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24th October 2001
Minutes of Special Meeting of Strabane District Council held in the Council Chamber, Council Offices, 47 Derry Road, Strabane on Wednesday 24 October 2001 at 7.30 pm
Present:-In the Chair:- Councillor I Barr Other Members:- Councillors A Bell, D A Bresland, D Breslin, J Donnell,D Hussey, T Kerrigan, T McBride, C McGill, C McHugh, B McMahon, J McNulty Total = 12 In Attendance:- Mr Steven Lindsay, Chief Executive ) WH&SSB, Mr John Bradley, Board Chairman ) Clerk & Chief Executive, Committee Clerk
Acute Hospitals Review Group
The Chairman, on behalf of the Council, welcomed Mr Lindsay and Mr Bradley to the meeting and invited them to make their presentation.
Mr Bradley referred to the Hayes Report and its recommendations for a radical change in the way in which hospital services are provided and managed. He explained that this was the last in a series of meetings with Councils and key stakeholders across the area prior to the end of the initial consultation period of 31 October 2001. Mr Lindsay explained that the Minister would consider the responses along with the Executive Committee and decide on the way forward and it was anticipated that a further consultation period would take place in 2002. He then proceeded to make his presentation by recapping on the report, highlighting the key areas and inviting Members’ comments as follows:-
The Review Group’s Remit:- To review the current provision of acute hospital services and taking account of the issues of local accessibility, safety, clinical standards and quality of services, to make recommendations to the Minister on the future profile of hospital services. To take into account the views of individuals, organisations and groups with an interest or involvement in the provision of hospital services and to assess the scope for co-operation in the provision of local services with hospitals in other parts of the island.
Main Themes in Report:- Whole system . . . primary-secondary-tertiary-community (to provide a seamless service). Access within one hour to emergency and in-patient maternity services (based on average and peak travel times). Emergency care services and in-patient maternity services as a minimum on 9 sites including new hospital in South West.
Review of Acute Hospital Services:- The day of the stand-alone institution attempting to do everything from its own resources, acting in isolation from the wider system is already gone. Co-operation, co-existence and mutuality point the way to sustainable and accessible services in the future. Hospitals must be part of a series of networks.
Hayes Review of Acute Services – Service Configuration:- Northern System – population of 4-500,000 Southern System – population of 4-500,000 Greater Belfast System – population of 700,000 Radical departure from the existing framework.
New Organisational Structures:- The role of the Department of Health, Social Services and Public Safety will include regional policy, health promotion, systems integrity, quality assurance and performance management. The role of the Strategic Authority will include strategic planning, capital planning, resource allocation, commissioning of regional specialties and workforce planning and control. The role of Primary Care Commissioning Organisations/Partnerships will include commissioning of non-regional hospital services within a strategic plan agreed with NI Strategic Authority.
Important Messages:- A long term plan for HPSS. The concept of networked services. The focus on access to emergency and maternity services. Emphasis on locally accessible services. Recognition of the need for a hospital in the South West including A&E and maternity services. The role to be played by primary care. The emphasis on workforce planning and workforce development. The need for both capital and revenue investment. £1.1bn was required in terms of capital over the next 10 years. The cross border dimension. The Board was of the opinion that this was not examined sufficiently. Some Thoughts:- Service issues. Organisational arrangements. Affordability. Implementation.
Service Issues:- South West hospital. The Board identified a need for a networked hospital in the South West Local hospitals. Sustainability in the interim. This was a priority and additional resources were required to maintain the current pattern of services. Overall reduction in beds (500). The Board has difficulty with this issue. Networks – clinical, geographic or institutional; existing networks. Networks are a fairly new concept and operate across organisations but must not be forced. There are concerns regarding the three definitive network systems proposed by Hayes. North/South networks? This deals with the two delivery systems. Natural population flows? Greater Belfast System/Regional Authority and impact on the West? Wider systems issues. Inter-agency and partnership working. Need detailed consideration. Funding Delegation of statutory functions.
Organisational Issues:- Hayes brief Evidence base Debate on structures, not services Integrated service Lines of accountability. These are not clear in the document. Bureaucracy. Local representation. The new proposals plan to abolish the Health & Social Services Council and the Board is not supportive of this course of action.
Affordability:- Overall levels of funding. Assumed growth rate (8% p.a. over 10 years). Capital costs (£110m per annum). Other costs.
Implementation Issues:- Implementation plan in the report focuses on changing structures. Need to improve pattern and provision of acute services. Incremental implementation. Then focus on organisational form. Final Thoughts:- Priority must be acute agenda. New high quality hospital in the South West. Maintain services in the interim. Role of Altnagelvin as a sub regional and area wide hospital. Bed numbers.
Carefully think through:- Proposed organisational changes. Impact of wider Review of Public Administration. Benefits of Western identity and infrastructure. Links to other initiatives. Financial implications.
Members’ comments were invited. Councillor Hussey sought clarification on the difference between a Level II & III hospital. In response, Mr Lindsay advised that four categories of hospitals were described in the report. The Royal Victoria Hospital was a Level I hospital. Level II would be capable of dealing with all emergencies and major incidents i.e. Altnagelvin, Antrim, Craigavon and possibly Belfast City. Level III would be a network hospital, serve a smaller population i.e. Causeway, Daisy Hill and the new hospital in the South West, have 24 hour consultancy cover, be A&E led, in-patient and maternity service.
Councillor Donnell welcomed the officials. He queried whether there was any danger in the foreseeable future that Altnagelvin Hospital would be run down and whether the new hospital in the South West would have a negative impact on Altnagelvin. Mr Lindsay referred to the 5-10 year planning horizon and pointed out that all hospitals were dependent on catchment populations. Mr Lindsay stated that the new hospital had to be networked and could be linked with Altnagelvin with consultants undertaking work in both hospitals. Mr Bradley remarked that a hospital was required in the South West but pointed out that there was not a patient flow from Antrim to Derry and this had to be taken on board. The Chairman queried the likelihood in the long term of a threat to the viability of Altnagelvin and urged everyone in the Council area to take steps to ensure that the new hospital was located close to Omagh. Mr Lindsay stated that the threat to Altnagelvin was as a sub-regional hospital. Hospitals in the future needed to rely on each other in order to survive and to be sustainable.
Councillor McHugh queried whether the Board had an opinion on the preferred location for the new hospital in the South West. Mr Lindsay advised that the Board had taken a view at the time of its acute review. The South West quarter of NI was preferred and the wider factors had to be taken into account. A decision on a NI basis was required. Councillor Hussey referred to the Fermanagh Campaign and the Hospital Campaign for the Rural West which stressed the need for Level II provision. He queried whether the Board regarded such provision as a threat to Altnagelvin regardless of its location. Mr Lindsay stated that a Level II hospital in the South West would struggle to survive in the long term. The hospital must be networked, provide the proper services and be sustainable. He stated that the birth rate in Altnagelvin was 2,400 and the NI birth rate was falling dramatically and would have major implications for the nine maternity units in NI.
In welcoming the presentation, Councillor Kerrigan commented that the South West area would only receive a Level III hospital and it had been mooted that Fermanagh was not a suitable location for a new hospital. He spoke of the removal of services from the Tyrone County Hospital and pointed out that people in the Castlederg area travelled to Altnagelvin or Craigavon in preference to the Erne. He also spoke of the need for similar type hospital provision to cater for the people of Tyrone and Fermanagh otherwise they would be treated as second class citizens. He stated that Hayes had not taken into account the cross border dimension. The provision of a new hospital in Fermanagh would deprive approx. 150-170,000 people. People in the Dungannon area were supportive of a hospital being sited in Tyrone.
Mr Lindsay remarked that the Hayes report had paid lip service to the cross border aspect. The concept of networks would result in local service provision. The future was service provision and not the Institutions and the buildings. Councillor Kerrigan spoke of the need for morale building in the West of the Province for the nursing and medical staff and the need to bolster services in Altnagelvin and Craigavon. Mr Lindsay stressed the Board’s commitment to protect Altnagelvin’s catchment area. A networked hospital in the South West was required but should provide 24 hour cover. Mr Bradley stated that the Board was totally committed to maintaining services in the South West.
The Chief Executive queried whether ENT and Renal Services would be continued in a local hospital environment. Mr Lindsay stated that early evidence shows that renal and ENT services would move to a new site.
Councillor McBride voiced concern at any threat to Altnagelvin Hospital and expressed the hope that it was not being used as a deliberate “smokescreen” to make people in the South West settle for less than they were entitled to. With regard to the cross border dimension, he spoke of the substantial population in North Donegal and the natural travel patterns to Altnagelvin. He also referred to major inward investment in Derry and more recently the announcement regarding Debenhams and questioned any suggestion that Altnagelvin could not be sustainable. He stated that the Board should have taken a lead but had deliberately stayed “on the fence” at a time when transparency was of crucial importance. He expressed concern that the location argument was being used to deflect from the real pressing concern in the Health Service i.e. a lack of adequate resources generally. He suggested that a greenfield site would, eventually, have been an acceptable compromise for the South West.
Mr Lindsay stated that his reference to a sub regional centre related to issues in the Hayes report which could be detrimental to the catchment area of one of the hospitals which the residents of the Strabane District Council area avail of. He also commented that Hayes had access to a report from Dr Hindle and other supporting information and the Board would be raising this point in its response. He suggested that Hayes would have been privy to meetings with the Roads authorities, Planning Service, Economic Analysts etc. which framed his report. This was much more than a health service issue and a decision was required on a NI basis. Mr Bradley reiterated the Board’s position and gave an assurance that the Council’s comments, and the views of the other key stakeholders, would form part of the Board’s response.
Councillor Hussey referred to the cross border issue and the “South of the Lough argument” in the Fermanagh campaign. Hayes had demonstrated a lack of knowledge of the National Roads Plan and the upgrading within 3-4 years of the road infrastructure. With regard to Consultants working between hospitals, he suggested that this could have facilitated the initial suggestion of a split hospital site. Mr Lindsay stated that the population base was too small to sustain such a service as a catchment area of 300,000 was required for Royal College accreditation. Councillor Hussey commented that the Royal College had lowered its criteria. He queried why the management structure within Sperrin Lakeland Trust over the past 10 years had increased by approx. 60% despite severe financial constraints. He also queried the implications for mental health care, currently delivered by the Tyrone & Fermanagh Hospital, given Hayes’ recommendation that this service be located alongside Acute Services. Mr Lindsay stated that Trusts are totally autonomous organisations and are accountable to the Minister, not the Board. The Board was aware of the increase in staff at senior level. In terms of maintaining services within the Sperrin Lakeland Trust, he explained that the closure of the South Tyrone Hospital had impacted on the Tyrone County Hospital and the Board had invested additional funding over the winter period due to the increase in throughput. Additional resources were required, however, the Southern Board prioritised the Craigavon area. With regard to mental health service provision, institutions such as the T&F Hospital were being replaced by specialist units and community care.
Councillor McGill welcomed the Board officials. She queried whether the Board was in favour of a Level II hospital in the South West. Mr Lindsay stated that the Board was in favour of a hospital in the South West with 24 hour A&E, in patient care, general surgery and general medical. Councillor McGill queried whether this was similar to services provided at Altnagelvin Hospital. Mr Lindsay stated that Altnagelvin delivers sub regional services. The hospital in the South West should be networked to a bigger hospital with Consultant teams etc. travelling to the smaller networked hospitals to deliver the services. Councillor McGill stated that the hospital would be less than that anticipated by the people. Mr Lindsay stated that Hayes did not envisage a Level II hospital in the South West. The key issues were patient numbers and sustainability. Councillor McGill queried whether the Board was in favour of the hospital being located in Omagh and Mr Bradley responded by indicating that neither himself nor Mr Lindsay were in a position to answer this question. In terms of geography, Councillor McGill queried whether the South West included Omagh and Mr Bradley stated that it did. Councillor McGill stated that Omagh was an excellent site for the hospital and given that the Board was not against this location, that the Board should have made its position clear at the outset thereby preventing a lot of the difficulties which had arisen.
Councillor Bresland welcomed the officials. In the event that the hospital was located in the South West, he queried whether it would be attached to Altnagelvin. Mr Lindsay stated that the Board would be in favour of this, however, Hayes was not. Councillor Bresland spoke in favour of a greenfield site. Mr Lindsay advised that a greenfield site was still an option but the Board was unclear regarding the transition from a greenfield site to a specific location in the Hayes report and would be highlighting this issue.
Councillor McMahon welcomed the officials. He stated that the one hour response time for emergency services was not achievable in areas such as Greencastle, however, this was not taken on board by Hayes. Mr Lindsay acknowledged that there was an issue with Hayes recommendations regarding the “golden hour”. In response to a query by Councillor McHugh, Mr Lindsay advised that the hour related to the time at which a person became sick until the time he/she was seen by the relevant person. He explained that there were a number of ways of dealing with this, for example in rural Scotland Paramedics were appropriately trained. He reiterated the point that the emphasis should be on services rather than buildings. Councillor McGill commented that a site at Enniskillen would not permit people from areas such as Greencastle to access services within the “golden hour” and the video highlighted this issue. Mr Lindsay advised that the Hayes report stated that people will be within one hour of nine in-patient sites. He suggested that the Council may wish to take up this issue with Hayes.
Councillor Kerrigan commented that the WH&SSB had the expertise and should have shown leadership on this issue. He stated that the Hayes report was clearly flawed in respect of a number of issues, a level II hospital was required and it was imperative that equity and fairness was applied. Mr Lindsay reiterated that the Board did not name the location in the South West nor had the Minister asked the Board to directly name a location. Hayes was requested to carry out an independent review. As highlighted earlier, the Board was not privy to meetings with Roads Service, Planning Service or economists etc. The Board would take a lead at the Minister’s request and make a decision but it did not have the necessary supporting evidence. Councillor Kerrigan requested that the Council be provided with a copy of the Board’s response and Mr Lindsay advised that this would be arranged and the Board officials would also assist the Council in shaping its recommendations.
Councillor Barr supported the need for categorisation of minor and serious injuries within A&E Departments resulting in patients receiving treatment more speedily and efficient use of resources. Mr Lindsay commented that such provision would not result in a second rate service. The Board was concerned that Hayes focused on structures and buildings rather than on services. In the event that Hayes report was accepted, or indeed a variation accepted, Councillor Barr queried the Board’s powers and stance in the event that 9-5 A&E cover was provided. Mr Lindsay stated that the Board would be totally opposed to 9-5 A&E cover only and would lobby against it.
Councillor Hussey queried whether the Board was content with the services proposed by Hayes for the South West. Mr Lindsay remarked that the Hayes proposals were unclear. Councillor Hussey commented that the Board had views on the services needed within the South West and in the event that those services were not provided he queried whether the Board would join with any grouping who lobbied for an improvement. Mr Lindsay confirmed that the Board would commit its support.
In response to a query by Councillor McBride, Mr Lindsay advised that the Board was a consultee and would be reflecting the views of the five District Council areas in its response. Councillor McBride remarked that service provision was an important matter and that people increasingly chose to return to the areas in which they were reared and required services close to home. Mr Lindsay advised that Hayes had suggested that the public meetings in Omagh and Enniskillen had demonstrated an affinity with Craigavon. Councillor McBride commented that a lot of energy had been wasted on the location whilst the real issue was “finance”. Mr Bradley advised that this would be included in the Board’s response.
Councillor McGill quoted from information highlighted at the public rally in Omagh. In the event that the Hayes report was implemented, the following would occur on a County basis:- Antrim 3 Hospitals, 3 A&E Units, 3 Maternity Units, 3 CT Scanners Down 2 Hospitals, 3 A&E Units, 2 Maternity Units, 3 CT Scanners Derry 2 Hospitals, 2 A&E Units, 2 Maternity Units, 2 CT Scanners Armagh 1 Hospital, 1 A&E Unit, 1 Maternity Unit, 1 CT Scanner Fermanagh 1 Hospital, 1 A&E Unit, 1 Maternity Unit, 1 CT Scanner Tyrone 0 Hospital, 0 A&E Unit, 0 Maternity Unit, 0 CT Scanner
Councillor McGill concluded by stressing that location is important and urged the Board to take this information on board in its submission.
Councillor Barr thanked the officials for their presentation and responding to Members’ queries on such an emotive issue. Mr Bradley thanked the Council for receiving the presentation. The Board had significant misgivings regarding the Hayes report and the Council’s comments would be taken on board.
It was agreed on the proposal of Councillor Bresland, seconded by Councillor McGill, that the meeting go “Into Committee” in order to discuss the Council’s response.