day and hour it opened, the battle has been about maintaining services at the hospital.  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.  That was supposed to take the Downe Hospital off the radar in some of the cases in A&E.  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.  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.  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.’  We heard that and, two or three years on, we are back having the same debate again.  They are back saying, ‘We cannot maintain it the way it is and we are going to downgrade it.  We are going to close it at this part of the day and open it at that.’  There 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.  I, too, accept that there is a problem there; but, next month, this Minister will have been in post for three years.  Are we any further on in developing proper workforce planning or in recruiting and retaining doctors?  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.  Can we even rotate doctors between Trusts?  Can we look at all the options to make this work and give people the confidence to buy into some of the changes?  Quite frankly, confidence in the Minister and in the Trust is at an all-time low.  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.  He 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.  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.  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.  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.  Therefore, the safety of the people in South Down would have been compromised.  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.  The shortage of emergency medicine doctors is a regional one, not a local one.  There is no quick fix for the shortage of those key medical staff.  However, I have taken a number of steps, which I will say a bit more about later.  Perhaps I might cover in that what Mr McKinney wants to ask about.dn_screen

“I referred to contingency arrangements being put in place to reduce the impact of the temporary changes on neighbouring emergency departments.  It is equally important that steps are taken to minimise the impact on local people.  Local arrangements were, therefore, put in place to minimise disruption to patients.  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.  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.  He can update himself with the Ambulance Service, which will be very accommodating at any time.

“Another measure concerns the topic of this debate.  That is the weekend minor injury service, which was introduced at the Downe Hospital from 1 March.  No one is suggesting that the minor injury service at the Downe Hospital can replace an emergency department service.  It is, by definition, a service that treats minor injuries and, therefore, cannot treat people suffering from serious injuries or critical illness.  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.  It is not providing a substitute for it.

“It is an excellent service.  I know that Mr Nesbitt made it clear that he did not want it, but it is an excellent service.  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.  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.  They are particularly valuable in rural areas, where people might otherwise have to travel a considerable distance to an acute hospital emergency department.  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.  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.  In March, there were 210 new attendances.  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.  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.  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.  When 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,  a substantial amount of emergency care activity is being retained in the Downe.  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.  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.  However, there were 1,467 attendances at the Downe Hospital emergency department in March 2014 compared with 1,675 in March 2013.  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.  That was not something that I supported, and I have made that very clear to the trust’s chiefs.  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.  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.  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.  I have also met the British Medical Association to consider solutions to current medical staffing issues in emergency medicine.  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.

dn_screenLocally, my Department will be carrying out workforce planning activity at all levels for the medical workforce, including undergraduate intake levels.  Specialties where there are currently shortages, such as emergency medicine, are being given priority.  Negotiations are also under way nationally to agree a new junior doctor contract and a consultant contract.  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.  That is absolutely not my intention.  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.  The Downe Hospital has links with specialist acute services in the Ulster Hospital and with primary and community care services in the Down area.  It houses GP out of hours practicesand community health.  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?”