I welcome Councillor Carmel Hanna MLA, SDLP health spokesperson, Mr. Dominic Bradley MLA and Ms Nuala O'Neill to the meeting to discuss issues of mutual interest in health and social care North and South. I am aware that the delegation will attend a lunch with the Ceann Comhairle at approximately 12.40 p.m. That means we do not have much time. I will, therefore, ask Councillor Hanna to make her opening remarks and then we will have an interchange of views.
Health and Social Care, North and South: Discussion with SDLP.
Ms Carmel Hanna
We were happy to receive the invitation to attend this meeting and I thank the committee for the courtesy and speed with which it replied to me. It has worked out well for us to have this opportunity to meet the committee when we are in Dublin for the day. I also thank Deputy Liz McManus for facilitating this meeting. I am aware she had to go to a funeral today, but she has been very helpful and I wanted to mention it.
I introduce my colleague for Newry and Armagh, Dominic Bradley, and our policy officer Nuala O'Neill. I mention first the considerable political movement in recent weeks. To some extent it has had an impact on everything. In some ways it represents a triumph for democracy. We are all democrats in this room. We have that in common.
With the exception of the few months when we were in the Northern Ireland Assembly we have had nearly four decades of direct rule. Westminster has been very generous with resources for health. We will have £3.8 billion by 2008, which is a considerable amount of money. That is 43% of the Government spend. For 1.7 million people it is a great deal of money. We certainly got our fair share of the billions of pounds that have been poured into the health service. However, the problem with nearly four decades of direct rule is that to some extent it has resulted in a culture of lack of responsibility-taking because all the decisions have been made by civil servants. That is not good for civil society nor for the health service.
I follow health developments in this jurisdiction. I have been watching the Minister for Health and Children, Deputy Harney, and I support what she is doing. I am not sure whether everyone here agrees.
Most definitely not.
Ms Hanna
I definitely do. There must be ultimate political control and direction of the health service. The people with the expertise — the consultants, nurses and the professions allied to medicine — are the producer groups and, while they certainly have the right to be well paid, that expertise needs to be managed. I do not know whether anybody here saw the recent BBC series where Sir Gerry Robinson, formerly of Donegal, was sent to the Rotherham Hospital, which is one of the good hospitals across the water. He was told by one consultant that waiting lists were good because it meant he had a full order book. To some extent that sums the matter up.
I will give a snapshot of the health services in the North. Many of the problems are similar to the ones here. The difference is that the Government here has power and can make decisions. We have a very large number of people on trolleys and very long waiting lists. The hospital activity per member of staff is 19% lower than the UK average. The hospital activity per £1 spent on health is 9% lower than the UK average. Per available bed it is 26% lower than in England. We now have more administrators in the National Health Service than beds. While there are similar challenges here, we envy the fact that the Government here can make decisions.
I note today the main business is about cross-Border co-operation and what can be of mutual benefit to all of our people. Thanks to the political will we will have smoke free workplaces from 30 April. We admired and took leadership from the Republic on that issue and very much appreciated it. We are also watching the way Ireland is tackling issues such as alcohol and drug abuse and under age drinking. It is one of the lifestyle challenges with which we must come to grips to try to encourage people to take more responsibility for their own health. It is part of the whole public health agenda. While North and South work together in some areas, particularly in the areas of cancer and radiotherapy, it makes sense, when there are fewer than 6 million people on the island, to share our expertise and our research and development.
I am very aware that much work is going on in the field of mental health, particularly in regard to depression and suicide prevention. North and South there are areas where there is a very high rate of suicide. We are working through the Bamford review of mental health, which is the strategy and recommendations on mental health. It has been worked on for several years and was launched in recent months. It brings mental health into the 21st century. I would love if we could do something together on mental health, for example, set up an all-Ireland forum.
A particular issue for the north-west is the acute hospital for Tyrone and Fermanagh. This has been an ongoing issue. At the time we did not make enough of the cross-Border links in the context of acute hospitals in Sligo and Letterkenny. There is tremendous scope for better and more co-operation in regard to acute hospitals and GP out-of-hours services. While I am on the subject of cross-Border co-operation, I mention the CAIT initiative. I am sure members of the committee are aware of the work and co-operation in the Border areas. A quarter of the total area of Northern Ireland consists of Border areas, so approximately 21% of the population lives in the Border regions, most of which are rural areas. They are more likely, therefore, to suffer from poor infrastructure and deprivation. It certainly makes sense for health providers, North and South, to share ideas and experience, particularly in those areas. I am well aware that Dr. Jane Wilde and the Institute of Public Health have done much work on that, particularly on equity and tackling poverty. We welcome the national development plan and look forward to more detail on that. A great deal of money is being rolled out.
I do not want to say any more. I want to give Dominic Bradley an opportunity to speak. I would welcome hearing from the members. I again thank the committee for inviting us. It is good to be here.
Thank you, Councillor Hanna. Does Mr. Bradley want to say a few words?
Mr. Dominic Bradley
Tá an-áthas orm a bheith anseo libh chun cúrsaí sláinte a phlé. Tá mise i m'urlabhraí Gaeilge agus oideachais ar son an pháirtí, ach tá spéis agam fosta i gcúrsaí sláinte, ach go háirithe sa cheantar cois Teorann.
I thank the Chair for the invitation to attend this meeting. I am spokesperson on education and Irish language for the SDLP but I also have a strong interest in health affairs, especially as they relate to the Border areas and the possibilities for cross-Border co-operation. I note the very good work that has been done under the CAIT initiative.
I represent south Armagh for which the local town is Newry. The ambulance station is based at Daisy Hill Hospital in Newry. For an emergency call to south Armagh the travel out time from Newry is approximately 25 minutes. In the case of a major trauma the time taken to give on-the-spot treatment and to make the return journey would be added to that. It could amount to well over an hour, all told. We are told that after a major trauma the first hour, referred to as the golden hour, is a time in which life can hang in the balance. My constituents in the Border area are very concerned about that issue. It is one in regard to which there are possibilities for cross-Border co-operation in the provision of ambulance services, especially at the intersection of the three counties, Louth, Monaghan and Armagh. It is certainly an issue that is very well worth exploring to see what the possibilities are.
The ambulance service in Northern Ireland suggested that we should follow a model trialled in some areas in England where local people trained in first aid are the first respondents to accidents, major trauma and so on. That is a huge responsibility to put on local people in a local area. I would much prefer the model where there is a local ambulance station in the rural area which can respond properly, rapidly and with trained personnel.
Another issue about which we have been concerned locally is the provision of trauma services in our local Daisy Hill Hospital in Newry. The health service in Northern Ireland initiated a consultancy exercise about a year ago. As part of those proposals the ending of trauma services in some local hospitals, Daisy Hill Hospital included, was proposed. We opposed that very strongly. It has now come up with other options which are less threatening. That is another possible area for cross-Border co-operation in the provision of trauma services. Newry is well placed to serve parts of counties Louth, Monaghan and Armagh.
These two issues come to mind about my own locality and they illustrate the possibilities for cross-Border co-operation in health, which could be of mutual benefit to communities on both sides of the Border, as Ms Hanna said. I am pleased to have had the opportunity to address the committee and I hope we will be able to progress some of these issues.
Many issues are of mutual interest. My constituency borders that of Mr. Bradley and we are familiar with many of the issues. However, I do not share his enthusiasm for the Minister for Health and Children's handling of her brief. The delivery of health services must change. Sometimes my colleagues and I are accused of seeking an all-singing, all-dancing hospital at every crossroads but that will not happen.
We had a trial run of the proposed changes in the health service and between mid-2002 and January 2005 Monaghan General Hospital was off-call. Seventeen deaths occurred during that time, which were attributed to this change. Numerous people living within a short distance of that hospital who suffered heart attacks at 9 p.m. or 10 p.m. had to be taken to another hospital. As every medical person knows, the sooner antithrombolic medication is administered to patients, the better their chances of surviving. Patients should be in a position where they can be taken to hospitals such as Monaghan General Hospital to be stabilised. The only alternatives for people in the area are Cavan hospital and Drogheda hospital, which is overworked and overcrowded. These patients regularly account for 20% of trolleys in accident and emergency departments.
If an alternative service was provided, we would have to examine it. The Hanly and Teamwork reports suggested that alternative services be put in place before any service is discontinued. Professor Drumm gave the committee a commitment that no service would be removed until a better, safer service was in place but that has not happened. Insufficient use has been made of cross-Border services. Lip-service has been paid to this and pilot projects have been run in one or two areas for GP out-of-hours services but the ambulance service has not been developed. People in Tyrone have the same concerns as those in Monaghan about the withdrawal of services. The lack of acute services in unacceptable in the northern part of the country.
CAIT has been in operation for a long number of years. What has the organisation implemented? It has done a little in regard to mental health services but it has not addressed health services in Border communities. The Teamwork report completely ignored the delivery of services beyond the Border. It did not examine the provision of health services on an all-island basis and it referred to a pilot project that will be rolled out for the entire State. The report conducted in the North on hospital services ignored our side of the Border. I cannot see how those who write these reports can be taken seriously. We are doing little more that paying lip-service to cross-Border services. A trauma centre in Aughnacloy or Emyvale, accessible by people from Tyrone, Armagh, Fermanagh and Monaghan, is needed so that patients can be brought in to be stabilised within a reasonable time. Patients from my area will not mind where they are taken after that. The issue is that they are stabilised and their lives are saved. The withdrawal of hospital services from communities is a major issue in Northern Ireland.
I welcome the group because these exchanges are important. Making contact with fellow politicians in the North is a good exercise in democracy. It is good that many recent decisions are bringing the communities together. I will not challenge the view expressed about the Minister for Health and Children. It is good that Mr. Bradley recognised what is being attempted. I represent Dublin South-West, which includes Tallaght, a major population centre, and the siting of the new children's hospital is an issue.
The Government will close Tallaght Hospital
Over my dead body. It will not.
That is not what the Deputy's boss is saying.
I represent the third largest population centre in the State and children's services need to be retained. What is the delegation's view on such services? This is relevant for our Northern colleagues but I am not trying to draw them into the controversy. Tallaght Hospital was founded in 1998 following the adoption of a charter which led to the amalgamation of the Adelaide and Meath Hospitals and the National Children's Hospital. What is the delegations view of children's services? I wish them well and I hope they enjoy the day in Dublin.
Cuirim fáilte roimh gach duine go dtí príomhchathair Phoblacht na hÉireann. I was interested in the analysis of what should happen regarding cross-Border co-operation. The island is 308 miles long and 178 miles wide. It is common sense that there would be co-operation, particularly regarding out-of-hours services. That might raise some eyebrows but it should be given serious consideration.
I subscribe to the call for an all-Ireland forum on mental health. It is a marvellous idea. I worked in that area for a long number of years and such an idea is common sense. A sub-committee of this committee produced a report on suicide prevention and the delegation should meet the committee again on that issue because it is a serious problem. We must try to get to grips with it and I am sure we can learn from each other.
Some 21% of the population lives along the Border area and that provides a focus on how we address the problems of people living there. What proposals has the delegation to resolve them? The current arrangements are not working well enough. War should be declared on under age drinking and drug and alcohol abuse. Road accident statistics confirm that alcohol and drugs are a significant factor.
Many of my relatives live in south Armagh and I communicate with them regularly. They have expressed the concerns raised by the delegation. What is the delegates' view on how the authorities North and South might come together to resolve these difficulties? We have spent much time talking about the problems. The question is what we will do to solve them.
I welcome the delegates. I am still trying to figure out why Ms Hanna is in awe of the Minister for Health and Children, Deputy Harney.
It is obvious.
A Government Deputy at this meeting is clearly at odds with his own party leader as to how the health service should be moved forward. Nobody should be in awe of the numerous reports that are published; they seldom translate into improvements for patients. None of the recommendations of the task force on alcohol, for example, has been implemented. What intrigued me about the television programme featuring Sir Gerry Robinson was the discussion of reducing the waiting times for endoscopy from six weeks to four. One is likely to be on a waiting list for ten weeks or more to have this procedure performed. The reality of our health service is vastly different from what the delegates may have read in reports given to them by civil servants.
There is opportunity for co-operation between North and South across the spectrum. In terms of primary care, this might focus on the GP out-of-hours cover service. The ambulance service is another area where co-operation would be useful. Nothing much has been done but there is great possibility for co-operation. The ragged nature of the Border means that a system whereby ambulances could be deployed and GPs' services availed of regardless of whether they are based North or South would be of great benefit to communities in both jurisdictions. There is no reason that this could not have been put in place ten years ago when the political situation became more stable.
In regard to hospital services, there has been some co-operation between Letterkenny and Altnagelvin in Derry, for example. This has consisted mainly of the provision of neonatal and maxilla-facial services in the latter hospital for patients in Donegal. No two-way process is in place, however. There was scope to develop a radiotherapy unit in the north west with co-operation between Donegal, Sligo, Leitrim, Derry and Tyrone, but nothing has happened in this regard. One possibility that has been discussed in detail is the treatment of patients from Donegal in Belfast City Hospital. This, again, would involve a one-way process. It is clear, however, that the capacity of the new radiotherapy unit in Belfast City Hospital will be sufficient only to cater for Northern patients.
There is major potential in terms both of acute and elective services for co-operation between the two jurisdictions but that is simply not happening. Nor do I see such co-operation developing to the degree it could potentially have done in the last decade.
I am delighted to see Ms Hanna and her colleagues. I share Deputy Twomey's concern about the capacity of Belfast City Hospital to deliver radiotherapy services for the Donegal area. Dr. Jane Wilde was appointed five or six years ago as director of the Institute of Public Health, which promotes public health on an all-island basis. Dr. Henrietta Campbell has a similar all-island role in regard to the promotion of cancer awareness. Do the delegates believe these all-island initiatives have been useful?
I welcome the delegation. My own area of responsibility relates to the provision of mental health and psychiatric services. I fully endorse the points made about the usefulness of North-South co-operation. There is a mountain to be climbed in bringing the delivery of services into the 21st century. We should climb it together as much as possible and work off each other's ideas and experience.
Outside of my role as a politician, I am president of the Irish Association of Suicidology, a Thirty-two County organisation. We Southern members enjoy excellent relations with our Northern counterparts, who have included Roy McClelland, a past chairman and professor of mental heath at Queen's University Belfast, Daniel Thompson, a coroner from Fermanagh, and our current vice chairman and incoming chairman, Mary Hutchinson. We hold one in three national conferences in the North. I have learned much about the sensitivities and nuances that apply in regard to North-South co-operation and the differences between how the systems work in either jurisdiction. From my experience, I would fully support an all-Ireland forum. Nothing but good can come of it.
There were a large number of questions. I ask the delegates to respond as best as they can within the time constraints.
Ms Hanna
I was asked why I admire the Southern health service. What I envy is the availability of resources and the fact that Members here have the opportunity to partake in government and exercise power. To be blunt, I particularly admire the Minister for Health and Children, Deputy Harney, for taking on the consultants. That had to happen. Health service providers must be accountable, whether consultants, primary care workers or others. All of us who serve the public must be accountable.
I understand there will shortly be a new Secretary in the Department of Health in the North. It seems we are beginning seriously to examine reform, including a focus on effective public health measures, treatment in the community, and how to use our acute hospitals more effectively and efficiently. The South has great opportunities to make positive changes. We admired the leadership that brought about the smoking ban and are watching with interest developments in regard to alcohol. There is no doubt that we must do something radical to tackle alcohol abuse because both jurisdictions have a culture where it is acceptable to binge drink.
Deputy Connolly spoke about the situation at Monaghan General Hospital. We have had the same debate, particularly in regard to Enniskillen and Omagh. When we undertook our acute hospital review, we did not take into account the potential for cross-Border co-operation. I was Minister for a short time when the Executive was in place, during which time I raised the issue. However, little consideration was given to cross-Border co-operation in this area.
An important issue in the North is the provision of facilities to stabilise patients. This discussion is taking place because of the siting of the new regional trauma centre in Belfast. There are genuine concerns that problems may arise in rural areas, unless one has somebody competent on the scene to make the decision quickly as to whether a patient should be brought straight to Belfast or stabilised elsewhere. It is a question of deciding how best to deliver equity of service, particularly for those in rural areas.
I am a nurse and midwife and worked in Baggot Street Hospital. I lived in the Republic for many years. We could do much more together; it is a small island and we could certainly share expertise. It would be great if we could make a start today. Reference was made to mental health services. I would like if we could meet regularly. It is only by meeting and getting to know each other that we can start to learn from each other.
Senator Glynn mentioned the out-of-hours service. We have been trying to get that up and running but regulatory matters are holding it up to some extent. Deputy Connolly mentioned CAIT and his concerns. On the occasions when I met CAIT I was surprised at its lack of resources. It deals with Border initiatives and local communities but it could be built on and be a much more powerful organisation which is what we need.
Deputy Twomey and Senator Henry spoke about the city hospital which I know well, having trained there. My office is just across the road from it. We watched the new cancer service with interest. We waited for it for quite a long time and we are delighted to have it. Certainly in the areas of cancer and radiotherapy we could do so much more together. It highlights the fact that there is so much potential for us to do real work rather than pay lip-service. We could do a great deal more and we could make a start by meeting regularly. This is about building relationships and moving it on from there. I am not sure if I have omitted anything.
Thank you. As a committee we will communicate through our secretariats and establish more formal and regular links if that is acceptable to members.
Ms Hanna
That would be great. We would appreciate that. It has been a pleasure to be here today.
On behalf of the committee I thank Ms Hanna and her delegation for a most informative discussion. I hope for similarly fruitful discussions in the future. Before I adjourn I would like, on behalf of the committee, to extend our sympathy to Deputy Connolly on the recent sad death of his brother.
The joint committee adjourned at 12.43 p.m. until 9.30 a.m. on Thursday, 1 February 2007.