NORTHERN IRELAND ASSEMBLY

Tuesday 5 June 2007

Executive Business
Health (Miscellaneous Provisions) Bill: First Stage

Private Members’ Business
Rural Health Taskforce
Provision of Speech and Language Therapy
Commissioner for Older People
Post Offices

The Assembly met at 10.30 am (Mr Speaker in the Chair).

Members observed two minutes’ silence.

executive business

Health (Miscellaneous Provisions) Bill First Stage

The Minister of Health, Social Services and Public Safety (Mr McGimpsey): I beg leave to lay before the Assembly a Bill [NIA 2/07] to amend the Health and Personal Social Services (Northern Ireland) Order 1972 in relation to the provision of health care; to amend the Smoking (Northern Ireland) Order 2006 to provide that in certain circumstances premises may not be smoke-free only in relation to performers; and for connected purposes.

Bill passed First Stage and ordered to be printed.

Mr Speaker: The Bill will be put on the list of future business until a date for its Second Stage is determined.

private members’ business

Rural Health Taskforce

Mr Speaker: The Business Committee has agreed to allow up to one hour and 30 minutes for this debate. The proposer of the motion will have 10 minutes to propose and 10 minutes to wind up. All other Members will have five minutes. Two amendments have been selected and are published on the Marshalled List. The proposers of the amendments will have 10 minutes to propose and five minutes to wind up.

Ms Ní Chuilín: I beg to move

That this Assembly calls for the establishment of a Rural Health Taskforce with the objective of delivering a focused and co-ordinated response to the health needs of people living in rural areas, including:

a shared vision and co-ordination of activities;

the development of strategic alliances;

proper healthcare as part of a Bill of Rights; and

an assessment of best practice and examination of how other European countries which share common borders deal with access to healthcare.

Go raibh maith agat, a Cheann Comhairle. A large proportion of the population lives in rural areas. Rural communities face particular challenges with regard to transport, access to services and sustainability of local communities. Those differences must be recognised and models of care to meet rural needs must be explored. However, we realise that hospitals cannot be provided at the end of every street. Indeed, in many cases, it is not hospitals that rural communities need most. That is in direct contrast to the default centralisation response embedded in the organisational psyche of the Department of Health, Social Services and Public Safety (DHSSPS) through items such as the trauma report and the reviews of pathology, maternity and children’s services — I could go on.

Suffice to say that almost all consultations and strategies under direct rule have defaulted to the centralisation of services of the so-called golden six hospitals. There are many reasons for that — a lack of staff; a lack of consultants; and a lack of clinical safety. However, most people believe that services are centralised because of a lack of vision and strategic thought in the DHSSPS and that the overarching goal is to cut costs and services.

Bairbre de Brún did much to rectify that imbalance and challenge the bias against rural communities. It is unfortunate that her ambitions and plans faltered under direct rule. A rural health task force is needed to address all issues affecting rural communities in accessing health and health services and to ensure that the health and well-being of people living in rural communities is paramount. Such a task force must explore how to work with the rest of the island: that is common sense. Currently, there are two competing health systems, and it is rural communities, particularly those located along the border corridor, that are losing out as a result.

The task force should study best practice from across Europe. When faced with similar problems, other countries have developed new and innovative approaches to rural healthcare. We must learn from their example. To that end, a Sinn Féin working group visited the Centre for Rural Health in Scotland last year. The centre has worked with the Scottish Executive and in partnership with Norway. I am happy to furnish the Assembly with details. Having taken the political decision to protect, enhance and sustain rural communities, the Scottish Executive adopted a specific system of healthcare that, while not perfect, did not adopt a one-size-fits-all approach.

The Kerr Report in Scotland sought to retain, maintain and maximise the services that could be safely provided in rural towns and villages via a range of innovative proposals and models. The proposals included aspects such as extended primary care; a resilient system of urgent and emergency care, including air ambulances; a rural general hospital, which meant re-exploring the issue of general surgeons with the royal colleges; midwife-led maternity units; and 24/7 care provided by rural practitioners, etc.

As yet, there is no clear agreement between politicians and those charged with delivering services on the best way forward. Furthermore, it is true to say that those involved in delivering services have not reached agreement on the best way forward either. The outworking of that situation has meant that political and electoral considerations have, on occasion, dominated what should be real health considerations.

We need to look at examples of good practice, such as the strategic approach of the Cooperation and Working Together (CAWT) programme, which considers health inequalities. That programme, and others like it, should be supported and resourced. Health inequalities should become a stand-alone issue, which would help to put the information and recommendations emerging from current work on addressing inequalities into operation, particularly for those in the rural community.

The work being undertaken to address health inequalities in the CAWT region should be co-ordinated, as it appears that everyone is doing their own piece of work. No one is co-ordinating the overall picture, and there is no overall plan. People living in rural communities therefore fall between two stools and miss out as a result.

Community and partnership development is ongoing in health action zones in the North, and the county development boards in the South should be further developed. We need to develop an ethos of considering how to tackle health inequalities in rural communities when developing services or initiatives. That would give life to equality, and individuals could begin the process of delivering their own services.

Further health profiles for rural areas are needed. A regional health profile should be developed so that an updated plan on the health status of each region could be provided. Most of all, lessons should be learned from the models already cited in the CAWT region, such as health action zones and county development boards, which must be taken into consideration in future plans.

Sinn Féin believes that it is crucial that a rural health task force should develop a common vision for rural healthcare that will regain the support of rural communities. It should develop an innovative strategy and an action plan with which the Assembly and others can agree, and it should provide good leadership and deliver health improvements to those in most need. Go raibh maith agat.

Rev Dr Robert Coulter: I beg to move amendment No 1: Leave out all after “Assembly” and insert

“notes the ongoing work of the Rural Medicine Working Group and urges the Minister of Health, Social Services and Public Safety to ensure that rural communities have access to safe and sustainable health services.”

In May 2002, the Assembly adopted a policy of rural proofing all legislation in Northern Ireland to recognise the essentially rural nature of much of the land area of the Province. The implementation of that policy was placed in the hands of an interdepartmental steering group, which was chaired by the then Minister of Agriculture and Rural Development.

In 2001, a rural proofing co-ordinator had been appointed in the Department of Agriculture and Rural Development (DARD). That Department had primary responsibility for implementing the directions of the Assembly in rural proofing all measures taken by the Assembly and the Executive.

I recall that while leadership on rural proofing was firmly in the Department of the Minister of Agriculture and Rural Development, other Departments in the Northern Ireland Government had a less than enthusiastic approach to the issue. That ethos clearly emerged during a meeting of the Committee for Agriculture and Rural Development on 3 May 2002 in a session chaired by my colleague George Savage MLA.

Rural proofing was essentially about proofing draft policies and making recommendations, on a cross-departmental basis, on the implications for rural communities. In May 2002, it appeared that the interdepartmental committee had not even agreed a working definition of what rural proofing meant in practice. The Burns Report and the Hayes Report were both due for publication at that time. Then, of course, the suspension of the Assembly in 2002 intervened, and the matter has almost certainly been on ice since then, given the somewhat patchy record of direct rule Ministers in such matters.

I mention that because the essence of what is contained in the motion is partly subsumed into the provisions that the earlier Assembly had already put into place for the rural proofing of all legislative and administrative measures adopted by the Assembly and the Executive.

If rural proofing were implemented adequately, there would be no real need for a dedicated and specific rural health task force. The rural proofing of all health issues would ensure that all the impacts on the rural community would be covered adequately.

As an example, I cite the air ambulance, which I successfully proposed when major cuts in rural Health Service cover were being proposed during suspension of the Assembly from 2002 to 2005. If there had been no suspension, then the impact of the effective withdrawal of emergency ambulance cover would have been raised through the rural proofing of that policy. As it was, there was no effective rural proofing of health reorganisation policies, and I had to lead a public campaign to demand air ambulance emergency cover for remote rural areas of the Province, especially in the glens of Antrim.

I contend that the motion has more to do with doctrinaire North/South health co-operation than with improving healthcare in rural areas per se.

Excellent, professional-led relationships already exist between health authorities north and south of the border, and those should proceed on a health-led basis without cheap political capital being made from them.

10.45 am

Some Members: Hear, hear.

Rev Dr Robert Coulter: This is yet another example of a motion proposing objectives that have not been properly costed. The Assembly cannot insert proper healthcare into some bill of rights without saying how we shall pay for it. The motion is also subjective, because what is “proper healthcare”? It must be defined. One man’s “proper healthcare” may not be another’s. Everyone wants the best healthcare for everyone; no one can question my commitment to that aim after years of defending and extending patients’ rights. However, putting proposals to the Assembly without costing them properly or saying from where the money will come does nobody any favours. In fact, it could lead to a great deal of embarrassment. Such proposals raise hopes that could be dashed for lack of available finance.

There is an ongoing examination of the situation, so let us reactivate or properly cost rural proofing as the Assembly envisaged back in 2002. This time, however, let us ensure that the civil servants implement rural proofing and that all Departments conform to Assembly policy. Let us use the machinery that we already have at our disposal to look after the rural population. We must stop talking about it and get on with the job.

Dr Deeny: I beg to move amendment No 2: Insert after “alliances”

“• equal access to life-saving services for all, irrespective of postcode;”

Thank you, Mr Speaker, for allowing me to speak to my amendment. I also thank the two Sinn Féin MLAs for tabling this motion so soon. The issue is close to my heart and important for us all.

I take on board what Bob Coulter has said, but I cannot accept his amendment, because it is too specific. I have worked on the rural medicine working group, and, although its work is to be commended, it does not look at maternity, paediatric, surgical or accident and emergency services. The working group focuses primarily on medical services for coronaries, pneumonia and so on. Its remit is not wide enough. I have asked it to widen its scope and to look at other issues that affect people in all areas, not just in rural areas.

Health provision — or the lack of it — in rural areas is extremely important to Northern Ireland’s large rural communities. Equity and equality across Northern Ireland is what this Assembly is all about, and that must also apply to healthcare provision. The Department of Health and Social Services’s ‘Fit for the Future’ paper from 1998 cites equity as the first principle of healthcare delivery. In 2002, the Department of Health, Social Services and Public Safety’s Investing for Health strategy proposed to reduce health inequalities.

The vast majority of our landscape is made up of small villages and rural communities. Some 54% of our people live in small villages and rural communities, not in the more densely populated cities of Belfast, Newry, Derry, Armagh and Lisburn.

It is important to bring to Members’ attention the difference between elective treatment and emergency treatment. People are generally fair-minded and do not mind travelling long distances to receive elective treatment, which is non-urgent. Emergency treatment — when one’s life is seriously threatened — is a completely different ball game. Those of us who work in front-line healthcare know that. Accessibility is vital in that area of healthcare, as it will very often mean the difference between life and death. Indeed, accessibility is really the major determinant in measuring standards of emergency healthcare provision in any area.

Therefore, however inconvenient the idea of running smaller acute services for rural areas may be, those who live in rural areas need — and quite rightly expect — to have effective, safe, modern and accessible health services, just like urban dwellers.

The motion is therefore admirable, and I support it. However, it is essential to agree my amendment in order to stop Northern Ireland’s current postcode lottery, which certainly applies to the area in which I live and practise.

I tabled the amendment because, having been a senior Health Service doctor for some years, I believe that we cannot simply accept that our postcodes should determine our standard of healthcare provision or whether our children or grandchildren will survive sudden and severe life-threatening illnesses such as meningitis, severe asthma attacks or prolonged epileptic seizures. Similarly, our postcodes should not be the deciding factors that condemn our wives, daughters and granddaughters to delivering their babies on floors or on the roadside, rather than in the safety of a maternity unit. All Members must bear in mind that such incidents occur.

I refer not just to those who have been involved in such single isolated cases in remote areas; I am talking about the many thousands of people who are risk because of where they live. It has been well documented that in my constituency this year there were four such dangerous births in a 10-week period. Healthcare provision is essential for expectant women and for rural people in general, and a dearth of such care is, to say the least, primitive and unacceptable in any developed twenty-first century country.

I have repeatedly asked whether it is not more beneficial for those who live in rural areas to be served by a small and well-managed rural hospital rather than to die en route to a hospital in a larger location that has state-of-the-art facilities? It is fine to have facilities in huge hospitals, but they are no good to people who were dead on arrival.

It is clear that infrastructure in rural areas is far worse than that in other locations. For example, my own county has dreadful roads, no rail network and no dual carriageways, never mind motorways. There is one dual carriageway as we leave the county, but that is it. Such a poor infrastructure worsens greatly people’s accessibility to healthcare provision and therefore contributes significantly to an unacceptable standard of that provision.

The problems with rural healthcare provision in Northern Ireland are exactly the same in other parts of these islands and in Europe. I agree with the Members who tabled the motion that we should learn from our European neighbours about how countries that share common borders deal with access to healthcare provision. I live in a border county, and I know that similar to tourism and infrastructure, people on both sides of the border must work on healthcare provision. That is known as joined-up thinking. Many Departments work in that way, and it has been mentioned with regard to healthcare. ‘Cross-border Co-operation in Health Services in Ireland’, a report by the Centre for Cross Border Studies, stated that:

“It has been suggested that people living in the vicinity of the border are materially disadvantaged on account of low levels of economic activity, rurality and geographical isolation.”

The report continues:

“As need for health services is highly correlated with material deprivation, it is likely that people living in border areas will have higher than average health needs.”

Indeed, Professor John Appleby’s report ‘Independent Review of Health and Social Care Services in Northern Ireland’ demonstrated that medical admission rates for those who are from deprived areas are 41% higher than for those who are not from such areas.

CAWT is one good example of cross-border joined-up thinking on healthcare. It is good that CAWT’s work, which has been ongoing for several years, covers places such as Cavan, Sligo and Enniskillen. However, an example of a dreadful lack of joined-up thinking is the main road from Dublin to Donegal, which is approximately 170 miles long. It is soon to be upgraded on both sides of the border — the A5 in the North and the N2 in the South — to either motorway or dual carriageway status.

That long stretch of modern road network will always be the main road north-west from Dublin, and many thousands of cars will travel on it, yet no acute hospital with any form of emergency services is to be located anywhere along that major route on the island of Ireland. What would happen if a major incident occurred with no emergency services nearby? That is another example of an absence of joined-up thinking, and it clearly shows the importance of adopting such an approach.

As medicine progresses and medical treatments continue to improve, the healthcare provision of the future will be different. In the not-too-distant future, GPs will lead primary-care teams in providing the majority of health services. We certainly do not want, or need, large acute hospitals at every corner. However, we must realise that there is a need for smaller acute hospitals that are equipped to provide life-saving resuscitation and ventilation services. GPs are neither qualified nor insured to provide those services. Furthermore, the failure to provide such essential services in rural areas will have an extremely detrimental effect on GP recruitment in those areas. GPs do not want to set up home and practise in an area bereft of emergency hospital backup. I can vouch for that, as it is happening in my area.

For any Department with responsibility for health to suggest that rural hospitals are no longer required because rural GPs will be able to provide such emergency services in future is a totally false and dangerous assertion. In fact, the lack of rural hospital services will lead to fewer GPs practising in rural areas.

Scotland has large rural communities, but there are small hospitals in the Shetland Islands, Orkney Islands, Western Isles and the Highlands. The six acute hospitals in the Highlands provide services for less than 8% of Scotland’s population. Some 168,000 people live in my county, yet there is a real possibility that there will be no services for 10% of the population. The previous session of the Scottish Parliament established a steering group to focus on remote and rural areas, and the Assembly should do likewise. I intend to visit a hospital in one of the areas that I mentioned to see how healthcare is provided in rural areas.

I ask Members to support amendment No 2.

Mrs I Robinson: The motion refers to healthcare across borders. I shall focus on cross-border co-operation in healthcare, especially in rural areas. In the 1998 agreement, health was one area where North/South co-operation was to be developed. The DUP has consistently stated that it does not oppose cross-border co-operation, as long as it is based on sound practical grounds for the benefit of the people of Northern Ireland and that it is not driven by an underlying political agenda.

In the aftermath of the Omagh bomb, professionals from both sides of the border provided emergency care for victims. Few would disagree that it makes obvious common sense to co-operate in such instances, or in response to road traffic accidents, for example. Indeed, lives can be saved as a result.

One current project involving GP out-of-hours services allows patients to attend the nearest centre, irrespective of whether it is in the same jurisdiction as their home. However, we must remember that it is the people of Northern Ireland whom we ultimately serve, and that they are our responsibility. As an illustration of that, an agreement between Altnagelvin and Letterkenny hospitals includes one condition governing co-operative action that provides that no proposal should undermine the service currently provided in either hospital. Furthermore, both hospitals have vowed that co-operation must be confined to services that a particular hospital cannot see itself providing in five to 10 years.

On a slightly more negative note, the EU publication, ‘Patient Mobility in the European Union: Learning from Experience’, states that:

“There is also a long-established practice of residents of the Republic of Ireland accessing free care in Northern Ireland through the use of an ‘accommodation address’.”

The publication further states that the extent of the practice is:

“very difficult to quantify, but may be substantial.”

That concern should be investigated and action should be taken.

In 1996-97, 0·3% of patients treated in Northern Ireland were from the Irish Republic. By 2003-04, some seven years later, that figure rose to 0·4%. The corresponding statistic for Northern Ireland patients being treated across the border fell from 0·13% to 0·11%.

11.00 am

The significance of, or potential for, cross-border activity may well have been exaggerated. In its conclusions on the rationale for cross-border co-operation in healthcare in Ireland, the authors of the EU report on patient mobility admitted that:

“we have not been able to find any detailed appraisal that could be used to justify public investment in a cooperation strategy or in individual initiatives. For example, although there is a general presumption that the population of border areas suffer from unmet need for hospital services, comparative analyses of mortality and utilization data conducted for the earlier study failed to confirm this.”

The people of Northern Ireland have benefited enormously from the tripartite relationship with the National Cancer Institute in the USA, and will continue to do so. Northern Ireland is producing world-class research into innovative treatments for cancer. Such co-operation, which threatens no one, is to be welcomed and can have positive consequences. However, its impact on general health provision must be kept in careful perspective. The DUP supports the Ulster Unionist amendment.

Mrs Hanna: I welcome the opportunity to contribute to the debate. We can learn from the rural medicine working group mentioned in the motion. However, the amendment proposed by Rev Coulter dilutes the substance of the motion. I support Dr Deeny’s amendment.

Rural life is often thought to be idyllic and good for one’s health. However, that is not necessarily the case in reality. Deprivation and social exclusion have a negative impact on the health of people who live and work in rural communities. More research on rural health issues is required to better understand and target the complex health needs of people in rural areas and, in turn, inform policy that will positively influence their health and well-being.

I hope and expect that the new health framework will result in the adequate decentralisation of health services and the necessary coterminosity. Complementary and interdependent community, primary and acute services are required. Those services will require adequate staffing levels: doctors; nurses; physiotherapists; occupational and speech therapists; and all allied health professionals.

Many rural areas do not have a doctor’s surgery or pharmacy nearby, and going to hospital requires a lengthy commute. Poor transport, poor geographical access to services and poor roads infrastructure all contribute to what is known as the “distance decay” effect on those who live in the country. Availability and choice of services in rural areas are very different to those found in the towns. Social facilities, especially for disabled people, are often inadequate.

All countries with a significant rural populace face similar healthcare challenges. In developing a vision for healthcare provision, Northern Ireland can learn how to establish best practice from its European counterparts. The highly developed Scandinavian rural healthcare system can provide knowledge and experience. Turning to cross-border co-operation, I have worked with CAWT. That body has been very helpful in that regard, but its work must be built on.

Mr P Ramsey: The Member mentioned decentral­isation, and I note that the Minister of Health, Social Services and Public Safety is in the Chamber. Given that thousands of people in the rural north-west are waiting for cancer screening and breast screening, why has a consultation document on the centralisation of pathology services from Altnagelvin Hospital to Belfast been published? Over 10,000 tests that were carried out over the border have been analysed in laboratories in Altnagelvin Hospital. Why is the Department insisting on centralising such services in Belfast?

Mrs Hanna: I thank my colleague for making that point. I will allow the Minister of Health, Social Services and Public Safety to answer those questions. I agree with Mr Ramsey; I support decentralisation, particularly with regard to healthcare.

Road traffic accidents are also a major problem in country areas, with young people often suffering major traumas. I am in favour of the trauma centre. However, to base the centre in Belfast will have implications for people who live in the countryside. There is concern that that will lead to downgrading of local hospitals and will have an adverse effect on rural communities. In order to alleviate those concerns, local hospitals must remain capable of dealing with emergencies.

Training and skills retention are problematic when exposure to major trauma is sporadic and access to training courses is limited by time, distance and money. That must be tackled. An efficient and adequately trained ambulance service is essential for the provision of an efficient trauma system that is based on the principle of equity of treatment for all. The bottom line is that hospitals must have the ability to stabilise trauma patients should the need arise.

There is also the problem of recruitment and retention of healthcare staff in rural areas. There is no quick fix when approaching the complexity of rural healthcare, but the issue must be tackled. Health promotion is crucial. Dissemination of education and information, as well as outreach working, is important for the improvement of rural communities’ overall health.

Elderly people who live in rural communities endure major problems. I am a firm believer in community care. The Assembly must ensure that the right services are provided in good time to those who need them most and that those who receive help can have a greater say in whether they stay at home in a domestic environment for as long as possible so that care in residential nursing homes and hospitals can be reserved for those whose needs cannot be met in any other way. A concentrated multi-departmental and agency approach is required.

Mr Buchanan: Members will be aware that people who live in rural areas, particularly those who live in the south-west of the Province, feel that facilities are much too heavily focused on Northern Ireland’s larger population centres. No place has suffered more from a decline in rural healthcare provision and life-saving facilities than my constituency of West Tyrone. That issue has been well documented and brought to the attention of direct rule Ministers on numerous occasions over the years. I am sure that all Members will agree that people across Northern Ireland are entitled to the same level of provision, equality of access and live-saving facilities no matter from where they come.

I want to focus on primary-care provision in a rural setting. People in rural areas must be able to access services conveniently. Better-organised public transport is essential. Improved co-ordination and planning of transport schemes is needed locally and regionally. Transport considerations must be integrated into any healthcare planning for rural or remote communities. There must be multi-professional working across different disciplines. Patients in rural areas must also have access to self-management programmes.

The use of telemedicine must be encouraged. It permits increased flexibility for healthcare service providers and allows them to expand the scope and quality of services. It is also cost-effective and provides expertise that would otherwise not be available.

In order to maintain optimum services in rural areas, it must be possible to recruit and retain sufficient staff. The 2005 British Medical Association (BMA) report, ‘Healthcare in a rural setting’, identifies areas where recruitment and retention can be maximised. It suggests that health professionals should all have received rural placements when they were students. That opportunity should be seen as a positive contribution to a student’s development. Placing students in a rural area should promote working in such an area as a positive career choice. Postgraduate training programmes must use the opportunities that are provided in rural primary and secondary care to teach healthcare professionals general skills.

Continuing professional development should be flexible and responsive to meet the range of needs in rural or remote areas. For far too long staff employed in rural areas have not had appropriate access to training, and that must be addressed urgently. Schemes to support healthcare professionals and their families in local areas are vital, and flexible employment arrangements must be made available so that highly professional standards are retained.

The general medical services contract for medical services and primary care contains a specific adjustment to cater for rural areas. That adjustment takes population sparsity and dispersal into account and ensures that rural practices are not short-changed.

Staff working in rural areas have many extra burdens — just getting to training courses, for example, can be problematic. Given the areas in which they live, many people are often involved in providing emergency care outside the hospital setting. Healthcare in rural areas depends on two vital matters: recruitment of healthcare professionals and the accessibility and sustainability of services. To bring that about there must be more joined-up working across the Departments to ensure that there is good quality of healthcare provision in rural areas.

I call on the Minister to give a commitment that rural communities across the Province will have access to safe and sustainable services.

Mr McHugh: Go raibh maith agat, a Cheann Comhairle. The debate is timely, and as someone from the rural constituency of Fermanagh and South Tyrone, the subject is close to my heart.

As a Member for a rural constituency that continues to be affected by the Department of Health, Social Services and Public Safety’s centralization agenda, I say that the debate should not focus on hospital services only but take a holistic view of all health services, primary and acute, and preventative public health strategies such as Investing for Health.

There is no doubt that hospital services, and equal access to them, are vital for rural communities. It should be totally unnecessary for people to have to travel to cancer services in Belfast. Chemotherapy, and similar treatments, could easily be delivered at a local level instead of having sick people make taxi journeys because of the centralization agenda. Those services should be made available in places such as the Erne Hospital in Enniskillen and in the new hospital. The rural health task force must resolve that problem and move well beyond it.

My constituents raise concerns about a wide range of health issues and services. Recent research highlighted increasing levels of child poverty and its correlation with ill health west of the Bann, yet access to children’s services in hospitals and in the community is still difficult, with long waiting lists for even basic services such as speech and language therapy and physiotherapy.

Mental health is another great concern given the social isolation of many people, particularly the elderly, in rural areas. A solution must be found to break the cycle of isolation that leads to poor mental health for which there is also poor access to services. Mental health services should have been included in the list of services that the new hospital in Enniskillen will provide. A further range of services could be brought to rural areas.

A rural health task force could do much innovative groundwork to improve the lot of rural communities. It cannot and should not focus only on the provision of acute services. A new approach is needed. We have looked at Scotland and at the Hebrides, areas that have proved that rural communities can be well provided for by acute and other services, which would normally be found in places such as London or Belfast.

11.15 am

Therefore precedents for such approaches have been set. Having visited the areas in which those services have been adopted and having given them consideration, it is clear that they can be used as examples.

It is not enough merely to supply the services: quality services must be provided. In order for that to happen, a health network must be established. That need not necessarily be initiated in Dublin; perhaps either Belfast or even London could establish it. People are much better off going to London for treatment that will save their life or improve their long-term health than going to a local hospital where they will receive mediocre services. Due to certain difficulties, of which Dr Deeny is aware, that is presently the case for many people.

Although I agree with his postcode lottery theory, Dr Deeny knows the difficulties that local hospitals face in trying to deliver quality healthcare provision. Given that rural hospitals cannot offer career progression, they find it extremely difficult to recruit nursing staff and consultants and doctors. Staff members simply do not want to come to places such as Fermanagh; Belfast’s greater career opportunities mean that they want to stay there. It does not matter how many new hospitals are built: if quality staff and consultants are not recruited, the outcome for patients will be no better. We know that statistics have proven that that is true of any services, even those that are provided by garages and so forth, and it applies to maternity and to other hospital services. The inability to attract highly qualified personnel plus the necessity to recruit abroad present major difficulties.

Young people must also be considered, and the lesson that preventive medicine is the best medicine should be taught in schools. Rural areas must be included in any broader consideration of education on those matters. Go raibh maith agat.

Mr Savage: I support the amendment tabled by my hon Friend Dr Coulter. I commend Members from the other side of the House on their interest in rural health matters. However, I cannot support Dr Deeny’s amendment, because the rural medicine working group already delivers for the rural community. As a rural dweller, I am pleased to thank that working group and to record my appreciation of its sterling work.

The second half of Dr Coulter’s amendment:

“urges the Minister of Health, Social Services and Public Safety to ensure that rural communities have access to safe and sustainable health services.”

I echo that call, because there is a feeling of isolation in the rural community. If one is not fortunate enough to own a car, the lack of public transport can deepen that sense of isolation, which, in turn, has a negative impact on social relations. Furthermore, isolation affects people’s health as well as their access to healthcare provision and public services. Stress is a major concern for many people in rural areas, especially older people and the lonely. Sometimes, having someone to speak to can have a major impact and can bring many benefits.

The home-help programme is the main link to the outside world for some older people. It should be expanded and given a budget increase so that the elderly, particularly those who are in rural areas, can reap greater benefit from such a good scheme. I ask the Minister to consider my request sympathetically.

The needs of older people should be at the heart of a flexible and holistic response in the development of a more integrated Health Service. The value that results from older people remaining in their rural communities should be a core vision. Therefore I am pleased to support Dr Coulter’s amendment.

The Minister of Health, Social Services and Public Safety (Mr McGimpsey): I welcome the opportunity to debate the establishment of a rural health task force. I am aware that people living in rural areas can feel a sense of isolation and may have difficulty accessing health and other services. Many people, particularly those in the south and west of the Province, have genuine concerns about that, and the topic must be discussed in a mature and measured way.

In expressing concern for the health and welfare of rural communities, I am in no way dismissing the needs of the many urban people who also face difficulties.

My concern as Health Minister has to be for the health and social care needs of all of the people of Northern Ireland, wherever they may live. Those needs will be different in different parts of the country, and are often dependent on economic conditions and the age profile of the local population. Some needs may be specifically related to either rural or urban factors. The key point is that our system of care must be flexible enough to address those needs, irrespective of where and how they materialise.

I want to emphasise that many factors that impact on people’s health cross Government Departments — factors such as housing, employment, education and the quality of the environment. Health is a cross-cutting issue that is the business of all Government Departments. My priority is to improve the health and well-being of the whole population of Northern Ireland, regardless of where they live.

I will start by referring to the Investing for Health strategy that was launched in 2002 by my predecessor as devolved Health Minister. That strategy is regarded by many, including many outside Northern Ireland, as a model for public health strategy. Effectively, it recognised that health and well-being issues crossed a number of Departments and issues, rather than simply being “health”.

The general health of the people of Northern Ireland has improved in recent years. The implementation of Investing for Health, in particular, has brought about many tangible gains. Life expectancy has increased in all areas and in all socio-economic groups. Death rates from diseases such as heart attacks, strokes, cancers and respiratory diseases — the main killers in our population — have fallen over the past few years. Among those under 75 years of age, deaths from coronary heart disease have fallen by 55%, and deaths from strokes by almost 50%, in the last 10 years. Cancer-related deaths in the same age group show an 18% drop.

However, inequalities remain, and we must not become complacent. Mortality rates in Northern Ireland are still too high and lag behind those of many other European countries. A review of Investing for Health will begin next year. I see that as a valuable opportunity to ensure that the strategy is still fit for purpose. I will also be looking for any other actions that can be taken to improve the health of our population, whether they live in a rural or an urban setting.

It is inarguable that accessing services can be more difficult for some people living in rural areas. However, it is interesting to note some key health indicators that compare the 20% most rural areas with the 20% most urban areas in Northern Ireland. Men in rural areas can expect to live, on average, about one and a half years longer than their counterparts in urban areas. Women living in the countryside can expect to live almost six months longer than those living in cities or towns. Infant mortality, a key measure of the health of a population, is lower in rural areas. The rate of teenage births in rural areas is less than half that in urban areas. The suicide rate is also lower in rural areas.

Members will understand from that that the needs of some urban communities are, potentially, as great as those of rural communities. That is not in any way to dismiss the needs and concerns of rural communities; I just want to illustrate that not all health indicators for rural communities are negative. Living in the country has its upsides.

Investing for Health is being taken forward through a partnership approach between statutory, voluntary and community organisations. A health partnership has been established in each health and social services board area, and each partnership has developed, and is implementing, a health improvement plan for its area. That is in line with the priorities set out in the strategy document and takes account of the needs of the local population, including the particular needs of rural communities. We have some excellent examples of innovative practice involving working in partnership. The partnerships work with rural networks to take forward a range of health improvements including, for example, research to explore the impact of rural isolation on poverty and disadvantage, and the promotion of dedicated transport to enable access to services.

My Department and the Department of Agriculture and Rural Development (DARD) currently fund Rural Support, an organisation that provides a telephone helpline, so work is being done. I firmly believe that living in a rural area should not prevent people from receiving the necessary high-quality care. In response to Bob Coulter’s point, I must say that all healthcare policies are subject to rural proofing.

My Department’s strategy for hospital services was developed through the Developing Better Services programme and recognises that a balance must be struck between ease of access for all and securing the medical benefits that are realised when the expertise and technology needed for the treatment of more complex conditions is brought together in an acute centre.

Mr D Bradley: Will the Minister give way?

Mr McGimpsey: I will be happy to give way when I finish this point.

We cannot all live close to an acute hospital, but, through the plans for a network of acute and local hospitals, we ensure that everyone, including those who live in the most rural communities, has access to the required services for scheduled and emergency care. Developing Better Services delivers a model of hospital provision that ensures that the vast majority of people will be within 45 minutes of emergency care and consultant-led maternity services, and that, on arrival, everyone will have access to those services within one hour.

Mr D Bradley: Does the Minister agree that there is a pressing need to retain resuscitation and stabilisation facilities in hospitals such as Daisy Hill in Newry, and other rural hospitals, in the event of major trauma? To do so may save lives in areas where the “golden hour” may not be met because of poor rural roads.

Mr McGimpsey: There are nine acute hospitals in Northern Ireland. Daisy Hill is one of them, and it will retain the services to which the Member referred, particularly trauma services.

Across Northern Ireland, health boards and trusts have introduced plans to make their services more responsive to local needs. I will continue to drive plans to bring high-quality primary-care and community-care services closer to where people live, and to invest in and improve the Ambulance Service, to which Mrs Hanna referred. That is another key area.

The vast majority of services that people receive in hospital settings do not need to be carried out at a large acute hospital, and local hospitals will continue to deliver those services in future, typically at outpatient, diagnostic, urgent-care and day-procedure services. The decentralisation of some services that, in the past, have been delivered solely from Belfast, such as chemotherapy for cancer patients, is also a feature of my Department’s strategy.

Mr Ramsey mentioned pathology services. A new laboratory at Altnagelvin Hospital opened last year at a cost of £18 million. There are no plans to move that; it is very much part of the fabric of services in the area. Consultation on the future of pathology services is under way. By the end of February 2007, the closing date for responses, we had received 280, which we are working our way through. We are not yet in a position to decide on the future of pathology services, so I will not predict what the final recommendations might be.

Mr McGlone: We are dealing with the topical issue of healthcare and health services for rural areas. As someone who lives in a rural area, the Minister may be aware of detrimental changes to the care practice for nurses in some smaller GP practices. Those changes undermine confidence in the level of medical care available there.

11.30 am

Secondly, I was unfortunate to have to attend the accident and emergency department of a local hospital from Friday evening until the early hours of Saturday morning. I discovered that the only method of commun­ication that medical staff had with ambulance control to obtain an ambulance was to dial 999. That is totally unsatisfactory. Some members of staff at the hospital asked me to highlight that to the Minister.

Mr McGimpsey: I thank the Member for those points. I am not in a position to comment, but I will be happy to talk to him afterwards. It is not satisfactory that the only way for medical staff to get an ambulance is to ring 999. The Department will look at that matter along with other issues concerning ambulances.

Care practices for nurses have been brought to my attention again. I have not had the opportunity to deal with the subject, however, I would be happy to talk about care practices for nurses in the Member’s area.

Linking services is a critical part of the review of rural medicine, which is being carried out by the Chief Medical Officer. That review is examining how inpatient medical services can be delivered in local and rural hospital settings. I am sure that Members agree that the review is important, and I look forward to receiving the Chief Medical Officer’s assessment of the findings at the end of the summer.

The largest proportion of health and social care needs are met by primary and community services in Northern Ireland. My Department’s 20-year strategy for health and social care, which is called A Healthier Future, is currently beginning, and will ensure a front-line role for primary and community care services. It is important that the strategy will focus on making services, such as out-of-hours services, more accessible as well as expanding the range of services that are available close to people’s homes.

To support the strategy, there will be major investment in primary and community care services through an extensive network of health and care centres across Northern Ireland over the next 10 years. It is anticipated that there will be 41 health and care centres, each of which will be designed to meet the needs of the local population. It is expected that each centre will provide a generic range of services including treatment, care, information, chronic-disease-management programmes and some diagnostic services currently only provided in a hospital setting.

The strategy is about placing an emphasis on primary care — that is what people have told me that they want from local health and social care services, and that is what I want to see delivered. I will continue to work with cross-border agencies such as CAWT to explore opportunities for more effective healthcare solutions to the problems faced by people living along the border. Our health boards are working with their counterparts across the border; a cross-border pilot scheme is underway in the north-west, which is creating mutually beneficial cross-border arrangements.

I am not convinced that a rural health task force is the best way forward at the moment. I say that in light of ongoing developments — the review of rural medicine; the pending review of the Investing for Health strategy and the prospect of duplication that may arise from the creation of another task force.

I believe strongly that rural health and well-being must involve a wider response across Government. However, I will consider how to best take forward the spirit of the motion and address the issues involved in improving the health and well-being of people living in rural communities. In doing so, I will take the views of my ministerial colleagues, as the health and well-being of our local communities is an issue for all of us. It is a shared—

Mr Speaker: I remind the Minister his time is almost up.

Mr McGimpsey: Thank you. It is a shared responsibility.

Dr Deeny: I thank the Minister for his presence. He has been at many of the debates on health, which is good. Nobody is suggesting that there should be large acute hospitals in every town in Northern Ireland — that is nonsensical.

We are talking about establishing rural hospitals that have acute services that will save lives. Such hospitals exist in the National Health Service Scotland system, for example.

Carmel Hanna, speaking as a former health professional, made a good point. We are requesting the establishment of rural hospitals that have stabilisation facilities — they work in Scotland and can work here. Such hospitals need not be huge; the important point is that their acute facilities would allow patients to be stabilised before they are transferred to larger hospitals for appropriate treatment.

The current plans to develop better services do not apply to some areas, including my own. Currently, transporting people the length of the M1 is a chance that must be taken in the hope that patients are still alive when they arrive at the acute facility.

Smaller acute services in rural areas can be run efficiently and effectively with the approval and guidance of the royal colleges. The colleges have not been mentioned, but they are important players that decide which hospitals close. If consultants’ skills cannot be maintained, and facilities and services are not provided for the training of junior doctors, a hospital has no future.

Gerry McHugh made a well-made point about staff, and I agree that attracting good staff to country areas is a serious problem. The answer lies in staff rotation, which occurs in some places. If that were adopted on a wider scale, a condition for employment in larger urban hospitals would be that consultants and junior doctors would spend some time in smaller rural hospitals. If rotation were introduced, the problem of attracting doctors to rural areas would be removed and doctors’ skills would be maintained. Therefore rotation is the future.

The Minister mentioned the healthcare needs of the urban population, and although I am proud of the fact that I live in the country, I do not suggest for a minute that the needs of urban dwellers should be overlooked — of course they should not. However, I have come across a mother who told me that before she has children she plans to move from her home to live with her sister because where she lives is unsafe. In Belfast, where each hospital can be seen and walked to from the others, people argue over whether a baby should be born in one hospital or another. I see that disparity day and daily in healthcare provision. We must not deny city dwellers what they need, but let us have a sense of fair play. People are actually leaving the area in which I live and work in order to give birth safely.

Despite the UUP amendment, I ask that party’s Members to vote on health issues instead of according to party direction. Amendment No 1 is well made and well intentioned, but it focuses on medical care, which includes coronary heart attacks, pneumonias and strokes. That is a single area of medicine that I know and of which I have been a part. The UUP amendment relates simply to medicine. People outside the medical profession do not realise that “medicine” is simply a branch of what is known collectively as medicine. I made that point to the rural medicine working group when I told it that it must widen its scope to consider the needs of children and mothers and the future of trauma services in rural areas. If Members support the UUP amendment, they will neglect and deny the rights of our mothers and children and those of us who will suffer trauma. That amendment does not consider the needs of rural areas, and therefore, as a doctor, I cannot support it.

A rural health task force is a good idea and is the way forward. That is why I support the motion. The remote and rural steering group was established in Scotland. I assume that it is still in place, and I volunteer to investigate how the Scottish Parliament looks after rural people. Members owe it to all the people in Northern Ireland, whether they live in cities or in rural areas, to provide decent and acceptable modern-day healthcare. I urge Members to support the motion and my amendment.

Mr McCallister: The UUP’s commitment to rural areas and to rural proofing is well documented. My party colleague Mr Elliott has championed that agenda for several years. I am much encouraged that this debate has not been characterised by an urban-rural divide, because that is not a helpful road to travel. Our aim is to secure quality healthcare for everyone.

I am encouraged that the Minister is, again, present for the debate. He mentioned several points that are of great interest to me. At a meeting of the Committee for Health, Social Services and Public Safety last week, I asked the Minister about establishing a good cross-departmental arrangement. On too many issues, when one mentions the word “rural” the matter immediately goes to DARD, and everyone else forgets that they share responsibility. If one mentions mental health, the issue goes to the Health Department, and other Departments forget that they too have some responsibility for those matters. The Minister has, quite rightly, made it clear that he will take up this vitally important matter with ministerial colleagues to secure a proper cross-departmental response.

Dr Coulter and I have tabled our amendment because, as Dr Coulter quite rightly said, issues of cross-border co-operation must be entirely health-led and not, as Mrs Robinson put it, driven by some other agenda. Mrs Hanna quite rightly said that we want to establish best practice. I am sure that no one in the House would disagree with that. We want best practice across the board.

Mr McHugh mentioned the Scottish experience. In the Scottish isles, there are areas of isolation that go way beyond anywhere in Northern Ireland. There may be excellent examples of best practice in Scotland to examine and from which to gain knowledge and ideas.

I do not accept Dr Deeny’s arguments on the UUP amendment. Our amendment is quite clear, and I do not see how Dr Deeny can argue with urging the Department of Health, Social Services and Public Safety to:

“ensure that rural communities have access to safe and sustainable health services.”

That is what we are seeking. There is nothing weak or watery about “safe and sustainable services”.

Mr Elliott: Was the Member more than surprised when the Member for West Tyrone Dr Deeny, at the last meeting of the Health Committee, indicated that no hospital should be built in Omagh or the Tyrone area?

Mr McCallister: I was very surprised that Dr Deeny did not want the building of a new £190 million hospital in his constituency.

Dr Deeny: It is not a hospital.

Mr McCallister: It is being called a hospital and it represents £190 million of investment in health in his constituency. It was a great surprise that Dr Deeny wanted to stop that project.

I am encouraged by the Minister’s comments on Rural Support and the work that his Department and DARD have been doing to fund that group. That is an organisation with which I have had previous involvement.

Our amendment sums up our approach to this matter. The Minister has, in his short period in office so far, driven home the message that he is not interested in quick fixes for health services — he wants a sustainable future for healthcare; sustainable safe access for all our citizens, urban and rural; no postcode lottery; and the best health system in the world, provided by the best staff in the world.

11.45 am

Mr McElduff: Go raibh maith agat, a Cheann Comhairle. Tá sé beartaithe agam féin agus ag Carál Ní Chuilín go nglaonn an Tionól seo go mbunaítear tascfhórsa um shláinte tuaithe.

As the Speaker knows, Sinn Féin is strongly calling for the establishment of a rural health task force to respond to and meet the health needs of people who live in rural areas. We appreciate the Minister’s attendance and participation in the debate and in respect of all health-related debates that have taken place in the Assembly so far.

People who live in rural areas are more likely to suffer ill health. Healthcare is a basic human requirement and a basic human right; it should be included in a future bill of rights.

This has been a well-informed debate, and as many of those who took part have personal experience of the deficit of health services in rural areas, I am glad that the Minister has taken every opportunity to apprise himself of the special health needs of people in rural communities.

Sinn Féin will accept the amendment tabled by Kieran Deeny. It makes eminent sense to include the reference to:

“equal access to life-saving services for all, irrespective of postcode;”.

As proposers of the motion, we are not inclined to accept Rev Coulter’s amendment, as it is too minimalist and does not have a wide enough scope.

Essentially, we seek strong acknowledgement and strong investment of the necessary resources by the Department in relation to special health problems that arise from living in a rural community. Distance from essential health services is a real issue, and poor road infrastructure and lower socio-economic status are just some of the reasons for the major deficit in health provision experienced by people living in rural areas.

There are general low levels of health in the North, both urban and rural, but the rural situation must be accentuated.

Mr B McCrea: I thank the Member for giving way. Would he support a £190 million investment in healthcare provision in the West Tyrone constituency?

Mr McElduff: I thank the Member for his intervention. I would accept the £190 million and seek to build on it, in order to provide proper acute services in the area.

Mr Simpson: Will the Member give way?

Mr McElduff: No. I will carry on, because it gets out of hand sometimes, David.

A significant proportion of the population lives in rural areas; urban models do not support the rural situation. How often have Members heard the excuse that investing in 20% of facilities will cater for 80% of the population? The 80:20 rule and figures should be thrown out of the window.

I am glad that several Members drew attention to the Cooperation and Working Together (CAWT) model. I ask Members to study the report on health inequalities that was published by CAWT following a one-day conference in March 2005. As other Members said, CAWT is an agreement between health boards adjacent to the border with the stated objective of improving the health and social well-being of the population.

It is regrettable that too few areas for joint working have been carried forward despite the fact that health is an area of co-operation under the Good Friday Agreement. To respond to Rev Coulter’s comments, Sinn Féin is not being doctrinaire in relation to the health issue. This motion is not about cheap political capital.

Far be it from me to quote someone of whom I am not the biggest fan — and in fact on one occasion, I joined one of the DUP Members for West Tyrone and others to occupy the office of this Minister; I do not think we were breaking the law, Tom, but we did it anyway. Nevertheless, I agree with Sean Woodward’s view that North-South co-operation in relation to health was “the patients’ solution”. Let us put the patients first.

My colleague John O’Dowd challenged Members to name an area of service provision or social policy where North/South cooperation would produce a better outcome than that of healthcare.

More initiatives are needed to reduce health inequalities in rural areas, not least in border communities. I commend to Members an initiative in the Carrickmore area of mid-Tyrone. The initiative is well known to Dr Kieran Deeny, who is a GP in the area. Indeed, I wish to put on the record that he is my GP. [Laughter.]

I appeal for calm. [Laughter.]

The rural link to health scheme is an excellent initiative that transports people to the local health centre to attend their appointments. The scheme also affords people the opportunity to go to the post office at the same time, for example. It was created by GPs in the Carrickmore practice, with input from the health action zone partnership and the Investing for Health strategy.

The scheme is a good example of how the provision of transport can help to meet the needs of rural communities. I hope that that pilot scheme will continue to be funded in the future. In a rural area such as mid-Tyrone, the scheme performs an essential service. As has already been well articulated, the needs of that community are great.

On the issue of North/South cooperation, I wish to highlight the issue of GP out-of-hours access. Sinn Féin is not being doctrinaire or engaging in cheap political point scoring on that issue. A person living in Lifford in County Donegal — one mile from Strabane — who falls sick in the evening or at the weekend is expected to travel to the North Western Association of Doctors on Call in Letterkenny, around 15 miles away. There is a perfectly good GP out-of-hours service just one mile away in Strabane, but that service has not been part of either of the two cross-border schemes that have been piloted to date.

Those pilot schemes struggled to get off the ground because of resistance from within DHSSPS. One scheme was located in the Castleblaney, Keady and Crossmaglen areas; the other in the Derry and Inishowen areas. A similar pilot scheme should be introduced in the Lifford and Strabane areas. That is the patient’s solution; in supporting it, I am neither being doctrinaire nor engaging in cheap political point scoring.

Sinn Féin does not support Rev Coulter’s amendment because it is too minimalist and its scope needs to be widened. My party specifically wants a task force to be established as it would be a demonstration of political will. The Minister said that he would take forward the spirit of the motion. I commend him on classic departmental-speak. What did he mean? Why will he not set up, or be seen to set up, a properly resourced task force with the objective of reducing health inequalities in rural areas? That would demonstrate real political will and real investment.

Other Members have spoken in their capacity as constituency representatives. As a Member for West Tyrone, I ask the Minister to intervene to ensure that the urgent care treatment centre and the high-dependency unit at the Tyrone County Hospital are retained, developed and expanded to meet the needs of people as a part of a wider solution to the problems of health provision west of the Bann. He should not allow an urgent-care treatment centre to become a minor injuries unit. Go raibh míle maith agat.

Mr Speaker: Before I put the Question on amendment No 1, I wish to advise Members that if amendment No 1 is made, amendment No 2 will fall. I shall then put the Question on the motion as amended.

Question put, That amendment No 1 be made.

The Assembly divided: Ayes 44; Noes 36.

AYES

Mr Armstrong, Mr Beggs, Mr Bresland, Lord Browne, Mr Buchanan, Mr Campbell, Mr T Clarke, Rev Dr Robert Coulter, Mr Cree, Mr Dodds, Mr Easton, Mr Elliott, Mrs Foster, Mr Gardiner, Mr Hamilton, Mr Hilditch, Mr Irwin, Mr Kennedy, Mr McCallister, Mr McCausland, Mr McClarty, Mr B McCrea, Mr I McCrea, Dr W McCrea, Mr McFarland, Mr McGimpsey, Miss McIlveen, Mr McNarry, Mr McQuillan, Lord Morrow, Mr Moutray, Rev Dr Ian Paisley, Mr Poots, Ms Purvis, Mr G Robinson, Mrs I Robinson, Mr P Robinson, Mr Ross, Mr Savage, Mr Shannon, Mr Simpson, Mr Spratt, Mr Weir, Mr S Wilson.

Tellers for the Ayes: Mr Armstrong and Mr McClarty.

NOES

Mr Boylan, Mr D Bradley, Mrs M Bradley, Mr Brady, Mr Burns, Mr Butler, Mr Dallat, Dr Deeny, Mr Doherty, Mr Durkan, Dr Farry, Mr Gallagher, Mrs Hanna, Ms Lo, Mr Lunn, Mr A Maskey, Mr P Maskey, Mr F McCann, Mr McCartney, Dr McDonnell, Mr McElduff, Mrs McGill, Mr McGlone, Mr M McGuinness, Mr McHugh, Mr McKay, Mr Murphy, Mr Neeson, Ms Ní Chuilín, Mr O’Dowd, Mr O’Loan, Mrs O’Neill, Mr P Ramsey, Ms S Ramsey, Ms Ritchie, Mr B Wilson.

Tellers for the Noes: Mr P Maskey and Mrs O’Neill.

Question accordingly agreed to.

Main Question, as amended, put and agreed to.

Resolved:

That this Assembly notes the ongoing work of the Rural Medicine Working Group and urges the Minister of Health, Social Services and Public Safety to ensure that rural communities have access to safe and sustainable health services.

Provision of Speech and Language Therapy

Mr Speaker: The Business Committee has agreed to allow up to one hour and 30 minutes for the debate. The proposer of the motion will have 10 minutes to propose and 10 minutes for the winding-up speech. All other Members who wish to speak will have five minutes.

Mr P Ramsey: I beg to move

That this Assembly notes the inequalities in the provision of speech and language therapy throughout Northern Ireland, and calls on the Executive to provide adequate and equitable resources and financial support.

The motion is not intended as any criticism of, or reflection on, the good work of speech and language therapists, managers or technical assistants.

For the past five years, I have been working closely with a group of parents in Derry whose children have been statemented and require speech and language therapy. Unfortunately, for some of those parents, their children have come of age — they are 18 — and no longer have access to speech and language therapists. Their stories are alarming. However, the parents are continuing with their campaign to ensure that other children do not face similar disadvantages.

I have attended numerous meetings with health boards and trusts. I remember a meeting with a direct rule Minister whose arrogance and ignorance left a lot to be desired. He took a telephone call during the meeting and did not even introduce his departmental officials to the parents who had accompanied me. Imagine the impression that his behaviour made on those parents: it did not give them much confidence in direct rule.

In 2006, a follow-up review carried out by the Northern Ireland Commissioner for Children and Young People (NICCY) reported that over half the children who required assessment or speech therapy in the Western Health and Social Services Board area could not access those services. NICCY found also that speech and language therapy services are allocated on the basis of a postcode lottery, meaning that the area in which one lives has a huge bearing on the expected waiting time for assessment and treatment.

In my constituency of Foyle, children can wait for up to 18 months to be assessed by speech and language therapists and receive the necessary therapy. In anyone’s life, especially that of a five- or six-year-old child, 18 months is a huge amount of time. Such a delay in assessment and treatment impedes a child’s learning and his or her enjoyment of school.

Parents in my constituency are being forced to fight with health authorities to obtain the services that their children need and are entitled to as of right. That situation cannot be allowed to continue.

There has been systematic failure of leadership and management. For example, in 2004, John Hume tabled a series of questions in the Westminster Parliament about speech therapy services. It transpired that the most basic information about the length of the various waiting lists, waiting times and budget allocations for speech and language therapy across the trust areas was not available to the then Minister to allow for strategic decision-making, allocation of resources and equality assurance. Clearly, there was no central control and, more worryingly, no democratic interest in providing an essential service for our children.

It is clear that there are simply too few speech and language therapists in the system generally, and, particularly, in some areas such as Foyle. I mentioned earlier that I met repeatedly with Health Service managers. They told me that they could not recruit and retain speech and language therapists. It turned out that speech and language therapists in the Foyle Trust area were earning less than those employed in other trust areas. That is no longer the case, but it seems that posts are simply not available for speech and language therapists who want to work in the Foyle Trust area.

(Mr Deputy Speaker [Mr Dallat] in the Chair)

Parents and users have serious concerns about moneys allocated by the Department through the children and young people’s funding package for 2006-08. The use of that funding will discriminate against children in mainstream education who need speech and language therapy. The Department has made £1 million available. However, parents have serious concerns that the money is only to be used by special schools and language units attached to special schools. That presents a serious problem for children with special needs who attend mainstream schools in that they will not be able to avail of the services being offered to children who attend special schools. That situation cannot be tolerated.

In the Foyle Trust area, there is a ratio of one speech therapist to 3,200 children, compared to the Southern Health and Social Services Board area, which offers one speech therapist to 1,700 children. That difference in provision leaves a lot to be desired.

I want to talk about the current lack of resources and the costs that will no doubt rise from our call to provide more speech therapists. Given the money that is spent on public administration in Northern Ireland — Members are all aware of Northern Ireland’s burgeoning public sector — is it not amazing that front-line services in speech therapy and other essential areas are so poor? On the face of it, given what is being spent, we should have the best public services in the world. However, we do not.

There has been a systematic and long-term failure of strategic direction from direct rule Ministers, and subsequent mismanagement, which has resulted in cumbersome, bureaucratic systems that do not deliver the services that people need.

Non-delivery of essential services would not be tolerated in the private sector — heads would roll and companies would go out of business. In public services, non-delivery of services has been followed by inaction and more of the same. Under direct rule, questions were answered with excuses. However, that was then; this is now.

12.15 pm

The review of public administration (RPA) needs to be completed as soon as possible. Health Service management must be given the flexibility, authority and control required to make the necessary changes. More staff need to be employed on front-line services, and they should be given the backup that they need. In the Civil Service and public sector, the mantra should be: if you are not serving a citizen; you had better be serving someone who is.

We can no longer accept that the weak and vulnerable in our society are provided with desperately inadequate services. The people of Northern Ireland do not want to hear lectures about finance and cost; they want efficiency and value for money. Furthermore, public servants want to work in an efficient system that clearly delivers for the people.

I recently became aware of an early years centre in Ballynahinch, which is a centre of excellence for communications, particularly for children, and others, who have communication difficulties. It is good that such an organisation exists, and I draw the Minister’s attention to it. The centre is literally a one-stop shop and it has addressed some of the difficulties that have been ongoing in the Department.

The people who attend the early years centre have severe language and communication difficulties. One of centre’s outputs is that 71% of those children who attended the centre during their early years are now in mainstream schools. It is important that children who are statemented become involved in mainstream education and feel equal to others.

As well as providing specialist support for children, the I CAN early years centre in Ballynahinch is a centre of excellence locally, regionally and nationally and provides outreach support and training for early years facilities across the South Eastern Education and Library Board. If that project is the model of good practice, we must ensure that it continues and that its sustainability is maintained. The support provided at the centre should be rolled out across Northern Ireland to allow all children to have equal access to it.

Children cannot wait any longer, and they cannot wait for RPA to be concluded before the services that they need are delivered. People are aware that, in the short term, there will be an overspend pending rationalisation under RPA. However, they would rather make that investment now because they know that our children are worth it. They are also aware of the long-term social and economic costs of not making that investment now. Immediate action must be taken to provide better front-line services. We already know what must be done. We need more speech and language therapists in place. We must get our children the help that they need, and we must get it done now.

In the recommendations from NICCY’s ‘Overview Report of Speech and Language Therapy Provision in Northern Ireland 2004/05’, the late Children’s Commissioner Nigel Williams stated that the Secretary of State for Northern Ireland:

“should ensure that children’s right to speech and language therapy is accepted and prioritised by relevant Government Departments and Commissioners and Providers of Service.”

The report’s most important recommendation is a fundamental concern for parents — joined-up thinking:

“The Ministers for Health and Education should make this right a reality by ensuring that policy, planning and service commissioning at a strategic level is strengthened to allow a child centered approach to be developed which meets children’s speech, language, communication… needs.”

That is a crucial issue for many people across Northern Ireland, some 21,000 of whom require access to speech and language therapy, and that is not currently being achieved.

Parents who are now becoming part of the campaign do not want other people to suffer the same difficulties that their own children have experienced, such as delays in communication skills and delays in accessing adequate services.

I hope that the Minister has good news to deliver today. To deal with this issue effectively, joined-up thinking is required between the health authorities and the bodies that statement children — initially education and library boards. That must be done as a matter of urgency. I commend the motion to the House.

Mr Easton: I welcome the opportunity to discuss the motion. As with many other issues that we consider, the Assembly must take the provision of speech and language therapy seriously. Although such therapy is a particular specialism, it shares with other health services the same traits of long waiting lists and lack of resources.

Speech and language therapists undoubtedly undertake a much-needed and vital role, but the current resources for the service cannot meet the demand. That means that children and young people are losing out on a most basic right to communicate effectively. Given the pressure that has been put on our Assembly and Executive to distribute finances accordingly to help to maintain services such as SLT, I urge the Executive and the Minister of Health, Social Services and Public Safety to consider carefully the funding for speech and language therapy.

Frustration at the current situation is shared not only by the families of children and young people who are in need of SLT but by the professionals who want to provide the best possible service. For the best results, such children need regular sessions with a speech therapist. Families should not be left waiting for inexcusable lengths of time. The therapy needs to be administered effectively and consistently over time. SLT involves constant attention and it requires the freedom to be able to adapt the situation to suit individual needs.

A report from the Northern Ireland Commissioner for Children and Young People highlighted that more than 2,000 children await an initial SLT assessment and that some 3,400 who had already been assessed await the commencement of their programmes. Those findings cannot be ignored, nor can the needs of our children and young people. We must find efficient ways in which to improve the situation. Can we further encourage collaboration between trusts and universities throughout Northern Ireland so that we reap the benefits of having experienced and trained staff who can move into speech and language therapy? How can we reduce waiting lists? We cannot judge demand on huge budgets without a strategic plan for implementation. We must consider that issue before throwing money at the problem and then failing to see long-term improvements.

SLT must meet the distinctive needs of all those who require the service, including, for example, autistic children and young people. Such children should not have to go through years of their life without the necessary support to communicate in the best possible way. In too many cases, resources are just not available. No one questions the quality of the therapy that is provided, but we need to consider how we can improve and support the service. We readily acknowledge the importance of SLT and call for further work to be done to shed light on autism and to resource SLT. I support the motion.

Mrs O’Neill: Go raibh maith agat, a LeasCheann Comhairle. I suggest that, although inequalities in provision exist throughout the various trust areas, there is a shortfall in provision across the North. That is not the fault of, or as a direct result of, speech and language therapists, who do a great job in difficult circumstances.

As a mother of two small children, I know only too well the stress and anxiety that all parents face when their child is ill or requires treatment. That some children must wait for more than three years is appalling. Speech and language therapy is a vital service that about 10% of all children in the Six Counties require, yet access to the service and the time that a child must wait are, by and large, determined by the postcode lottery that Pat Ramsey mentioned. Those children who are most vulnerable and most in need usually face the longest waiting times.

Speech and language therapy is an important service that could be enhanced in many ways with a straight­forward injection of cash from the Department. We need to train and employ more speech and language therapists to meet our higher levels of need. SLT is not a so-called soft service. During a recent debate, the Minister told us that mental-health services for children were seen as the poor relation, but I believe that children’s services in general have had a raw deal. Let us send a clear message from today’s debate that all services that children and young people require will be properly resourced and that we will listen to the concerns of those who are most aware of where need exists. A recent report from the Northern Ireland Commissioner for Children and Young People highlighted:

“The overall lack of action at a strategic and or policy level as regards the concerns raised by NICCY, professionals in the field and parents/carers.”

Those concerns have been ignored to date, but let us change that from today. Let us listen to those who are well aware of the services and needs in this area.

Without proper access to speech and language therapy, many of our children are being condemned to a life of poor educational achievement. That results in poor employment prospects, poor social skills development, low self-esteem and emotional and behavioural problems. Early intervention by speech and language therapists can help to prevent many of those problems and increase the life chances of many children. Undoubtedly, that would be cost-effective in the long term.

As a mother, I have focused on the positive impact that speech and language therapy can have on children. However, many other people could benefit from an enhanced speech and language therapy service — those with communication difficulties, post-stroke sufferers, young offenders and people with mental-health problems. The ability to communicate, which all Members take for granted, is being denied to many people by failures to invest in speech and language therapy. We must end that situation today. For that reason, I support the motion. Go raibh maith agat.

Rev Dr Robert Coulter: I congratulate the hon Members who tabled the motion. The issue of speech and language therapy impacts heavily on many people across our land. I am chairman of the board of a special school, so I know that such therapy can have a good impact on children who receive it.

The Royal College of Speech and Language Therapists reckons that Northern Ireland has 57,000 preschool children who have speech, language and com­munication needs. As many as 5,500 of those children will have problems that persist into later life and require specialist help. Such figures underline the importance of today’s debate.

This is a significant disability, and it may contribute to other social problems, including the cycle of social exclusion, alienation and offending. That is why the problem should be considered in the round and the funding of services should be examined in the proper context, which includes consideration of how much it costs society in Northern Ireland not to act on this issue. How much does society lose through not dealing with the problem more effectively than it does at present?

The Assembly should commission empirical research and a scoping exercise that defines the true extent of the problem. Those should be followed by an evaluation of what would happen if the present levels of speech, language and communication needs were allowed to continue unabated. That would produce a proper context for action.

It is probably short-sighted to consider the provision of an adequate response to speech, language and communication needs as simply being another item in the health or education budgets. If early intervention could alleviate the problems suffered by young offenders that in turn have led to their offending behaviour, surely a case could be made for Budget savings to be set aside for those offenders.

Members have mentioned the uneven level of care throughout the Province, and that issue must be addressed. The phrase “postcode lottery” has been used again and again, and it is also relevant to this argument. There have been sub-regional differences in waiting times for referral, the availability of sufficient therapy posts, the procedures for assessing referrals, the provision of assistants to help the specialists and differing care packages. A rational and even approach is needed across Northern Ireland to address shortfalls in different geographical regions and areas of provision.

The importance of early intervention and, conversely, the dangers of late intervention are well documented. Those dangers include: developmental disadvantage; damage to social skills and employment prospects; educational underachievement; emotional problems; and behavioural problems. All those dangers must figure in the downside costs of inaction, which must be balanced against the actual costs of improving the service to meet professionally led standards of adequacy. The net cost can then be understood, and the relatively small amount of that net cost will ultimately justify this much-needed reassessed public investment in this important service.

12.30 pm

What worries me most is that, currently, there are no speech and language therapy services for children and adolescents with mental-health problems and for young offenders, and there is only limited provision for patients suffering from brain injuries, cancer, voice conditions, and strokes, and for secondary-school children and children with Asperger’s syndrome.

All of that is a reproach to us. We must look not only at the net cost approach that I have outlined, but at better, more innovative ways of spending the current budget. I support the motion.

Mr Lunn: I welcome the motion; it raises a significant issue. However, the motion does not indicate where the “adequate and equitable resources” it calls for are to come from. As Dr Coulter rightly says, debate around the issue suffers from a lack of statistics.

The scale of the problem is indicated primarily by concerns raised by health professionals, rather than bare statistics. The figures indicate that this time last year, of 17,000 children requiring speech and language therapy, approximately 15,000 were receiving it. That means that nearly 15% of children who needed the therapy were not receiving it. Overall, approximately 3,500 children and adults who have been assessed and require treatment are still awaiting it. Those are the figures that the Alliance Party has researched. I did not understand the figure that Dr Coulter gave of 57,000 pre-school children in need of speech and language treatment.

As Mr Ramsey said, the evidence suggests that there is a postcode lottery, which is also the case for many other services. The trend for patients going from assessment to provision is declining in some areas. The gap is typically a few months, but in some locations there is a wait of up to two years between being assessed as requiring therapy and actually receiving it. That is particularly unacceptable for children. It is intolerable that a six-year-old child should have to wait until he is eight to receive treatment.

We need to be cautious that our attempts to provide an equitable service do not result in a reduction of the level of provision in high performing areas. The task is to bring every trust area up to the standard of the best, not to equalise the level of treatment to an average. Our objective of speeding up access to therapy should not lead to any reduction in the quality of the therapy provided. Requirements can differ significantly, so it is not enough to illustrate the issue with mere statistics.

Resources and financial support also require some thought. Fewer speech and language therapists qualify than are needed. I would like to know what the position is across the whole of the UK, and Ireland. Anecdotally, it seems that Northern Ireland’s school-leavers are going elsewhere to train. If that is the case, why is it so? Is there any way of encouraging them back?

Discussion on this issue has focused on the regional task force. However, the electorate has already become a bit fed up with “government by review”, and “government by task force”. Executive action is required via cross-cutting policies to ensure all of the following: that finances are available; that enough therapists become qualified; that the public is properly informed about the availability of speech and language therapy assessment and provision; that underperforming trusts are brought up to the level of the highest performers; and that children requiring therapy are identified as soon as possible.

We welcome the motion as it stands, as a great start. The Executive now faces the challenges of finding where the inequalities in speech and language therapy exist, clarifying exactly what equitable resources are needed, and locating adequate funding.

The determination to waste money on segregated services brings a high cost for other areas; the Executive has four years to examine that. Nevertheless, the Alliance Party supports the motion.

Mrs I Robinson: I congratulate the hon Members for proposing the motion. As the DUP health spokes­person I had the privilege, just over a year ago, of hosting a reception in the Long Gallery to celebrate the diamond jubilee of the Royal College of Speech and Language Therapists. Those individuals make a hugely important contribution to healthcare in our Province.

As with all the allied health professionals, there are stringent resource limitations on what staff can achieve. Retention of people undergoing training has been a problem, and I am encouraged to see that the numbers of new speech and language therapists commencing work in the Province is growing gradually — that is to be welcomed.

Significant financial incentives have been attracting newly trained professionals to practice elsewhere; and they cannot be blamed for following that course, because people outside the Province appear to value their exemplary credentials more than we do. I am not sure of the current figure, but recently there were 20 vacancies in Northern Ireland. It has always been difficult to obtain from Ministers precise figures for the waiting times of those seeking speech and language assessment or treatment. Ministers have only been able to provide the length of waits experienced by those who received an initial assessment in the previous quarter.

A cynic might conclude that that situation could be useful to the Department in limiting negative media headlines. It cannot be difficult to obtain the waiting list for assessment or treatment across the Province, and the point was referred to in NICCY’s follow-up report in 2006, which states:

“There continues to be great difficulty accessing information uniformly across Trusts. It would appear that information … critical to effective service planning is not yet routinely collated analysed, or easily accessible. The urgent need to address this deficiency cannot be over-stated.”

I appeal to the Minister to address the problem urgently. Precise numbers must be obtained so that proper resource planning can be put into effect.

There have been marked disparities in different parts of the Province. Waiting times are not the staff’s fault: they do as much as can reasonably be expected. Unlike other disciplines, waiting list figures for speech and language therapy encompass adults and children. Long waits are particularly significant for children, as many of them are at an important stage in their development.

Vacancies and pressures on special schools also pose particular difficulties. I am aware of great problems at Torbank School, which is in my own constituency, and I wish to highlight the need for an urgent look at that school’s needs.

One third of young people with special educational needs is statemented with speech and language needs. In order to improve that situation, the Department of Health, Social Services and Public Safety and the Department of Education must work together in a close and cohesive format.

In 2002, the comprehensive review of the speech and language therapy workforce highlighted the need for more posts and to encourage trained staff to remain in the Province. A year ago there were 314·4 whole-time equivalent speech and language therapists in the Province, as well as another six full-time and 22 part-time support staff.

The workforce is overwhelmingly female: there are only two full-time and one part-time male therapists. The NICCY follow-up report states that more than 2,000 individuals were awaiting assessment with approximately 3,500 who had been assessed but were waiting for their treatment to start. Across Northern Ireland, over 15,500 patients were receiving treatment, which meant that to provide treatment for all those who need it the capacity of the service would have to increase by more than one third.

Recently, 11 out of the 14 health trusts reported having inadequate financial resources for speech and language therapists. Many were also concerned about limited clerical and administrative staff and ineffective appointment systems. I support the motion.

Mr McKay: Go raibh maith agat, a LeasCheann Comhairle. I thank the SDLP Members who tabled the motion, which I support.

Sinn Féin recognises the important role that speech and language therapists and support workers play in the lives of many people with communication, eating, drinking and swallowing problems. Speech and language therapists provide an essential service in the Health Service for both children and adults. Not only do they assist and work with people with communication difficulties but they help to instil confidence in those people to express themselves to the best of their ability. There is clearly inadequate and inequitable service provision in the sector across the Six Counties. That needs to be acted on urgently.

The Commissioner for Children and Young People’s follow-up review of speech and language therapy services for children and young people for 2005-06 showed that, from available information, 5,457 children and young people were awaiting assessment and/or speech and language therapy.

For assessments, the review states:

“the maximum wait stated by any Trust for community settings was just over 10 months”.

The figure was even worse for waiting times for therapy. The maximum waiting time recorded between assessment and therapy was 24 months — two years. That was recorded in the former Homefirst Community Health and Social Services Trust area, which takes in part of my constituency of North Antrim.

The geographical inequity in the service is extraordinary. Waiting times for assessment last year ranged from three weeks in one trust area to five months in another. Waiting times from referral to therapy range from 15 weeks to 29 months.

Last year, 11 of the 14 trusts identified:

“inadequate financial resources and/or speech and language therapists”

as reasons for the failure to meet need. The recognised shortage of speech and language therapists is caused by recruitment and retention problems, and that means that many clients, particularly children, experience severe delays in accessing therapy.

Sinn Féin calls on the Minister to make the service more equitable across the board and to end the postcode lottery that currently exists in the sector. There is a pressing need to ensure that appropriate financial resources and more speech and language therapists are provided. The need that exists for speech and language therapists looks set to grow even more. That is why the Minister should approach the problem with a degree of urgency in order to get it addressed now.

There is greater need for speech and language therapy intervention for a number of reasons. People live longer, and many now live longer after cancer treatment. People with dementia or who have suffered a stroke — conditions that affect communication — need assistance. Problems such as autism and learning difficulty are more widely recognised. Improvements in neonatal care mean that survival rates for preterm babies with developmental problems such as cerebral palsy is increasing. Children are losing out on vital treatment, and that is simply not good enough.

If the opportunity is missed for children and young people to avail themselves of speech and language therapy services, that could have a huge effect on their development. The longer that it is left, the more difficult it will be to address some of those difficulties.

Go raibh maith agat.

Mr Simpson: I also congratulate Pat Ramsey and Dominic Bradley on their motion.

A recent review of speech and language therapy services by the Commissioner for Children and Young People showed that some 20,000 children require, or currently receive, speech and language therapy services in the Province. The findings of the then Children’s Commissioner, Nigel Williams, were shocking.

In some trust areas, children and young people were forced to wait for up to 18 months to two years to be assessed by a speech and language therapist. A clear inequality exists in waiting times from the date of the referral to the first assessment. The whereabouts of a child or a young person in Northern Ireland seems to determine how long he or she must wait for speech and language therapy. I know that from experience in my constituency. Waiting times for pupils at Ceara School in Lurgan, for example, are much longer than those for pupils at Donard School in Banbridge.

I have nothing but admiration for the dedication and work of the diligent staff at all those schools in Upper Bann, especially the principal of Ceara School, Dr Peter Cunningham, and Mrs Freda Wylie at Donard School, who will be retiring next Tuesday after many years at the school. Those years of dedication must be commended.

12.45 pm

We asked direct rule Ministers for details on how many patients and young people were awaiting speech and language therapy appointments and the duration of those waits, but we were told that the statistics were not available; they were not kept. That is not good enough. To plan for the future, we must know how many individuals require services, but we are merely provided with general information on the duration of wait experienced by those who have been treated in the previous quarter. For instance, 18 months ago, more than 650 individuals in the southern health area received initial speech and language therapy assessments; 255 had waited more than three months, and 30 had waited over six months. Many of those requiring treatment are young children, and such waits for therapy can have a major impact on their development.

The Commissioner for Children and Young People’s report of 2005 made several recommendations. It called for the establishment of a regional task force to address the postcode lottery that exists in service provision and an agreed maximum waiting time for assessment and therapy. A follow-up review by the Office of the Commissioner for Children and Young People took place in 2006, which identified that some trusts had made positive improvements. However, that was not universal across the Province, and there was evidence that some waiting lists for assessment and therapy had increased — for instance, the number of children awaiting assessment in the Sperrin Lakeland Health and Social Care Trust had increased by 28·3%.

Eventually in 2006, direct rule Minister Lord Rooker announced that the task force recommended by the Commissioner for Children and Young People would be established. The task force met for the first time last year, but, to date, it has not published a report. Even though some investment has been announced, it does not address the postcode lottery or the ability of principals of special schools to access services directly for pupils.

Many children in Northern Ireland need access to, and suitable provision of, speech and language therapy. The current allocation of resources, structures of service delivery and lack of interest on the part of the Government in addressing that means that children and young people who have speech and language difficulties are being denied their basic rights.

Government officials tell us that there are not enough therapists because they drop out from their courses, or because there is no funding or insufficient funding available for them — or a mixture of all three. Perhaps the Minister will tell the House why that is so. I support the motion.

Mr McCallister: Approximately 2·5 million people in the UK have communication problems. Speech, language and communication difficulties are the most common disabilities presenting in early childhood. This year, the Education Select Committee at Westminster acknowledged that as the number of children with special needs rises, so does the incidence of communication problems.

The statistics relating to children with special needs demonstrate the extent of the problem in this country: up to 90% of children with learning disabilities have speech and language difficulties; approximately 80% of those who have severe learning disabilities do not acquire effective speech; 62% of children with mental-health disorders have speech and language difficulties; and 5% to 8% of preschool children with speech, language or communication problems and 10% of school-age children have communication problems. Furthermore, over one third of stroke sufferers have persisting speech, language and communication problems; more than three quarters of the people who have mental-health disorders have communication difficulties; and almost two thirds of young offenders have speech and language impairment or communication needs. Unfortunately, the list goes on.

Speech and language therapists provide an invaluable service in Northern Ireland, so there are serious risks to patients if speech and language therapists are not availed of, or applied for, when needed. Children with delay and communication difficulties are an exceptionally high-risk group with high rates of later developmental disadvantages.

Difficulties can arise with social skills and behavioural and emotional problems, which can lead to poor employment prospects. One third of children with communication problems, if untreated, will go on to develop mental illness, which will result in involvement in criminal activity in over 50% of cases.

The importance of the service that speech and language therapists provide is realised when we examine the extent of the need for their services in Northern Ireland. Statistics provided by the health trusts reveal that over 15,000 children and young people are currently receiving speech and language therapy in Northern Ireland, while a further 2,000 are awaiting assessment for therapy. Those individuals can experience delays of up to 24 months between assessment and receipt of therapy. Average delays range from, at best, two and a half weeks to, at worst, 9 months. That is clearly unacceptable, given the identified need of those children and young people.

When considered together, those figures reveal that well over 5,000 children and young people are still awaiting assessment and/or therapy. Up to 21,000 children and young people, therefore, require access to speech and language therapy in Northern Ireland. The Assembly must act to address this inadequate provision. The facts and figures speak for themselves. I un­conditionally support the motion and commend its proposer.

Mr Beggs: I declare an interest in this matter as a member of the New Horizon Sure Start committee, which operates in Carrickfergus and Larne and is a potential recipient of funding to address the speech and language therapy needs of children in the area.

Much is made in education debates of the large number of young people leaving school with limited literacy and numeracy skills. The Royal College of Speech and Language Therapists advises that in Northern Ireland there may be as many as 57,000 preschool children with speech, language and communication skill needs. If a child at preschool stage or at school has such a need and it is not addressed, how can we expect him or her to realise their full potential? How can a teacher cross that barrier and communicate effectively with the child? Likewise, how can the child connect with the teacher or have his or her queries answered? This is a major problem that ultimately affects the education of young children. It also affects their social lives as they try to mix with others, even in their own homes.

Other Members have commented on the Northern Ireland Commissioner for Children and Young People’s report on speech and language therapy provision for 2004-05 and his follow-up report, which was launched last March. The follow-up report showed that 2,055 children and young people were waiting for assessment. Yes, it was a 17·4% drop on the previous figure, but does that simply reflect an increase in the number of children and young people who had been assessed but had yet to receive therapy? Children and young people must go through a number of lists before they start to receive the treatment that they need.

The report showed that 3,402 people in Northern Ireland were waiting to start therapy. As others have said, children and young people faced a delay of up to 24 months in the former Homefirst Community Health and Social Services Trust area, which covers my constituency of East Antrim — including Larne, Carrickfergus and part of Newtownabbey. That is unacceptable; it is ruining young people’s potential, and that gross inequality must be addressed. Yet, we are told that, in other areas, the delay between assessment and receipt of therapy can be as little as two and a half weeks. Why should children and young people in my area be exposed to such a postcode lottery defect? Why is there such gross inequality in Northern Ireland? It is unfair, and it is ruining their potential in life.

Worringly, the NICCY report on speech and language therapy provision showed that, compared with previous years, more trusts complained of inadequate financial resources, a shortage of speech and language therapists, a lack of administrative support and lengthening waiting lists. It was clear that by March 2006, when the report was published, that that situation was worsening.

Other Members mentioned the regional task force that was set up in March 2006 by Lord Rooker, the then Minister with responsibility for children and young people, to review speech and language therapy services. Who are the members of that task force and how often has it met? I am led to believe that it has met once, but a lack of clarity exists. Given the new structures in place in Northern Ireland, to whom does that regional task force report? It is important that those questions are answered and that ministerial responsibility is assumed, so that progress can be made and lessons can be learned that will improve the lives of children and young people in Northern Ireland.

When are we going to hear of any recommendations by the regional task force? When will it produce a report? One of my constituents had been on a waiting list for 13 months, only to receive a 20-minute assessment from a locum who did not have the notes from previous assessments that other professionals had conducted. As a result of intervention, my constituent has commenced an eight-week therapy course, but what happens then? What ongoing support is available? Difficulties such as those that I have described cannot be cured in eight weeks. Those problems must be solved, and I hope that the Minister of Health, Social Services and Public Safety will help to solve them and improve the defects in the system. We must improve our young people’s lives.

Mr Deputy Speaker: Order. Members will know that the Business Committee has arranged to meet immediately upon the lunchtime suspension. I propose therefore, by leave of the Assembly, to suspend the sitting until 2.00 pm.

The sitting was suspended at 12.57 pm.

On resuming (Mr Deputy Speaker [Mr Dallat] in the Chair) —

2.00 pm

Mr Deputy Speaker: The sitting is resumed. We shall continue the debate on the provision of speech and language therapy.

The Minister of Health, Social Services and Public Safety (Mr McGimpsey): I thank Mr Ramsey for bringing this important issue to the House. I am aware that he has raised it with the Department on several occasions with regard to his constituency of Foyle.

I acknowledge the problems that there have been with the provision of speech and language therapy, particularly with regard to the excessive and unacceptable waiting times for assessment and treatment. I assure the House that I am focused on the issue, and improvements will be seen in the near future.

I want to outline some of the initiatives that the Department is considering. I recognise that the ability to communicate gives children and young people the capacity to participate fully in society. Without the correct assistance, children who have communication difficulties are likely to experience significant long-term educational, economic, social and health ill-effects. That is why I am keen to ensure that everyone who needs speech and language therapy has access to the appropriate services.

My Department has been working in close partnership with the Department of Education to ensure that children and young people receive the therapy that meets their needs and, consequently, improves their life chances. That type of co-ordinated partnership between Govern­ment and agencies is recognised by all who are involved in speech and language therapy provision as the most effective way forward for the planning, commissioning and delivery of services.

An increasing number of children and young people who have speech, language and communication difficulties are seeking help from the health and social services and early education organisations in Northern Ireland. Many of those children also have complex needs and medical conditions that are associated with those needs. Recent national research shows that approximately 10% of school-age children have communication problems and up to 90% of children who have learning disabilities have speech and communication difficulties. The fundamental service review of special education, which reported in March 2003, showed that the number of schoolchildren who have special educational needs increased by 70% between 1991 and 2001. Those statistics show that pressure on speech and language therapy services throughout Northern Ireland has increased. My Department is working towards tackling that need.

The former Northern Ireland Commissioner for Children and Young People recommended the establishment of a regional speech and language therapy task force, and that was established