Professor Deirdre Heenan:

That was insightful. To start off, with regard to admissions and people turning up at accident and emergency departments, there is a serious problem in the North with GPs and GP funding. GPs in the North are funded to a much lesser extent than their counterparts across Britain. It is historic. They used to attract almost double the health budget, but it has been reduced year on year. We cannot seem to find out where that decision was made or who made it. What we know is that post Covid-19, people in the North have real difficulties in accessing their GP. We hear that daily on phone-in shows and when we are out undertaking research.

There will, of course, be this debate that it is the fault of the GPs, who must be off playing golf or sitting at home in their pyjamas. If people visit a GP multidisciplinary team, however, they will see how overstretched they are, what they are expected to do on a fairly limited budget and how many people they are expected to see. Of course, the issue for GPs is being able to see people in a safe fashion so it is not a production line. The GPs in the North are under severe pressure in terms of capacity and reduced funding. I do not know whether the committee is aware that they are in a dispute with the Minister regarding the amount of funding they have currently been allocated.

Of course, if people cannot get access through the GP, where is their next port of call? They are going to turn up at accident and emergency departments. They will be willing to sit for 12, 24, 48 hours, or as long as it takes to be seen. It is an entirely inefficient and ineffective system. We do not want people, for example, to receive a cancer diagnosis in an accident and emergency department. That is utterly inappropriate.

We also feel that this system has almost become normalised. People are of the opinion that if they cannot get access through one service they will go to another. If we are going to radically change the issues we see year on year in Northern Ireland, we have to start with the GPs. They are the gatekeepers. They are being asked to do more with less.

As we look into winter pressures, we have to set a winter pressure plan with nowhere near enough emphasis on the fact that most people who feel unwell will go to their GP in the first instance. That, in a large part, explains why we have so many more people putting pressure on the accident and emergency department to the point where the accident and emergency system cannot cope.

In the North, on any given day, whether it is in May, June, July or November, there are 500 people sitting in hospitals who are medically fit to be at home. Why is that allowed to happen? Why is that not a number one priority in our healthcare system? It is emotionally and physically damaging on those people, who are medically fit to go home but remain in a hospital. It is also an inefficient use of resources. Yet, we seem surprised when it happens month on month, without any ability to ask about step-down facilities, district nursing services or acute care at home. We know what the answers are but we seem surprised that we still have the problem.