I am grateful for the opportunity to have this debate, albeit in the dying moments of this Parliament. I again raise the issue of health, having done so at the Northern Ireland Grand Committee during the draft Budget debate. However, as the Minister who then responded was not the Health Minister, I hope for better answers today, and I am delighted to see the Minister in her place.
Health service provision is a major concern for people in Northern Ireland, because it has the worst waiting lists in the United Kingdom. As I said in the Grand Committee, the Audit Office report into the Province's hospital waiting lists, which was published last year, confirmed that Northern Ireland has the worst waiting lists in the United Kingdom. The Ulster public face longer waits to access services than patients in England, Scotland or Wales.
The latest quarterly waiting list statistics for the Province indicate slight improvements in relation to in-patient lists, which have been deemed a departmental priority. However the number requiring an initial hospital out-patient appointment continues to rise, and has almost doubled since 1998 to 164,672. In England, 1.8 per cent. of the population are on waiting lists for treatment, but in Northern Ireland the comparative figure is 3 per cent.
In seeking to improve the in-patient list, the out-patient lists are suffering. We even have waiting lists to get on to waiting lists. Greater investment in the training and recruitment of health professionals is essential and I also want to see the prompt restructuring of our dozens of health bodies to streamline decision making and enhance accountability.
Although a proposed increase of 9 per cent., up to £3.3 billion, in the current expenditure of the Department of Health, Social Services and Public Safety may, on the surface, appear generous, health service inflation continues to grow at a much steeper rate. By 2007–08, the percentage rise that direct rule Ministers have committed themselves to will be less than 6 per cent. The positive public messages from Ministers do not equate with the demands and restrictions that they are placing on senior managers away from the media spotlight.
Differential access to private health care, as well as rurality, and factors related to ability to pay, reduce the differential spend per head on health and social services. Statistics indicate that, after assessing relative needs, to provide services at a comparative level would cost 17 per cent. more per person in Northern Ireland than in England. Different levels of private health care elevate that to 21 per cent. more to achieve the same level of service. However, the Barnett formula makes no allowance for differential need.
I want to make a particular point about the quality of Northern Ireland's hospital stock, which is very poor. There is also a greater backlog of maintenance compared with that in England. Many of our hospitals are of a substantial age and require redevelopment or replacement. Imaging and laboratory equipment that is more than 10 years old needs to be replaced to improve quality, effectiveness and staff productivity, and to reduce patient delays.
Although the cost of treating the victims of 35 years of terrorism soaked up hundreds of millions of pounds from the local health budget in past years, some imagine that, because violence has significantly reduced, those extra costs are no longer being incurred. Sadly, however, apart from the many new victims requiring attention, which do not make the headlines to the same extent, the health service still has to care for the victims of the past. For instance, bomb victims still require prosthetic limbs, and many still live with the psychological consequences of terrorism. And, of course, the trauma has not stopped. I unsuccessfully sought an estimate of the costs associated with caring for recent victims of the ongoing paramilitary beatings and shootings.
I am sure that the Minister has been briefed on the fact that the local press in Northern Ireland were this morning reporting the tragedy that is waiting to happen as ambulance cover falls to dangerous levels across the Province. Union officials report that large swathes of the Province were left without sufficient cover over Easter. On Easter Saturday, the entire city of Londonderry had no ambulance crew. Staff in other divisions had to scramble around to provide personnel.
On the same night, there was no vehicle to cover the night shift in Strabane, County Tyrone, so the crew were forced to drive a minibus the fifteen miles to Altnagelvin hospital to find an ambulance. Staff from Enniskillen were sent to Londonderry to cover an area with which they were unfamiliar. A patient was transferred in a day-care vehicle in order to free an emergency ambulance. Last Saturday night in East Antrim there was only one crew covering Whiteabbey, Rathcoole and Carrick, but there should have been at least two. The depot in Downpatrick regularly takes ambulances off the road because staff are unavailable.
A major overhaul of ambulance staffing is required to ensure that each depot has the appropriate number of personnel. I trust that the Minister will address that most critical matter. I fear to contemplate what might happen were a major incident to occur while we are reliant on an unsatisfactory skeleton service.
I hope that the Minister will deal also with the question of chemotherapy drugs, which illustrates the problem of rising costs in Northern Ireland. A new regional cancer centre will open its doors at Belfast City hospital early in 2006. However, hospitals, including Belfast City, recently had to produce emergency contingency plans because of multi-million pound shortfalls. One area identified for savings was that of cancer drugs. Thankfully, an injection of cash averted the withdrawal of those vital medications, but it highlights the difficulties that we face.
Diagnosing cancer earlier, and keeping more people alive, means treating cancer as a chronic disease, with third and fourth-line drugs often being required. Experience in other countries indicates that the rapid growth in the use of chemotherapy and haematology drug-based therapies will continue. Cancer drugs are also being used more frequently for symptom control.
Chemotherapy drug costs at Belfast City hospital rose by about £3 million last year, and £1.4 million had to be found just to maintain the services currently being provided. More cancer patients are being diagnosed and treated in the Province every year. Day case and out-patient attendances at the City hospital were up by a staggering 30 per cent. in one year. We are building a new cancer centre of excellence and attempting to attract world leaders in the field to come and work in the Province, and funding is proving problematic. Cancer sufferers should be entitled to the very best treatments. It is dreadful to think that life-saving treatments may not be available to those in the greatest need because the local health service cannot afford them.
Haematology patients also have concerns. A constituent of mine, Anne Aitchison, a lovely lady, has been campaigning for many years for improved local health services. In particular, she has been promoting the provision of coagulometers. Not only would those devices benefit patients, but they would save the local health service money and time. Patients currently face a trek to the hospital warfarin clinic, and they often have to wait several hours for the results of an invasive blood test before seeing a doctor.
Regular hospital attendance can swallow up a significant part of the lives of patients whose blood needs to be checked every week; it can result in the loss of a whole day from work or education. Massive resources are used in warfarin clinics. Doctors and nurses are needed to conduct expensive blood tests, and ambulances are sometimes required to collect patients, whereas the new coagulometers can be used by patients in their own homes, and involve only a small pinprick, much like blood glucose monitoring. It is much easier to use them, especially where elderly and confused patients are concerned, than to take intravenous blood samples.
In Germany, hand-held coagulometers have been provided for approximately 100,000 patients, but in Northern Ireland, where some 1.5 per cent. of the population requires oral anticoagulation therapy, they can be acquired only by private means or through fundraising. The use of coagulometers empowers patients to take greater responsibility for their care, something that the Government have been keen to encourage. They should be made more widely available through the national health service, and I hope that the Minister will consider favourably the ongoing pleas of warfarin patients.
My party has been considering general improvements that could be made to the health service in Northern Ireland, and we aim to publish proposals in a policy document shortly. There is little direct responsibility or accountability in any tier of health care management in the Province. We need transparency in spending and detailed audit trails. In recent years, a huge amount of money has been thrown at problems, and it has disappeared without trace. There must be targeted strategies with clear responsibility and accountability. Under the 1998 Belfast agreement, the Sinn Fein Health Minister acted as she pleased, regardless of the views of the Health Committee, the Assembly or her Executive colleagues. If ever a new Executive is created, there must be more opportunities for scrutiny, and Ministers must be prevented from acting unilaterally.
The Minister will know that our health care staff perform complicated procedures in pressurised environments. However, they often feel unappreciated, and are suffering a morale problem. That must change if the national health service is to retain the cream of the health professionals, who are frustrated that they cannot deliver the optimum service. Maximum use should be made of highly trained staff. It is inappropriate for specialists to perform tasks that could be done by others who are less qualified.
Despite the new general medical services contract, general practitioners struggling to find beds for their patients feel undervalued, overburdened and unsupported. They do not have enough time to spend with patients, and that sometimes results in inappropriate referrals to already crowded emergency departments. Approximately 90 per cent. of national health service patients are dealt with in primary care. That speciality must not be allowed to suffer on account of acute care pressures.
The DUP wants to decrease administrative bureaucracy, not just to save money but also to streamline decision making and create a more efficient system. We advocate that, as a result of the ongoing review of public administration, the number of boards and trusts should be slashed to leave no more than half a dozen authorities. A single body should oversee regional services, and money must be channelled to front-line services rather than being frittered away in administrative costs. However, it is essential that the expertise developed over many years should not be lost as a result of such rationalisation. A co-ordinated health care network must develop, and replication of services must cease.
Significant investment is required in order to improve efficiency in the service. We advocate increased funding, in excess of the Barnett formula, to ensure that those in the Province receive a standard of care that not only matches the best found elsewhere in the United Kingdom, but relates to need. We are talking not just about providing extra beds but about finding more staff, which will lead to an improvement in hospital services. We urge the provision of more radiographers and extra physiotherapists, occupational therapists and speech therapists, and we would like more doctors and nursing staff to be trained locally.
We should invest in areas in which improvements are most likely to result in reduced spending in future. We must think holistically about the impact of ill health on our society; that includes the costs of long-term care, benefits and absence from work. There are insufficient residential, domiciliary and nursing home places and, of those that exist, a large proportion are nursing home places, which are the most expensive. At any one time in the Province, there are 400 individuals blocking beds in Northern Ireland hospitals because the resources do not exist in the community to support them. That contributes to access difficulties at the opposite end of the hospital admission cycle. A concerted effort must be made to remove that persistent brake on the system.
We have to plan for our ageing population. People are living longer now, which means a growing demand for health care among the elderly. More patients require treatment for conditions such as fractured hips, dementia and strokes. Our health service has been consistently overstretched for a number of years. That cannot continue indefinitely without repercussions. Rapid patient turnover contributes to rising levels of health care-acquired infections such as MRSA. Patients, including the infirm or disabled, and particularly their relatives, are fearful of their even going into hospital in case they come out in a worse condition than when they went in. That is totally unacceptable in today's age.
Aside from the threat to life, those acquired infections have massive resource implications for the health service. The Government must clearly address that issue rapidly. The capacity levels at which our hospitals consistently operate also raise questions about how we could cope if there was a major outbreak of influenza or an unpredicted pandemic. We must ensure that we have and maintain a sufficient stockpile of antiviral drugs for such an eventuality. I would be interested to hear from the Minister what level of preparedness exists in Northern Ireland.
I have previously expressed concerns regarding the contracting out of cleaning services at local hospitals. There must be appropriate regulation centrally of standards of cleanliness in each trust.
Individuals should be encouraged to adopt greater personal responsibility for healthy living, particularly in relation to diet and exercise. There still needs to be greater awareness of the danger and effects of binge drinking, smoking and illicit drug use. I strongly support a comprehensive ban on smoking in public places, which should be introduced with immediate effect. Another issue that concerns the general public is the difficulty patients and their relatives have in accessing details about their condition or treatment. Those on waiting lists should be provided with the best possible indication of when they are likely to be called for treatment. Uncertainly only exacerbates their ill health. Greater health service transparency would be welcomed.
Conditions such as diabetes are rapidly becoming more common. Many such illnesses do not attract media headlines, but lead to lifelong suffering for those affected. The long-term costs are very high when people with those conditions deteriorate. I contend that early and best treatment is not only best for the patient but for our economy. Equally, new anti-TNF medications have the potential to transform the lives of the most severe sufferers of rheumatoid arthritis. Such patients could return to or remain in work if more of those drugs were funded. Let us ensure that that medication is distributed where needed, rather than on a postcode basis.
Mental health and learning disabilities have traditionally been underfunded. The child and adolescent psychiatry service in the Province requires major improvement, particularly given the large number of suicides among young people in Northern Ireland.
This Government maintain that, alongside education, health is one of their greatest priorities. The public in Northern Ireland have not seen the improvements over the past four years that they would like to have seen. It is to be hoped that whoever has responsibility for the Province's health after the election will do everything that they can to ensure that the people of Armagh, Antrim and Ards are treated exactly the same as those anywhere else in England, Scotland or Wales.