Mr Speaker, I am grateful for this opportunity to make a statement to this Assembly on the important matter of accident and emergency services in the Belfast Trust, particularly in light of the decision taken by the Belfast Trust on 7^th September to close, on a temporary basis, the Emergency Department in Belfast City Hospital.  

This change will take effect from 1 November 2011 and will concentrate Emergency Department services within the Belfast HSC Trust on the Royal and Mater Hospitals sites.  These immediate changes will apply until there has been time to resolve a permanent way ahead through a full decision making process.

Whilst this urgent decision on change is an operational matter for the Belfast Trust, I want to assure Members and the public that my Department has obtained assurances from both the Trust, and the HSC Board, as the commissioner of these services, that the temporary model of Emergency Department provision is safe and sustainable and that it will deliver high quality care.  I have insisted that all parts of the service have acted to ensure that there are appropriate emergency services for those who need them in the Belfast area, and that the regional implications of this change, particularly in relation the South Eastern, Northern and Ambulance Trusts are well managed.

For people living in the greater Belfast area and beyond, I want to see a better emergency service than the one that we have at present. The key to ensuring that such services are effective is the availability of expert decision makers who know quickly what to do when faced with the wide range of conditions that need attention unexpectedly in A&E Departments.  For too long, we have been trying to cover rotas of doctors which spread the time and attention of these key doctors too thinly, meaning that the system is too vulnerable to situations where junior doctors cannot get the advice they need in managing patients arriving with immediate needs.

I know that these changes will mean greater travelling times for some people in Belfast – the distance from Belfast City Hospital emergency department to the one in the Royal Victoria Hospital is 1.2 miles and from the City to the Mater hospital is 2.1 miles.  These distances are small compared to the distances that are the norm in rural areas.  And they will be more than offset by the improved sustainability and safety of a model of care in A&E that ensures the right medical rotas are in place – in a way that is simply not possible in the status quo.  

It has been claimed that the closure will place lives at risk.  Mr Speaker, I deplore such ill-founded and irresponsible comment.  The clear fact of the matter, based on expert clinical and management advice, is that on the contrary, seeking to maintain the status quo would create risks that that can no longer be managed safely.  I recognise that there are major challenges in managing that change and that is why I would want the Assembly and the public to get behind the managers and clinicians in Belfast Trust and all the other affected organisations and do all we can to help make this temporary change work.  

While this urgent and necessary change has to go ahead now, my objective as Minister for Health, is to ensure safe and sustainable Emergency Department service provision in the longer term.  Any decision on the permanent reconfiguration of Emergency Department services will be a matter for me as Minister to determine and it is a decision that I will take only after I have listened to what key stakeholders, in particular the public and their representatives, have to say through a process of effective engagement and open and transparent consultation.

When I spoke to the Health Committee at its meeting on the 20 July 2011, I advised them at that time that immediate changes to A&E service provision would be required in the interests of patient safety.  In light of the announcement by the Belfast Trust on 7th September, I want to further elaborate on why these immediate and temporary changes are required.

The drivers for change relate to the safety and quality of care; they are not about efficiencies or cuts.  In fact, it is likely that some additional costs will arise in the short term as the Trusts gear up to address this change –I repeat – this change is necessary to ensure patient safety and is not a financial issue.  I am very concerned that some have chosen to try to make this an issue of finance, and I would ask the house to be responsible in handling this issue today – because the key issue here is the need to ensure that there is an emergency service for Belfast and the nearby areas that works and meets the needs of the population.

The main reasons for immediate and temporary changes are:-

My Department has been advised by the Belfast Trust and the HSC Board that immediate changes to improve supervision of junior doctors have been achieved.  But this has involved considerable rota redesign, significant reliance on locums, support from other Trusts, and the goodwill of medical staff within the Belfast Trust.   The HSC Board has highlighted that there would be inherent vulnerabilities in sustaining such immediate changes beyond an 8 week period; hence the need for further temporary change from 1 November  2011.   

It is for this reason therefore, that an Emergency Department service model involving temporary closure of the Belfast City Hospital emergency department will be put in place from 1 November 2011.  

Whilst further details on the actual model are being refined by the Trust, the end of October 2011 will provide sufficient time for other local Trusts, the NI Ambulance Service and GP Out of hours services to plan for such a change.    Inevitably there will be additional pressures in other Trust areas as a result of this change, both in terms of attendances in emergency departments and admissions to hospital; therefore, as part of the contingency planning arrangements further work is required on patient flows and there will be a need for ongoing monitoring, once the temporary changes are put in place.  

But I am sure that Members will agree with me that putting in place contingency plans now is a far better and safer approach than having unplanned cessation of services, especially over the winter months.

Let me say again, my first concern is the safety of patient care.  There is, and will continue to be, a 24/7 emergency service in the Belfast Trust.  The changes are necessary to sustain that service provision.  I am advised by the HSC Board that the Belfast Trust has looked at other options including limiting opening hours in the Belfast City hospital emergency department or putting in place a minor injuries unit on that site.  

However, the option the Trust has chosen (24/7service on the Royal and Mater hospital sites) will bring together greater medical consultant capacity on these two sites and will provide better access to these specialists outside of normal working hours and at weekends. This will be further complemented by specialty trainees and locum cover.  Such arrangements will address the issue of supervision of junior doctors and rotas will be compliant with statutory requirements of the European Working Time Directive.  It is my understanding that that there will be no staff reductions as a result of these changes but there will be a requirement for staff reconfiguration.  

Under these arrangements an important category of patients will continue to be admitted to Belfast City Hospital when they face an unexpected need for urgent hospital care.  This is because the proposed plan is to have a medical assessment unit and an acute assessment facility on site in Belfast City Hospital.  This will be able to help patients with acute medical conditions, such as those referred by a GP, and provide rapid and timely intervention for patients.  There will also be patient pathways in place for specialty admissions when an urgent need arises - for example, for patients who have certain cancer and renal conditions.    Thus while Belfast City will no longer receive self- referrals from members of the public who up to now have attended the A&E Department there, it is anticipated that a proportion of people who need urgent care will still be admitted directly to the City, without having to be assessed at one of the other busy A&E Departments.

In order to meet the anticipated increase in demand at the Royal, additional funding has been allocated to the Belfast Trust to undertake some refurbishment to the A&E department to create additional capacity.  This will include a 9 bedded short stay unit in the emergency department which will be open 24/7 for patients who require interventions with a length of stay of less than 24 hours. In addition, there will be an acute medical admissions unit operating 24/7 for patients who need 24 – 48 hour length of stay.  There is also a plan to relocate the Eye Casualty to alternative accommodation. These changes, together with enhanced arrangements for ambulatory care will assist in meeting the additional pressures on the system.

Some minor works are also in hand at the Ulster hospital which is likely to see additional patients as a result of the temporary closure. These works include upgrading and bringing back into use a disused ward and creating a Clinical Decision Unit to accelerate patient flow.

I want to reiterate the important point that this change will be subject to close and on-going monitoring.  But in the longer term, a strategic decision will need to be taken on provision of ED services in the greater Belfast area.  As I have said that will be a decision for me as Minister to take and it is decision I will take only after a full and open process of consultation and engagement.   I anticipate taking a strategic decision on these matters later on in 2012.    

Finally, I would like to emphasize that the public also has a role to play in making emergency services more effective by using the NI Ambulance Service  -999 calls - only when needed.  In addition, individuals should think carefully on whether an emergency department is the most appropriate place for treatment of their specific minor ailment or injury.  For example, it may be better for them to access treatment via their GP or local pharmacy.  

I commend this statement to the House.