The documents are marked

This document is solely for the use of personnel in the Health and Social Care Board and Public Health Agency of Northern Ireland. No part of it may be circulated, quoted, or reproduced for distribution outside the HSCB or PHA without prior written approval.

However, they are stored on a publicly-accessible area of Northern Ireland’s Department of Health, Social Services and Public Safety (DHSSPS) website, and are therefore in the public domain – perhaps either through oversight or hubris.

The documents can be accessed by entering a specific page address, or by doing a site search for ‘McKinsey’ – but no links to them appear to be available on any of the site index pages. It seems likely, therefore, that they were stored on the site for ease of access by remote personnel in the expectation – ill-founded, as it turns out, that no one else would notice their presence.

The documents are extensive, and heavy going in many parts. However, some sections are very clear. The first, under a heading that says:

begins with a preliminary paragraph warning that the measures about to be suggested would

challenge the principle that the NHS is free at the point of delivery

but that the report’s content

suggests that such options may need to be considered.

So, what are these measures that will challenge the founding principle of the NHS that treatment should be free at the point of need, but that McKinsey’s report suggests are necessary? The first may not seem so bad to those of us who live in England:

We could generate revenue through co-payment by the service user, an opportunity estimated to be worth £0.1 billion -£0.3 billion p.a. by 2014/15.

– Bringing co-payment protocols into line with the rest of the UK could be worth ~£50-80 million by 2014/15.

Co-payment means requiring the patient (‘service user’ in the more commercial jargon) to pay part of the cost of treatment, such as prescription charges or dental treatment tariffs. Since people in England already have to pay such costs, it might not seem unreasonable to impose the same regime in Northern Ireland. However, McKinsey don’t stop there:

In addition to this, other co-payments such as are used in other European countries – or beyond that – could potentially be introduced, if there was need and will. For example, people could pay for attending A&E (as in Republic of Ireland); for access to primary care (as in Germany); for inpatient stays (as in France).

The introduction of any of these measures would do far more than challenge ‘free at the point of use’ as an NHS principle – any one of them would mean its immediate end, and a massive burden on people at their most vulnerable moments.

A careful reading of the figures indicated by the report show that the underlying intent is to implement the wider range of ‘co-payments’, and not just to bring Northern Ireland into line with the system in England.

The report indicates that merely bringing NI into line with England would save between £50m and £80m. But the introduction to the section outlines an ‘opportunity’ of £100-300 million per year. The aim is clearly to save the higher amount – which would mean the complete destruction of the founding principle – and a massive theft of an entitlement which we rightly regard as an essential element of British life.

McKinsey’s recommendations go further still. The report outlines the ‘opportunities’ for reductions in staffing numbers as follows:

• a reduction in the number of consultants by 234
• a reduction in non-clinical staff of 4,300
• 12,600 fewer staff overall (clincal and non-clinical) compared to previously-expected 2015 requirements

Not only does the report recommend reducing staff numbers, but advises a saving of £100m per year by 2014/15 by freezing staff pay.

The grim news isn’t finished yet. The report outlines some of the likely results of having to achieve ‘further savings’ – which will certainly be required as government continues to squeeze funding:

If further reductions in funding were to prove necessary, beyond the identified improvements in productivity and quality, and the changes to income and staff costs described above, then..We would need to restrict access to services and treatments, for example by:

- Enforcing tougher eligibility criteria for treatments, e.g., hip replacements only for the over 80s, social care packages only for the acutely-ill, asking people who need it to buy their own equipment
- Introducing means-testing, i.e., making people pay for care if they can afford to
- Denying treatments that are high cost per Quality-Adjusted Life Year (QALY), e.g., high-cost end of life treatments such as chemotherapy
- Reducing funding of services seen as ‘non-core’, e.g., voluntary and community groups – which currently substitute and/or prevent need for statutory care.

Such actions would ..involve further bed closures and workforce reductions, of ~150 beds and ~1,200 staff per £0.1 billion further reduction in 2014/15 funding.

And, just in case we still need ‘icing on the cake’, the report recommends (but doesn’t quantify, that I can see), the closure of whole hospital sites and of large parts of others.

It’s no surprise that the NHS in Northern Ireland didn’t want these papers in general circulation – and quite a slip to put them into the public domain.

We should be thankful that they did slip. This report gives a frank view of the future of our NHS under this coalition government that robs the poor to enrich the wealthy, and which admits in private, no matter what the public pronouncements say, that the Tories’ long-term aim is not just to privatise the NHS but to eradicate all public services.

This particular document may only pertain expressly to Northern Ireland, but without question the cost-cutting, staff-cutting, service-cutting measures it recommends reveal the nightmare vision that this Tory-led government has for the NHS – one of the greatest achievements of our society.

It has to be resisted, its progress stopped – and the damage reversed by the next Labour government, no matter what it takes.

The South Belfast Assemblyman and former Health Minister said:  

“Mr Poots well knows that the Accident & Emergency departments at both the Mid-Ulster and Whiteabbey Hospitals were closed because senior professional medical advice said that the service was unsafe and patient safety could not be guaranteed.  

This is the same Edwin Poots who closed the Accident & Emergency Unit at the City Hospital and created chaos at the Royal Victoria as a result, in spite of one of the mildest winters in recent times. Mr Poots’ decision resulted in an unprecedented level of trolley waits and hundreds and hundreds of patients breaching the four hour waiting time target.

There can be no confidence in assurances given by Edwin Poots.” 

These figures prove the City Hospital’s A&E is sorely missed.

What would happen if the Royal A&E was forced to close due to some sort of outbreak, even just for 24 hours to be deep cleaned? Where would that leave people? The Royal’s A&E is also a temporary building and I had stressed that the City shouldn’t have closed until at least the new RVH Critical Care build was complete.

In a statement Mr McGimpsey said, “I have very much been against the closure of the City Hospital Accident and Emergency Department since it was announced back in July of this year. The people of South Belfast feel betrayed by the actions of the Department for Health in closing the unit. We see it as a premature decision prior to the completion and opening of the new critical care unit at the Royal Hospital in two years time.”

“There has been no consultation prior to the closure, nor has the Minister even been able to confirm when one is likely to begin. The credibility of the department has been damaged by this move as nobody in South Belfast believes that the closure is in any way temporary. We believe it is closed and closed for good. This belief would appear to be proven correct today by the Medical Director of the Belfast Trust who stated that there was no ‘significant prospect’ of the A&E opening again.”

“I am concerned by the increased pressure that the other emergency departments in the Greater Belfast area will have to cope with particularly entering the winter period with the increased demand that it will bring. Flu season as well as the inevitable increase in the number of fractures and broken bones associated with winter conditions will have a detrimental impact on the quality of care, particularly for our elderly population and place hard pressed staff under even greater pressure.”

In conclusion Mr McGimpsey said, “I believe that if the Northern Ireland Executive was serious about providing a quality health service it would make the necessary investment to do so and we would not be facing the closure of the City Hospital Accident and Emergency Unit. In my opinion this decision is purely economic and not based on what is best for patient care.”

This week’s statement by the Education Minister John O’Dowd on the future of education in Northern Ireland had the potential to make real change for every child in Northern Ireland. In his statement he highlighted the problem of empty desks in the system. He stated that the latest enrolment figures have revealed almost 85,000 spare places across the system, equivalent to more than 150 schools.

I see this as a real opportunity to tackle the problem of educational underachievement rife in some of our communities across Northern Ireland including areas within South Belfast. There has been much talk in the media and political spheres of the problems of educational underachievement but only when you get down to community level in areas such as Sandy Row where I have my Constituency Office, Donegall Pass, the Village, Taughmonagh etc. do you realise the devastating effect this is having on our young people and their communities. These young people are not only locked out of training and employment by their lack of basic skills such as reading and writing but they find it difficult to access services such as health, social security etc. as official letters and applications forms can seem daunting.

In his statement the Minister talks of creating an education system that ensures all our young people receive a high quality education that enriches both their lives and grows the economy respectively. This is indeed a noble aspiration. However I fear that the Minister may see this situation as an opportunity to simply save money.

The Minister needs to take this opportunity to target areas of serious economic deprivation and educational underachievement by using the additional teachers identified in this statement to reduce class sizes in these areas and allow the children the opportunity afforded to others across Northern Ireland.

I believe firmly in the principle that you have to invest to save. For example I along with the local communities in Sandy Row, The Village and Lisburn Road have worked and campaigned for a new primary school on a new site for many years. This would see the amalgamation of the three local primary schools on a single site I had identified on the City Hospital site while serving as Minister for Health. Despite the significant savings that could be made from this move out of three aging buildings the education department are dragging their feet. Meanwhile children from these communities are being educated in sub-standard accommodation.

Unfortunately it would appear the Minister for Education would rather close schools than look at the situation strategically and to the benefit of pupils. This is shown by his incorporation of an immediate viability assessment where schools can be closed quickly when no longer deemed viable by the department.

I am calling on the Minister for Education to show his commitment to the children of Northern Ireland and invest in their future. Redeploy teachers where they are needed most and ensure that before he throws out the old he has new facilities and schools in place so we can offer our children and our economy the best future we possibly can.

The South Belfast Assemblyman said;

“Mr Murphy should take heed of the old adage that people in glass houses shouldn’t throw stones. This is a man who is only known for his handling of last Winter’s Water Crisis. As a result of Conor Murphy’s bungling, the people of South Belfast – and indeed throughout Northern Ireland – had to queue up for bottled water.

Mr Murphy states that my Party got rid of me after the election. It must be galling for him that he is the one who was dropped by his Party due to his incompetence at DRD, and as a result the newly promoted John O’Dowd is now the acting Deputy First Minister instead of Mr Murphy.”

The statement from the Ulster Unionist Assembly Member follows today’s adjournment debate at the Assembly on the proposals to close Belfast City Hospital’s accident and emergency unit.

Mr McGimpsey said, “I find it very difficult to understand the rationale of the Minister in closing the City Hospital A&E at this time. Accident and Emergency Service provision in the greater Belfast area is undergoing a period of change. The Royal Hospital A&E is currently housed in a temporary building to accommodate the construction of the new Critical Care Unit that will provide a new A&E unit with intensive care and emergency theatre provision. This multi-million pound development is not due to be completed for at least another two years.”

“The Ulster Hospital A&E which was originally built to accommodate 30,000 visits per year and now copes with around 70,000 is due to be upgraded but with no start date confirmed there is still great uncertainty as to the future of this development.”

Mr McGimpsey continued, “Under the Belfast Trust’s own plan, ‘delivering better services’ the closure of the City Hospital A&E had never been anticipated. The Royal would be upgraded to be the main A&E for Belfast with the City Hospital providing a backup service.”

In conclusion Mr McGimpsey said, “I am calling on the Minister for Health to defer his decision to close the City Hospital. I can see no justification for such a move at this time. Entering a period of winter pressure where we are likely to see increased demand for elderly services, treatment of flu and orthopedics is no time to be testing a reduced accident and emergency service when the existing system is already struggling to cope.”

The South Belfast Assembly Member has spoken publicly of his opposition to the closure of the unit prior to the completion of new units at the Royal and Ulster Hospitals.

In a statement Mr. McGimpsey said, “Despite meeting with the Minister this afternoon I remain unconvinced that the proposal has been thought through sufficiently so that patient care will not be affected. No explanation was given as to why the City Hospital was picked for closure over the Mater nor did there appear to have been sufficient consideration given to the capacity of the two remaining accident and emergency units to cope with demand.”

In conclusion Mr. McGimpsey said, “I stand by my call that no decision should be taken on accident and emergency services in the Belfast Trust until the new critical care building at the Royal and Ulster Hospital A&E are complete.”

Ulster Unionist Assembly Member for South Belfast Michael McGimpsey has called on the Health Minister to rethink his decision to close the Belfast City Hospital Accident and Emergency Unit. The plans outlined by the Minister will leave the Royal and Mater having to cope with up to an extra 50,000 patients from the City as well as those who may come from Lisburn as a result of reduced hours at the Lagan Valley.

In a statement Mr. McGimpsey said, “I believe that the decision by the Minister to close the City Hospital A&E is putting money before patients. No decision should be taken on Accident and Emergency services within the Belfast area until the new A&E unit at the Ulster Hospital and critical care unit at the Royal Hospital are completed.

Almost 1,000 people per week visit the City A&E, where are these people expected to go? The Mater already copes with over 40,000 per year, the Royal 70,000 and the Ulster 70,000, more than double what it was built to accommodate. Add to this the additional numbers who will travel to Belfast as a result of reduced hours at the Lagan Valley.”

“As Minister for Health I warned that not enough money was being allocated to Health to allow it to cope with demand. This money, rather than patient lead decision will do nothing but further increase pressure on already overstretched staff and adversely affect patient care.”

In conclusion Mr. McGimpsey said, “I am calling on the Minister to hold off on any decisions for the future of Accident and Emergency services in the Greater Belfast area until work is finished on the Ulster and Royal Hospitals. Only then can we be sure that decisions are being taken in the interests of patient care rather than money.”

Everyone in Northern Ireland has the basic right to high quality health and social care services, delivered in modern and well equipped buildings.

The significant challenges facing the health and social care service can only be overcome with radical changes to the way services are delivered and configured.

Too many of our hospitals and healthcare facilities are no longer fit for purpose, many are potentially unsafe and of such poor quality that we should not expect either staff or patients to tolerate it.

Despite, the urgent need to build new modern facilities which will deliver efficiencies and improve care the money is simply not there to do this.

I made bids of £1.8billion for the new budget period but this bid was not met.

The final budget allocation slashed my available capital spend to £851million – almost £500million less than the original £1.3billion promised under ISNI.

Under these circumstances I no longer have the funding to proceed with many important projects. I have had no option but to balance all the competing priorities to decide on a programme of work for the next four years.

This was no easy task but when health is continually starved of the funding it needs, then very difficult decisions have to be made. Decisions over whether to fund care for elderly people in their homes, or cut thousands of job or increase waiting times or build a new hospital.

These are choices which have to be made because the health and social care service is broke. These are choices which can only cause pain and anxiety to the public.

Today I am announcing that, subject to normal business case processes, construction can start on the following high priority schemes:

The next phase of the Ulster Hospital Redevelopment which will replace the current Ward Block;

• The new regional Maternity Hospital at the Royal;
• The new enhanced local hospital at Omagh;
• A new Acute Psychiatric Facility at the Belfast City Hospital;
• A new A &E Department and Ward Accommodation at the Antrim Hospital;
• New Operating Theatres at Craigavon Hospital; and new Health and Care Centres in Ballymena and Banbridge.

I remain committed to the future development of the Altnagelvin radiotherapy unit. However, the present budget proposal seriously undermines the ability to deliver this because of the absence of revenue funding and the reduction in capital resource available to my department.

Revenue is critical to the project. Decisions to commit the revenue were to be taken in 2011-12 to commence the necessary specialised training of staff for them to be fully trained and available when the project opens in 2016. These include oncologists, radiologists and radiographers. The current budget does not enable this decision to be taken.

This project is also dependent on the new Government in the Republic of Ireland, we must ensure they are still committed to contribute towards the costs of this essential scheme.

I remain totally committed to ensuring that people with cancer in Northern Ireland have access to the radiotherapy services they need.

Therefore I will ask the Board to put arrangements in place to introduce the two new radiotherapy machines at Belfast City Hospital over the next two years. This will help provide the capacity that is needed in the short to medium-term while the longer term service issues are being resolved.

Unfortunately my hands are tied and this will continue to be the situation until the need to provide properly funded Health and Social Care Services is recognised and given the due priority it deserves.

It appears that this Assembly is not prepared to provide enough money to maintain Health and Social Care in its present form, based on the long established principles that it is:

• Free at the point of delivery.
• Funded by taxation.
• With no pre-set limits on the care that will be provided – the point being that elsewhere in the UK – if a new specialist drug is cost-effective it is generally available. That principle is already not being fulfilled in Northern Ireland and the budget will only make that position worse.

Throughout the last four years as Minister, I have championed the Health and Social Care service. This is everyone’s health service and should be valued and supported.

Shame on all of us if we turn our backs on an organisation which every day performs tremendous life-saving work and provides endless care and support to the people of Northern Ireland.

I wish the new Health Minister well in their new post. They will have many challenges and many more difficult decisions to make in the years ahead. I hope they will treat the service with the respect and esteem it deserves.

View the full statement to the house at: http://www.northernireland.gov.uk/index/media-centre/news-departments/news-dhssps/news-dhssps-230311-health-ministers-statement.htm

Seventeen appliances were called to the scene and some 85 firefighters struggled for hours to bring the fire under control at Boucher Road Retail Park.

The South Belfast Assembly Member said: “This is a major blaze at a very popular shopping complex and the firefighters have been working very hard on the ground overnight to bring it under control.

“I commend them for the fearless way over many hours they have contained the fire and prevented further damage to adjoining premises. Thankfully at this stage there have been no reported injuries.”

“I am concerned for those who are employed in the shops, particularly in the run up to Christmas which is traditionally the busiest time of year for these retailers. As a local representative I will do everything in my power to work with employers at this difficult time.”

“The Fire Service and PSNI will carry out a full investigation in due course to find the cause of the fire.”

1. Was it ever a scam?
   No – the plan was always to raise money, get the fundraising and administrative infrastructure in place, and then launch the service

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2. Who suggested that it was?
   The initial story was run by BBC NI – basically they suggested that the Charity was one of the fastest growing in Northern Ireland, and highlighted the fact that a sum of money had been raised, but no helicopter had yet appeared
3. If that suggestion was wrong, why was it not challenged?
   The people involved in the organisation at the time would argue that the nature of the BBC report was never properly explained, nor was an opportunity given to present the facts – it was very poor “sensationalist” journalism with no attempt to properly investigate, or accurately portray the organisation’s plans – of course the counter argument would be that the organisation couldn’t defend itself because what the BBC were alleging was actually true. The truth is probably somewhere in the middle.
4. So the organisation couldn’t defend itself?
   Essentially no – once the BBC report had been run, there was very little the organisation could do, apart from spend ridiculous amounts of charitable funds (which WOULD have been very questionable) on professional PR to try to counter some or all of the claims made, by telling the truth and answering questions accurately.

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5. So the original organisation did nothing wrong?
   No – I didn’t say that (and hindsight is of course a wonderful thing…) – the old organisation should have defended itself better, and should definitely have been more open with the BBC in explaining their plans, the stage they were at, and how they foresaw the future – that of course assumes that the BBC would have engaged constructively, and were not simply in a destructive mode. Naturally the presumption is that as a public service and responsible broadcaster, they would have co-operated in fully investigating and establishing the truth, not simply engaged in sensationalist headline-seeking.
6. What does this “original organisation” mean?
   Sorry – I should have explained that. One of the quite correct observations around the time of the initial BBC reports was that there was a weakness in the structure of the old organisation. Most UK charities are companies, limited by guarantee, but many start up exactly as the old organisation did – as a “good idea”. Trustees are often then recruited as much for their willingness to become involved – not for their professional skills or backgrounds. That was what happened with IAA – the original Trustees were there because they genuinely believed in (and in many cases VOLUNTARILY worked for) the cause – no payments were thought of or given. BUT long before the BBC report, it was realised that running a Helicopter Emergency Medical Service is a significant business – it needs professional direction, and when a charity like this, requires a widely experienced Board of Trustees, and where, as in most sizeable UK charities, it is also a Company Limited by Guarantee, these Trustees are also Directors of the Company.

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7. So everything is OK now then?
   Well – if you mean in respect of structure and governance – yes – the Company is registered and the Board appointed – full details are on our web pages. If you mean, have we recovered from the BBC attack, the answer is “no”. People still Google us and find the reports – indeed, even this year when we announced that the structural changes were now in place and the old Trustees and senior staff had fully withdrawn, the BBC chose to headline this as “Air Ambulance grounded” – no attempt to state the accurate picture – that we had totally put our house in order, and that the Company was taking the concept forward, for which there is tremendous support “out there” – again, totally unnecessary NEGATIVE reporting, when what really should have been asked is “would an Air Ambulance make sense in Northern Ireland / is it something which the people want”. Undoubtedly the answer to both of those questions is “YES” – that’s why it was the fastest growing charity in Northern Ireland according to the initial BBC attack.
8. What about the initial report – what about this £700k+ which was reportedly raised?
   Ok – let’s tackle that one – yes, it was accurate, but this never was a capital project. It was NEVER about “let’s raise £x and buy a helicopter” – that’s simply not the way things work. The organisation started in 2006, and in the period to 31st March 2008 raised £194k. It became more successful throughout 2008/9 and raised another £478k in the year to 31st March 2009 – the initial BBC attack came shortly after the end of the 1st quarter of 2009/10 (i.e. early summer 2009). The problem is – this was (and is) about raising a sustainable £1.5m EVERY YEAR to keep an Air Ambulance flying, and to be fair, the old organisation weren’t that far off – other income streams would have been developed and nurtured had the BBC not attacked, and the organisation could have got to that £1.5m pa target with some changes in emphasis and perhaps some changes in resources (staff, etc).

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9. Would they have got there?
   The honest answer is – we’ll never know – but the initial BBC report and the various supplementary attacks and comments have severely curtailed fundraising income. Of course the attackers would say “and so it should”, but what they don’t seem to realise is that they have severely damaged a concept which the people of Northern Ireland seem to believe passionately in, and want to happen – that is why we (the Company) are continuing to push forward.
10. Will you get there?
    Again, the honest answer is – I really don’t know. What I DO know is it won’t be for the want of trying if we don’t – the current Board of IAA are a sincere, experienced group who are not being paid ANYTHING and yet passionately believe in the concept. The very small number of paid staff we have are equally sincere in wanting to make this happen – yes of course we’re being paid, but it is impossible to run any significant charitable enterprise on volunteer power alone – charities are businesses whether we like it or not – and in the case of one like ourselves who are seeking to provide a professional medical service, we absolutely need to be – our statutory sector colleagues need to work with competent and well managed organisations, who have the capacity, credibility and capability to deliver.

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11. What is the current attitude of the statutory sector?
    Well – as you probably know, last year, senior sources were quoted as “not seeing a need for an Air Ambulance”. We hope we’ve moved on slightly from that, and indeed, the Government have recently published the fact that they are talking to a number of organisations (ourselves included) who believe that we can operate such a service here – I think all are modelled along the lines of those already operating in England and Wales. Of course we don’t yet know whether our colleagues in the statutory sector will choose to work with us to establish such a service, but we very much hope that will be the outcome (and sooner rather than later…). Health Service budgets are tremendously under pressure (as indeed are Charities) but if we can succeed in raising £1.5m per annum, and delivering this “free” service for the people of Northern Ireland, we will have achieved something.
12. If the Government say “yes” – can you get a helicopter?
    I can’t really go very deeply into this one for reasons of commercial confidentiality. Suffice to say that the old organisation had sourced a helicopter, and were basically caught in the rather messy situation of not having backing from the statutory sector to make it happen.

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13. So all you need is backing from the Government?
    No – it’s a bit more complicated than that – even if there is a “yes” or even a “maybe” tomorrow, there is a considerable amount of work to be done. All of clinical governance and aviation procedures need to put in place, as well as the tasking arrangements for the service. Obviously in the case of the English and Welsh charities that we seek to pick up best practice from, you don’t ring 999 for a land ambulance and 998 for an air ambulance – the tasking is done from within ambulance control, based on their expertise of where an air ambulance capability is best deployed – all of that has to be put in place.
14. So what is the time scale?
    I honestly can’t say – it depends on how quickly the statutory sector are prepared to work with us to get all of the processes in place. We’re ready, and an aircraft is fairly readily available – all it needs is for us to raise the tempo and scale of our fundraising – once a “go” level is achieved, bring the helicopter in and start the service, but don’t underestimate all of the compliance and protocol matters outlined earlier – they will take time.

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15. So where did the money go that was previously raised?
    As outlined earlier, in the period to 31/3/08 they raised £194k and expenditure was £175k. For the year to 31/3/09 they raised £478k and spent £409k. Both of those periods were audited. In relation to the final period (of the old organisation) from 1st April 2009 to date (cessation) they raised £372k and spent £427k (£317k salaries & expenses, £34k office costs, £8k coin handling costs, £67k other overheads). The cessation accounts have NOT been audited, but the books are open to the Board of Directors of the new Company, should they wish to have an independent examination carried out.

http://www.irelandairambulance.com/