Northern Ireland Assembly

However, it makes sense to try to maximise the number of births with easy access to specialised paediatrics. Article 3 of the United Nations Convention on the Rights of the Child states that any decision affecting an individual child or children should be taken with their best interests as the most important consideration.

Mothers want, need and, indeed, have the right to be near their sick children, and if maternity services were not centred at the Royal, more mothers would be parted from them. Women require a service that makes them feel safe and in control, a service that lets them choose the type of care best suited to them and their babies. Regional and national policy and guidance for maternity and related services all emphasise the need for women-centred care, continuity of care and choice.

There is a full range of gynae services on both the Royal and the City sites. Both offer a wide range of methods of childbirth. In short, the current services at the City and the Royal are not just women centres but women-centred. A women-centred service is not a building but an ethos, and it should be possible to create a regional maternity unit which combine the best in the ethos of both the current services.

It should also be borne in mind that there are plans for a new cancer unit on the Jubilee site. If this does not go ahead, there will be knock-on effects on the treatment of cancer throughout Northern Ireland. Surely we should be most concerned about this.

Before concluding, I want to make some points on how this issue is being handled and the politics involved. First, the motives of those proposing the motion are not entirely clear. Are they doing this because they are convinced of the medical case for the City, or are they doing this to embarrass the Minister simply because she is from Sinn Féin?

Secondly, some parties are seeking to portray this as a clash between the interests of women, babies and children. That is totally misleading and out of order. Surely the interests of women and children are inextricably linked.

Finally, the decision of the Health Committee was hardly clear-cut: some people are arguing that the vote was cross-community. The evidence for this hardly adds up. The vote was seven to four.

Order. The time is up.

This debacle is further discrediting this fundamentally flawed process of government. In spite of claims by some Members, including the last Member who spoke, that each Minister will be brought to account for his actions, the reality is that we have had the very opposite graphically demonstrated in recent days by the Sinn Féin Health Minister. Not only has she ignored the wishes of the Health Committee, but she did not even inform its members of her decision.

The reality is that the Ministers are accountable to no one in the Chamber. The sole function of the Scrutiny Committees under Standing Order 45(1)(a) is to advise and assist Ministers in the formulation of policy. Even if 107 Members in the Chamber were to vote today to reject the Sinn Féin/IRA Health Minister's decision on maternity provision, we would be unable to change that decision. We cannot remove any Minister, even if he or she is deemed unacceptable, because political expediency dictates that the necessary cross-community consent will never be forthcoming.

The Belfast Agreement has therefore given full executive powers to members of Sinn Féin/IRA in the areas of health and education over the citizens of Northern Ireland without their being accountable in any way. The Sinn Féin/IRA Minister has already been censured by the Assembly. How some Ulster Unionists claim, therefore, that Unionists have gained from the Belfast Agreement defies logic. Dr Birnie's amendment talks of the Belfast Agreement's providing for key decisions to be taken on a cross-community basis. Obviously this concept is either a fanciful theory or maternity provision is not regarded as a key matter, which is rather alarming.

Perhaps the Ulster Unionist Party is now starting to realise that the Belfast Agreement is fundamentally flawed. One of its so-called principles is that of consent. This is no more than a mythical aspiration. We hear the expressions "transparency", "accountable democracy" and "consent". They are all loosely used, and no doubt we are going to witness more abuse of power in favour of Nationalist areas and Nationalist constituencies, particularly when it comes to health and capital expenditure on schools.

I recall that the Education Committee was also left completely in the dark about recent decisions, but let us examine the abuse of power by the Sinn Féin/IRA Health Minister. I quote her words from page 2 of a recent edition of 'Andersonstown News':

"The Falls Road Hospital held a special place in the hearts of west Belfast people. I wholeheartedly believe that the Royal is a crucial part of the economic and social fabric of west Belfast and I want to ensure it remains so."

My party's decision not to participate in the scrutiny Committees has been totally vindicated. Even the Chairman of the Health Committee has been discredited. It is widely accepted that a chairman in any walk of life acts with impartiality and fairness. However, I was surprised and saddened to hear the Chairman of the Health Committee, Dr Joe Hendron, put on his party political west Belfast hat and publicly be at variance with his Committee and even with one of his party's Assembly Members.

As someone who met with the previous Northern Ireland Office Health Minister, Mr John McFall, prior to devolution, who met with members of the Jubilee Action Group and who made a submission to the Department of Health last year during the consultation process, I want to highlight some important points.

There will be the loss of the ethos of the Jubilee Maternity Hospital. It would be much easier to preserve the ethos of the Jubilee if both maternity units moved on an equal footing into a new hospital, rather than having the Jubilee merged with an existing facility. There will be the loss of maternity services in south Belfast. In 1997 there were 2,668 births at the Jubilee Maternity Hospital, and mothers came from areas such as Belfast, Castlereagh, Lisburn, Ards and Downpatrick as well as from areas covered by the Northern, Southern and Western Boards. The Royal Maternity Hospital had only a slightly higher number of births for the same period - 2,896. I live in Newtownabbey, and my two children were born in the Jubilee, and many mothers from the Northern Board area go to the Jubilee too.

There is also the vital issue of security force members and their families, who continue to be particularly vulnerable when travelling to the Royal Victoria Hospital. There is evidence that 60% of Jubilee mothers will shun the Royal and opt for the Mater, Lagan Valley and other hospitals.

There will be a lack of impetus for a new hospital once amalgamation has taken place. If the Jubilee is closed an excellent maternity service will be lost, and any leverage on the Department of Health to press ahead with the promised new hospital will be gone. Is the necessary funding available? How will it be found? What other services will suffer in order to find the necessary funding?

The proposed amalgamation amounts to a cut in services and will reduce the current high standards of care which both hospitals provide. Even if money did become available, it would still be a number of years before a hospital could be built, and that is totally unacceptable to women who will be expected to accept an inferior or overcrowded service in the meantime. The view that at least £15 million of private investment will be required to fund a new maternity hospital will cause alarm. According to Dr Peter McFall, one of the Province's top gynaecologists -

Order. The time is up.

I do not intend to go over the lack of consultation and communication. I have no doubt that at the Health Committee meeting on Wednesday these issues will be gone into in some considerable detail, as they should be. I was concerned about the lack of consultation with members of the Health Committee and, indeed, with those of us who represent the constituency that is affected by the decision to close the maternity hospital. We should have been consulted more fully. I have already made the point that under direct rule we might have been. I called an informal emergency meeting of the Committee on the Thursday to clear up the lack of proper decision-making because I was concerned that rumours about who knew what and when during the previous evening were flying around and needed to be cleared up. I remain concerned that the press was informed before Members.

I now turn to the debate on clinical effectiveness. On the matter of maternity services, when the hospital in Tyrone was closed did not every Member say "Wait until we have locally elected, accountable Members of the Assembly, and then we will decide who makes these decisions."? Will it be the Royal College of Paediatricians, or will the issue come to the Assembly for a decision? This elite group - the Royal College of Paediatricians - has made the decision for us. Why are we sitting here when we can simply go to the Royal College and ask "Where would you like all the hospitals to be in the future?"?

It comes down to one paediatric surgeon being recruited. Because that paediatric surgeon has not been recruited, there is going to be an interim move of 3,000 mothers to a hospital on the Royal Victoria site. As I said before, two old hospitals into one old hospital will not go. The brave decision would have been to keep both hospitals open, to have stood up to the Royal College and to have told it to come to the Committee and give its evidence. To obtain the Royal College's report I had to go to the Royal, sit before the regional advisor for Northern Ireland, who is also based at the Royal - I ask myself whether there is a conflict of interests here - and read the report under supervision. Where is the freedom of information for those of us who are supposed to be making decisions when this is the sort of access we get to the report of the Royal College of Paediatricians?

I do not believe that there was a case to be made on the basis of clinical effectiveness. I have looked at the evidence, and I am in a position from my previous job to analyse data and to know whether, given the empirical evidence in front of me, a case stands up. This one does not. Not one baby has died during transfer from any hospital to the Royal. Why are we not also closing Altnagelvin, Craigavon and all the other hospitals? With regard to the Royal College's making this decision, I note that the Minister's statement says

"My conclusion was that maternity services would be more clinically effective if located adjacent to the regional paediatric services at the Royal."

The entire decision was made on that one conclusion, and that concerns me greatly.

There is also the issue of gynaecological cancer. Prof Paddy Johnston has spent his life building the oncology unit at the City Hospital, which treats 250 gynae-cancer patients annually. Where are these patients going to go if we split obstetrics from gynae cancer? The gynae obstetricians were so concerned that they delivered a letter to my door last night. It says that the reports are there and that the draft report which has just been issued - I am sure the Minister is aware of this - says that the City is the only hospital in Northern Ireland that meets the criteria for treating gynae cancer at the moment. If this service is moved, those criteria will not be met.

Dr Henrietta Campbell, the Chief Medical Officer, was given the task of looking at the services for cancer patients throughout Northern Ireland. Was she consulted about what would happen to gynae cancer at the City? If the case is being made, as it seems to be, around clinical effectiveness, I would argue that clinical effectiveness for sick mothers is extremely important.

Order. The time is up.

Politics is not confined to politicians. Medical men lobby very successfully, and with political skills, in their own interests. Many arguments can be advanced in respect of both sides. The question is which ones are spurious and which ones, as Monica McWilliams has pointed out, are substantiated by real data.

The fact that clinical paediatricians have come out on the side of the Royal is not surprising, since the paediatric unit is at the Royal and they are based there. Having said that, I should point out that I have worked closely over many years with almost all the leading paediatricians in the Royal Victoria Hospital, and I have not the slightest doubt that, no matter where this hospital is ultimately located, those professionals will give of their best when treating their patients.

Let me turn to Dr Birnie's amendment. This issue, though about the location of a hospital, throws into bold relief what happens to the fundamental principles of democracy in this Chamber and under the institutions of the Assembly. If this decision had been taken by a Minister in another place, the Cabinet would be backing it. There the Cabinet represents the majority party in Parliament, and its decisions are endorsed by that party, so the full democratic process is behind any ministerial decision.

The difficulty with this Assembly, and one of its democratic deficits, is the relationship between the Assembly and the Executive powers of individual Ministers. This, of course, is highlighted by the decision taken by the Minister of Health in this matter.

As I understood it, the purpose of the Statutory Committees was to scrutinise the Ministers' decisions and to advise the Ministers, in advance of decisions, on the best way forward. In a sense, because those Committees comprise Members from almost every party, they represent, at first instance, the feeling of the Assembly. The Committees are, as it were, a litmus test for what the Assembly as a whole might think. In this instance, and on a cross-party basis, a majority of the Health Committee was of a particular view, which was communicated to the Minister. The Minister then took the decision, ignoring the majority view of the Committee. That decision having been taken, the question is this: can it be reviewed by the Assembly?

As Dr Birnie pointed out, the decision did not have the benefit of discussion in the Executive Committee, and it was certainly not brought to the Floor of the Assembly for debate by Members. The Minister simply took the decision, and we will all have to decide what import this has for the future running of the Assembly and for democracy here.

Are we to accept that every time Ministers make decisions, regardless of how they have been advised or what consultation they have undertaken, they are not accountable to the Assembly? What if, on a cross-community basis, a majority of the Assembly takes the view that a Minister's decision is wrong? In what circumstances can it be put right? The Assembly will have to take note of the balance of power between itself - and it is made up of elected representatives of the entire community - and individual Ministers of the Executive, selected not by the community but by their parties, taking decisions on a party basis.

The problem here is the suspicion - it may be no more than that - that the decision of the Minister was influenced entirely by political considerations relating to her party. That, indeed, is the accusation that is made by the Chairman, and I believe that he was fundamentally wrong to advance his personal views when he chaired that Committee. He should simply have left his views on the record, as they have been over many years, without advancing them in these circumstances.

Order. The time is up.

I agree with Dr Birnie's amendment.

The provision of maternity services in Belfast is a most serious matter that has been the subject of a tug-of-war for many years between a number of different and differing interests. My concern is for those who really matter - mothers, newborn babies and the dedicated professional staff in both hospitals. This issue has been gravely mishandled from the beginning.

Devolution of power to the Assembly was greeted by everyone as a major step forward towards giving Northern Ireland politicians hands-on authority over local services. There was an expectation that, through the d'Hondt principles, the structure of the Statutory Committees and the allocation of ministerial posts to provide a fair distribution of responsibilities to the parties represented in the Executive, there would be an open consultative process at all levels on major issues.

Now we have the Minister of Health, Social Services and Public Safety taking a very divisive decision, which, she claims, it is her prerogative to take and which, she states, cannot be challenged.

As a member of the Health, Social Services and Public Safety Committee I was present at briefings by staff in the Royal Victoria Hospital and the Jubilee Action Group. The Committee, by a majority vote, decided in favour of the Jubilee. The Committee was meeting last Wednesday when the Minister made her decision. Some of the Committee members learned of it from the press later that evening, and others got no information about it until after 10.15 am on Thursday when a press release was issued. The only exception to this was the Chairman.

If the Minister was not prepared even to consider the Committee's decision, it would have been mannered at least if she had informed the Committee of it before the public announcement. Furthermore, given the absence of Executive policy, she should have advised the members of the Executive of what she was intending to do and given them an opportunity to participate in the decision-making process.

It was obvious that the Minister had been fully briefed by her officials, but the Committee did not have such briefing. How and when the Assembly was informed about this, and the authority or influence that it should have had over a decision on a matter of cross-community interest are matters of grave concern.

We have all received a copy of the latest publication from the Executive Information Office telling Northern Ireland's public what the role of a Committee is. It is to

"consider and advise on departmental budgets and annual plans . [and] . in forming policy".

Definitions of "considered" include: looked at carefully; thought or deliberated on; weighed advantages and disadvantages with a view to action; and showed regard or consideration for. And a definition of "consider" is: recommend, inform or consult with.

I submit that in this case the Executive, the Committee and the Assembly were given no opportunity to consider or advise on the decision-making process prior to the Minister's announcement.

I ask Members to support the amendment.

I wanted to be a member of the Assembly Committee because I am passionately concerned with health issues, and I want to be in a position to influence change. I am glad that we are debating the future of Northern Ireland's regional maternity hospital today. Decisions such as this must be taken in the most open, democratic and transparent way. Everyone in the House knows my views on this, and I speak from the perspective of a woman, a mother and a midwife. However, today I speak as an elected representative, and not in any personal or professional capacity.

The Minister's statement says that she concluded that regional maternity services would be more clinically effective if located adjacent to regional paediatric services. That statement appears to be the extent of the clinical argument for opting in favour of the Royal. Any new regional maternity hospital, wherever it is sited, will inevitably attract the best midwives, obstetricians, gynaecologists, neonatologists, and paediatricians. There will be no question of having to transfer a very sick baby to the Children's Hospital. The experts will be on site in the new unit, and that clinical argument is therefore flawed.

There is a second inconsistency in the key argument: surely it would be much more clinicially effective to build a new regional maternity hospital beside the gynaecology department, which is on the City site.

This is normal practice throughout the UK. Is there any medical evidence whatsoever that the Royal Maternity Hospital has provided a better service because of its proximity to the Children's Hospital? I believe that there is none. A neonatologist is a paediatrician who specialises in caring for the newborn. These specialists will be on hand in a new regional maternity hospital. If there is a long-term problem, a specialist paediatrician may be called in. Health care should bring the doctor to mother and baby, not the other way around.

Furthermore, do we have any idea where the money for a regional maternity hospital is going to come from? Has the Minister taken into account the fact that the City site might more easily attract public/private finance for a new building? The Royal Group recently announced a rather large capital spend on a new hospital. Can we therefore assume that we should now add a further figure of about £15 million to that outlay?

What are the plans for the future of the City Hospital? Will it continue to be asset-stripped? The fractures department has already gone to the Royal, and accident and emergency services are going the same way. If maternity services go, can gynaecology and gynae-oncology be far behind? My Colleagues have all referred to this. We are talking about part of the new cancer unit. The Minister's decision, like that of a previous Minister who implemented the Donaldson Report, may not stand up to a judicial review.

We know that a clear majority of the Assembly's Health Committee does not support her decision. It will be for the Assembly as a whole to judge it. This decision may have repercussions for any future decisions on local hospitals. This is not just a Belfast matter, nor just a struggle between two Belfast hospitals. It affects all women and babies in Northern Ireland.

When the Minister for Health made public her decision to locate regional maternity services at the Royal Victoria Hospital she quite clearly exposed the nonsense that is Belfast Agreement and the democratic body that that agreement claims this Assembly to be.

The Assembly's Health Committee spent a considerable amount of time and effort listening to both sides of the argument. After showing due care and attention and examining all the relevant data and information available, the Committee took the considered view that maternity services would be best located at the City Hospital. It is worth noting that, in taking its decision, the Committee did so on a cross-community basis with a majority of seven to four.

Of course, none of the Health Committee's endeavours on this matter cut any ice whatsoever with the Minister of Health. Despite previous assurances to the contrary, she did not advise the Committee of her decision before making it public. This attitude was reinforced by her rather inadequate performance at Question Time earlier today, during which she was dismissive and contemptuous and showed a total lack of regard for the Assembly.

Since a West Belfast Minister, aided and abetted by a West Belfast Chairman of the Health Committee, decided in favour of a West Belfast hospital, Members can only draw their own conclusions.

Is it not reasonable to suggest that the timing of the Minister's decision has more to do with political expediency than with medical and clinical considerations? What other explanation is there? Surely it is much easier to ignore seven members of a Committee than a more sizeable and, perhaps, significant vote in the Assembly at the close of today's debate.

We must take a further point into account when considering the Minister's motive for taking such a crucial decision at this time. As we are all aware, there has been some speculation over recent days about whether the Secretary of State will find it prudent to suspend the authority of the Executive.

He will feel that he has no other choice, as Ms Brown and her colleagues in Sinn Féin/IRA have signally failed to address, in any meaningful way, the vital issue of decommissioning.

In the light of the recent events which I have already outlined, and given the fact there is a widespread perception that this decision was based solely on political reasoning, how can Members, not to mention the public, be assured that any future decisions facing the Minister will be taken properly rather than as now on the basis of what is best for west Belfast?

I support the motion.

Go raibh maith agat. I oppose the motion and also the amendment by the Ulster Unionist Party.

As a member of the Health Committee, I believe that this is the most complex issue that it will be faced with, either now or in the future. I was one of the four members who voted against the proposal to build at the Belfast City Hospital site, and instead voted for a new Royal Maternity site. I came to this decision after examining closely documentation and presentations from interested groups, including the Falls and the Shankill Women's Centres. Clinical arguments show that the Royal Maternity will provide a women-centred, family-led service, where a full range of medical care can, and will, be provided. Women and families want this, as do the doctors and nurses in the Royal Hospitals.

In 1994 the then Government set up the acute hospitals reorganisation project, under the chairmanship of Dr McKenna. Of his 28 recommendations, 27 were accepted by both hospitals. The issue of maternity services was controversial. The Labour Government commissioned a second report from an independent medical review panel, chaired by Prof Donaldson. He concluded that, clinically speaking, the best possible arrangement was to provide maternity and paediatric services side by side. As this hospital will be the new regional maternity hospital, as well as being the local one, it is important to have the closest links to the Belfast Hospital for Sick Children. That would mean a faster, more effective response to babies experiencing difficulties before, during and after birth.

There is also clinical evidence to suggest that neonatal intensive care units without on-site paediatric specialist support have higher mortality rates. Transportation of sick babies - and some people do not believe this - would be easier and safer in a new maternity hospital linked to the Children's Hospital. It would also ensure that mothers and babies remained on site. Removal of the maternity unit from the Royal Victoria Hospital, whether Members like it or not, would have an adverse effect on the communities of north and west Belfast, two of the most economically and socially deprived areas in the North.

The full Health Committee did not endorse the recommendation for a new hospital at the Belfast City Hospital site. The Committee agreed unanimously that the Jubilee and the Royal Maternity Hospitals should both remain open until a new regional maternity hospital was built. However, because of the decision taken by the Royal College of Paediatricians, there is no alternative but to locate maternity services at the Royal Maternity in the interim.

Other Committee members, especially DUP members, say that the decision by the Minister was a political one. This from a party whose member, when he had the chance to question the Minister on this very subject, withdrew in protest. This from a party which called for the Minister to resign over the flu epidemic two weeks after taking up her post. She has also been accused of making this a political decision because the Royal Victoria Hospital is in her constituency of West Belfast, but, on the clinical facts alone, the Royal Victoria Hospital always had a strong case. I await with interest to see what the DUP wants the Minister to resign over next week.

There was also concern on the issue of the Committee's not being informed. As a matter of courtesy, the Minister took the step of contacting the Chairman of the Health, Social Services and Public Safety Committee on Wednesday evening. She informed him of her decision on the location of maternity services in Belfast. So far as I am concerned, by informing the Chairman the Minister was informing the Committee.

Once again, I oppose this motion, and I also oppose the Ulster Unionist Party's amendment.

I rise to support the amendment. The situation is of concern. The Minister has scorned the Executive and ignored the Committee. She has taken a decision which mirrors Sinn Féin's previously stated position as well as her own. I wonder how much constituency considerations influenced. I quote:

"I wholeheartedly believe that the Royal is a crucial part of the economic and social fabric of west Belfast, and I want to ensure that it remains so."

It might be worth having a look at the background to this. The McKenna Report is quite interesting. The McKenna group was made up of eminent people from both the City and the Royal, including chief executives, a director of public health and clinical directors. There were 12 or 14 of them in all. They decided that maternity services should go to the City site. This clearly did not suit the Department, and it promptly commissioned another report from four eminent people who came across from England. Of course, they produced a different recommendation, which was that it should move to the Royal site.

The interesting thing about this is that the main pillar of both the Donaldson report and, indeed, the Minister's report, is that the clinical arguments came down to the potential linkage of the new hospital with other, on-site clinical services and to its closeness to the Royal Belfast Hospital for Sick Children. It is worth looking at the number of children who are transferred across each year. My understanding is that it is fewer than 1% from across the Province.

There is confusion, and a smokescreen was presented to the Committee by paediatricians about what happens when a baby is born and is poorly. After babies are born, they are stabilised by neonatologists. Neonatologists are paediatricians who have specialised in looking after newborn babies. The other paediatricians at the Royal Belfast Hospital for Sick Children are people who specialise in children's brains, hearts, legs, and so on. There is a turf war going on here between the two groups.

The neonatologists are tasked with stabilising the babies once born, so there is no question of a baby's being born, being poorly and being thrown into an ambulance and rushed to the Children's Hospital. The neonatologists stabilise the child, or, if the situation is very serious, a paediatrician operates. Otherwise the baby is stabilised and can then be moved. There is no rush. The idea that all hospitals have to be close to the Royal Belfast Hospital for Sick Children is clearly nonsense, but it is one of the basic premises on which all this was based.

Another key consideration in both the Donaldson and McKenna reports was that no one should separate obstetrics and gynaecology. Gynaecology and obstetrics are two different things, but they must not be separated. What has happened now? As of 1 February, obstetrics is being moved to the Royal. [Interruption]

Order.

Gynaecology is staying at the City. They are splitting them up - the one thing that the Royal College of Obstetricians and Gynaecologists said should on no account be done. This decision has done that.

Let us look at the question of a mother's choice. The Department's own consultation paper says

"However, the Department recognises that whatever option is chosen, some Belfast mothers may choose not to use the new combined maternity hospital, but to seek maternity care from another maternity hospital such as the Mater, the Ulster, Lagan Valley and perhaps even Antrim."

I wonder if the medical services are ready, for research has shown that 60% of the mothers at the City do not and would not wish to have their babies at the Royal. This needs to be taken into consideration.

The action of the Royal College of Paediatricians was mentioned in detail in our letter to the Minister. They knew that the Committee was looking at the matter, and they deliberately went ahead with a force majeure that obliged maternity services to move from the City to the Royal. What is interesting - and the Mater needs to take note of this - is that towards the end of a report to deal with this, and concerned with the removal of specialist registrars from the City site, it says

"Paediatric cover of the Mater Maternity Unit needs to be reviewed since after the rationalisation of neonatal services" -

Order. The time is up.

On a point of order, Mr Speaker. Can Mr McFarland explain what he means by his references to babies coming out and women's bits and pieces?

Regrettably, that particular medical treatise had to be brought to a close.

The SDLP will be opposing both the motion and the amendment. Before explaining why, I must mention the comments that have been made about the Chairman of the Health Committee, which have ranged from his "being unworthy" to "being discredited". The Chairman outlined his personal views on this issue to the Assembly, gleaned over a lifetime in medicine. He also told the Committee that he was prepared to step down when this matter was being discussed. He has outlined his anxiety and difficulty over this issue in a very honest and frank way in both the Committee and the Assembly. Given this, I trust that those Members who made those sorts of comment would acknowledge that he acted as he saw fit out of high principle at all times.

I trust they would acknowledge that he was in a difficult situation but behaved honourably and as best he could in the circumstances. I hope that the Chamber will recognise and acknowledge that. It is ironic that, in this Chamber of all places, two Assembly Members have referred to the "chill factor" involved in going to the Royal Victoria Hospital. There is a chill factor about this Building for a political tradition in this city, which has spent a lifetime not coming into this Chamber and is now spending a lifetime in it. If a chill factor can change with respect to a political institution, then it can also change with respect to a medical establishment. It is the responsibility of political leaders to say that the attitudes which served in the past, and which might have been justified in terms of people's concerns and anxieties, will no longer serve our needs in the future.

It is the responsibility of political leaders to say that things have changed and that people can now do things differently. We have done it in coming to this Chamber, and people can do it by going into west Belfast, where they will get the best service and the best medical care. It is those factors which will determine whether people go to the Royal - not whether people are prejudiced about west Belfast or the perceived history of that constituency in recent years.

I do not intend to go into the clinical arguments. They have been exhaustively rehearsed in the Chamber and elsewhere. However, in my judgement - and I am trying not to be partial, although that is difficult - the compatibility and the complementarity of the services on the Royal site are much higher in respect of mothers and children than is the case elsewhere in this city. That complementarity and compatibility make the argument in clinical terms more compelling than the argument in respect of the City site.

The decision should be taken on clinical grounds, but it has to be acknowledged that a wider factor is involved. West Belfast - all of west Belfast, the Falls and the Shankill - is exiting from years of discrimination in respect of one tradition and years of disadvantage in respect of both traditions. Every decision taken is legally required to be equality-proofed. It is also essential, if a new economic and social order is to be introduced in the North, that issues of economic and social discrimination and disadvantage be taken into account.

I am putting down a marker that those factors will have to be taken into account for every decision and judgement made by the Assembly when working out best practice and policy.

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