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5 Dec 2002 : Column 1162—continued

7.20 pm

The Parliamentary Under-Secretary of State for Northern Ireland (Mr. Desmond Browne): First, I congratulate the hon. Member for Belfast, North (Mr. Dodds) on securing the debate. I am grateful to him for his comments, which have allowed me to hear the concerns for the future of hospital services in his constituency. I stress that I have made no decisions in relation to the proposals for acute hospital services set out in XDeveloping Better Services: Modernising Hospitals and Reforming Structures", but I am mindful

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of the real deprivation in the hon. Gentleman's constituency, and in other constituencies in Northern Ireland, and I will want to reflect carefully on his comments. I know that the issue of the future of the Mater hospital was the subject of an Adjournment debate in the Northern Ireland Assembly—it was the last debate before suspension—which drew strong cross-party support for the retention of acute services at the hospital. I am aware also of Belfast city council's position on the issue.

The proposals for modernising hospitals set out in XDeveloping Better Services" are a recognition that the complexities of hospital services, and what they can deliver, have changed enormously over the past 30 years. However, the fact is that in Northern Ireland the necessary investment has not been made to keep up with the pace of change. As a result, it is becoming increasingly difficult to sustain services in some hospitals and the service is facing critical and mounting problems. Far too many people are waiting too long for hospital treatment, with pressures growing annually on hospital beds. What were once considered winter pressures have become an all-year-round occurrence.

The fabric of many hospitals is in disrepair and staff are trying to cope with outdated equipment and facilities. That is not acceptable and cannot be allowed to continue. It will require radical and sustained change in the operation and delivery of hospital services if we are to achieve the sort of modern dynamic hospital service that is capable of delivering the very highest standards of care, to meet the health care needs of the 21st century.

Some of the pressures facing our hospital system are inescapable. People are living longer and in their later years they are more likely to suffer from chronic illness such as heart disease, diabetes or arthritis. Consequently, they require more care by a wide range of staff in hospitals, the allied health professions and by those in the community. At the other end of the spectrum, many more children and young people are suffering chronic health problems such as asthma and diabetes. Many conditions require long-term care, often with complex hospital-based treatments throughout their lives.

At the same time, as perhaps never before, we are seeing significant developments in health care, with new medicines available to treat and relieve the symptoms of both chronic and acute conditions, such as malignant disease, heart disease, rheumatoid arthritis and multiple sclerosis. There are also advances in surgical techniques, with less invasive forms of surgery requiring shorter hospital stays, with many procedures now being carried out as an out-patient or day procedure, which previously would have required a long hospital stay.

Perhaps one of the most significant changes in the past 20 years has been the advance of medical engineering technology, such as medical imaging using CT, MRI and recently, PET scanners. Advances also in information and communications technology are

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beginning to transform how information is used and shared in and between hospitals. Telemedicine in particular, which allows images to be transmitted from a GP surgery to a consultant for advice, perhaps many miles away, is already making an impact on the way in which care is being provided.

We cannot expect doctors and other hospital staff to become expert in every new method of working. Instead, many are now focusing their interests on particular specialties or sub-specialties, bringing with them increased expertise and even greater advances in treatment and care. It also means that the era of the medical generalist trained to provide a wide range of clinical services is coming to an end.

We must also embrace the much more stringent requirements covering the degree of supervision and the specific nature of the work that is being undertaken by medical trainees. Increasingly the jobs available to junior doctors and other professional staff do not provide the opportunity to develop the sort of skills and experience that are necessary for modern practice.

Improving the standard of hospital care and the environment in which care is provided must be a major priority. The requirement for trusts to provide quality care will soon become a statutory responsibility, and accountability for the delivery of services will be strengthened by robust clinical and social care governance arrangements. The proposals in XDeveloping Better Services" recognise those inescapable drivers for change, and set out a pattern of hospital care which aims to concentrate regional and specialist acute care in an acute hospital network which can foster and develop the range of specialist skills required to deliver modern high-quality acute care. But the proposals also recognise that advances in medical treatment and technology mean that many procedures which currently require attendance at an acute hospital no longer need to be provided in that setting. The majority of out-patient and day procedures can now be completed safely outside an acute hospital setting, and so too can high-quality diagnostics, linking to the acute network through telemedicine or linked digital imaging systems. Those are not advances of tomorrow, but opportunities for today, and I agree with the underlying logic of the proposals.

XDeveloping Better Services" has proposed that the present pattern of 15 acute hospitals should be reconfigured to nine, with the remaining hospitals providing a wide range of local services, such as a minor injuries unit, out-patient and day procedures, high-quality diagnostic services and a number of step-down beds for people who have received treatment in an acute hospital, but no longer need to be there for the remainder of their hospital convalescence, thus freeing up much needed beds for others. As the hon. Gentleman said, it is proposed that the Mater and Whiteabbey hospitals be reconfigured to provide a range of local services, such as those that I have outlined, and operate as local hospitals linked to the acute hospital network.

I am aware that the proposals for the Mater hospital in particular have engendered widespread concern, not only within the Mater Hospital Trust and its staff, but

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also across the community in north Belfast, as well as among elected representatives across the political spectrum, who have united with the Mater to support the retention of its acute services. The Mater hospital has a special place in the hearts of the community in north Belfast, fostered through the worst of the civil conflict in Northern Ireland over the past 30 years, and has provided a neutral haven of care for north Belfast, an area which has some of the worst deprivation in Northern Ireland, as we have heard. To date, some 35,000 letters and petitions have been received by the Department in support of retaining acute services at the Mater, as well as a number of detailed submissions which are being carefully considered as part of the post-consultation process.

No decisions have been taken on any of the proposals in XDeveloping Better Services", and before coming to a final decision, I will want to satisfy myself about the proposals to remove acute services from the Mater and whether the hospital, networking with the Royal group of hospitals and Belfast city hospital, could meet the longer-term needs of the north Belfast community. No one can be in any doubt of the significant effect of years of community strife on the community in north Belfast, which has suffered some of the worst sectarian violence of the past 30 years. Nor are such days behind us, alas. The legacy of sectarian strife will remain with the community, particularly the young people of the area, for many years to come, manifesting itself in mental health problems and drug and alcohol abuse. I pay tribute to the work of the many cross-community groups in north Belfast that are working tirelessly to lift north Belfast out of the legacy of the past and give new hope to the rising generation.

It is well recognised that areas of high deprivation such as north Belfast bring with them a range of chronic health care problems. I know that, for many, the Mater has become a lifeline for the diagnosis, treatment and care of chronic conditions such as chronic obstructive pulmonary disease, which is associated with emphysema and smoking. One of the other manifestations of deprivation is unemployment—the Mater hospital is a significant employer in north Belfast—and the proposals for change have brought with them a very real fear for job losses in the hospital. I would be extremely concerned if the net effect of the proposals were to mean job losses in north Belfast, and I want to look very carefully at that aspect of the proposals before coming to any final decision.

The Mater has given north Belfast long and distinguished service since it was established in 1883, and up until the deed of arrangement in 1971 was funded entirely by the Young Philanthropists, mostly by small donations invested in trust funds for the future. Many people in north Belfast have a very real sense of ownership of the Mater, and I understand why the proposals have generated such strong feeling in the community. Some £17 million has been raised entirely by the Mater Trust and the community to develop new facilities such the McAuley wing in the hospital, which has some of the most modern facilities of any hospital in

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Northern Ireland. I have not yet had the privilege of seeing those facilities, but in view of the number of responses and the concerns expressed about the proposals in XDeveloping Better Services", I hope to visit the Mater to see the McAuley wing for myself, as well as to take the opportunity to talk to staff and members of the wider community. I want to do that before reaching decisions at the end of January.

However, I know that both the acute hospitals review group and XDeveloping Better Services" proposed that acute services should continue at the Mater for some years to come. I would certainly agree with that. It has not been lost on me that, in an area so divided by sectarian strife in recent times, the Mater issue has united the entire community. Therefore, I can say now that for a considerable period ahead, the Mater will continue to provide a full range of acute services to the north Belfast area. My hope is that in declaring that intention now, I can significantly reduce the concerns of the very large numbers of people who have campaigned for the retention of acute services at the Mater ahead of final decisions.

Having said that, I also referred to the enormous changes that have taken place in hospital services in recent years and to the drivers for further significant change. It will be essential to regularly review the profile and configuration of hospital services, and it will equally be essential that the Mater develops close working relationships with the Royal Victoria and the Belfast city hospitals so that it becomes an integral part of a Belfast teaching hospitals clinical network.

Whiteabbey hospital provides a limited range of acute services and XDeveloping Better Services" proposed that it should become a local hospital providing a range of local services as I outlined, linked to the acute hospital network. Whiteabbey is situated between Antrim hospital and the acute hospital network in Belfast. I know that the acute hospitals review group report suggested that Whiteabbey should network with the Mater to provide hospital services. XDeveloping Better Services" did not address that recommendation, but it is worth considering such a network. If the Mater were to continue to provide a full range of acute services, there would be merit in developing Whiteabbey as a modern local hospital delivering a wide range of local services and networking both with Antrim hospital and the Mater, since I understand that many people in the Whiteabbey and Newtownabbey areas look to Belfast rather than Antrim for acute hospital services.

Once again, I want to reflect on the responses to the consultation and consider the long-term viability of the acute services that are currently delivered at Whiteabbey and the opportunities that a local hospital might bring to the wider Whiteabbey community. I do not want to pre-empt the outcome of the consultative process and I realise that I cannot give the hon. Member for Belfast, North all the assurances that he requires. However, I am very much alive to the concerns of the people in his constituency and have sympathy with them. My

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overriding aim is to get the best possible outcome from the proposals in XDeveloping Better Services" that will address the compelling need for change in hospital care.

I can, however, give the hon. Gentleman an assurance

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that, in common with all the proposals in XDeveloping Better Services", I will not come lightly to any decisions that will set the future direction of hospital services in Northern Ireland for many years to come.

Question put and agreed to.

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