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Northern Ireland Assembly

Tuesday 13 February 2001 (continued)

Ms de Brún:

Will the Member agree that when Mr Beggs took the chance to talk about Larne today he did not take the opportunity to talk about those nightly attacks; to acknowledge that it is Catholics and Nationalists who are bearing the brunt of those attacks? He did not chose to take the opportunity he had today - speaking as the Member of that constituency - to appeal to all constituents in the area, Protestants, Catholics, Unionists and Nationalists to work together. He did not ask people from his own constituency and from his own party to come out and publicly support and defend their Catholic neighbours.

Mr C Murphy:

I agree totally.

Mr Deputy Speaker:

Are you winding up now?

Mr C Murphy:

I am - you will be pleased to hear.

I agree with what the Member has said.

Mr Davis:

It would be fair to say that Mr Beggs referred to the Loyalist paramilitaries in his speech. I assumed he was condemning those paramilitaries for attacks on Catholics.

Mr C Murphy:

I give the Member's assumption the benefit of the doubt.

Referring to his constituency, Mr Beggs appeared to grasp one incident, which he imagined had some relevance to Republicanism, and completely ignore the huge issue that has been keeping Larne to the forefront of the media in the last months - attacks on Catholics. Nevertheless, I am sure Mr Beggs can answer for himself at some stage.

I am disappointed. The opposition, particularly from the DUP, masks their declared opposition to the fact that the motion was proposed by me. Some of their contributions mask the fact that they are actually opposed to the Law Centre report and its recommendations. Some of the racist and xenophobic stuff that came from them was an embarrassment to the Chamber, but probably not to themselves - but again, they are quite hard to embarrass.

Some Unionist Members may unite to vote against the motion. If they do, they may feel they have scored another success over Sinn Féin and the Republican movement. However, the Assembly needs to send a clear message to the British and Irish Governments that asylum seekers here and in Great Britain are being handled very badly. It is a disgrace, given the fact that we are a nation that has sought asylum in so many other countries. It should be changed.

Mr Beggs:

Will the Member give way?

Mr C Murphy:

I was trying to conclude, but I will give way.

Mr Deputy Speaker:

You can give way if you want.

Mr C Murphy:

If the Member had not left the Chamber when I started to speak and only returned when his name was mentioned, he might have had an opportunity earlier.

If the motion is not adopted, the real losers will not be Sinn Féin or anyone who supported the motion. The real losers will be the asylum seekers themselves.

Question put and agreed.


That this Assembly notes with concern the report by the Law Centre, 'Sanctuary in a Cell', on the detention of asylum seekers and calls upon the Government to develop an alternative to detaining asylum seekers and to devise methods of expediting the application process.

(Madam Deputy Speaker [Jane Morrice] in the Chair)

Motion made:

That the Assembly do now adjourn. - [Madam Deputy Speaker]


Acute Hospital Services (Strabane and Omagh)


Mr Byrne:

Of all the devolved Administration's Departments, it is arguable that decisions taken by the Department of Health, Social Services and Public Safety have the most important effect upon the daily lives of people in Northern Ireland. Among other factors, the quality of health care provision has a direct impact on life expectancy.

According to the draft Programme for Government, our life expectancy is lower than in other developed countries. We have higher numbers of patients on waiting lists for 12 months or longer. In the North, ill health is closely linked to social disadvantage, and long-term sickness rates are three times greater in some areas than in others. Therefore decisions taken by the Executive Committee in relation to health care will have far reaching implications for everyone in this region.

The recommendations of the independent review group, which is chaired by Dr Maurice Hayes, on the provision of acute hospital services is keenly awaited by everyone in the North. In particular, the publication of the review group's report is awaited with much anticipation in my constituency of West Tyrone due to the gradual but consistent reduction in the level of acute services over a number of years. This has heightened the real sense of social exclusion and marginalisation felt by the population in this region.

The region is served by the Sperrin Lakeland Health and Social Services Trust which encompasses three district council areas - Omagh, Fermanagh and approximately one third of Strabane. Overall, the trust delivers health and social care to around 115,000 people spread across 1,000 sq miles of some of the most remote and marginal areas of Northern Ireland.

As I am a Member for West Tyrone, I will concentrate primarily on the West Tyrone area of the trust's responsibilities. That includes all of Omagh District Council and the Plumbridge, Newtownstewart and Castlederg areas of Strabane District Council. Of course, it is impossible to discuss this part of the region in isolation because the outcome of the acute services review will have consequences for the entire south-west.

Over the past 20 years, the people of West Tyrone have witnessed a gradual deterioration in the provision of acute services. This can be traced back to 1979 when the Department of Health and Social Services and the Western Health and Social Services Board recommended that acute services should be concentrated in Altnagelvin Hospital and Enniskillen. However, Omagh District Council successfully made a case which justified a need for three acute hospitals in the area, including the Tyrone County Hospital.

Since 1979, there has been some modest investment in the Tyrone County Hospital - for example, in 1987 a satellite renal dialysis unit was located in Omagh because of its central location. However, the maternity unit at the Tyrone County Hospital was closed down in 1994, and that was followed by the centralisation of neo-natal and paediatric services in the Erne Hospital.

Since then, there has been an ongoing leakage of services from the south-west, and from Tyrone County Hospital in particular. Overall, if one examines both inpatient and outpatient data between 1995 and 2000, there has been a continuous decline in the level of acute services' provision. In 1995-96, Sperrin Lakeland Health and Social Services Trust had an average of 257 acute beds, yet the number of beds had decreased by 24 to 233 from 1999 to 2000. It is worth noting that in the same period, the number of acute inpatient day cases increased from almost 3,500 to almost 5,000 -a rise of over 500.

Statistics also show a similar decline in outpatient services. The number of clinic sessions held in Sperrin Lakeland Health and Social Services Trust hospitals has decreased from around 4,000 in 1995-96, to under 2,500 in 1999-2000. There has also been a noticeable decline in GP written referrals to Sperrin Lakeland Health and Social Services Trust hospitals from 18,445 in 1995/96, to 14,057.

If one examines similar statistics in relation to Altnagelvin Hospitals, Health and Social Services Trust, there is a significant rise in outpatient activity.

6.30 pm

This debate is not a case of the Tyrone County Hospital verses the Erne Hospital, or Sperrin Lakeland Trust verses Altnagelvin. The people I represent do not want to see one hospital close down or one trust receive preferential treatment to the detriment of patients in another trust or constituency. Rather, this is an issue that goes to the core of the Health Minister's commitment to social inclusion in the provision of acute services in the entire south-west region on a fair and equitable basis that matches the needs of patients, as opposed to discriminating against patients because of where they live.

Several models of acute service delivery for the region have been put forward in recent years. A report funded by Sperrin Lakeland Trust and Omagh, Fermanagh and Strabane District Councils, and published in 1997, proposed that the Tyrone County Hospital and the Erne Hospital could be developed as one hospital on two sites. However, that scenario received little support and the rapid deterioration of acute services in the west generally, and in the Tyrone County Hospital specifically, have made that option unworkable. A new area category hospital to serve the entire south-west region is now the best possible option.

The Government's 1997 report 'Putting it Right' identified the need for patients to receive hospital treatment from a local hospital and recommended that hospital services be organised so as to ensure that all patients, no matter where they live, receive an equally high quality of health care. The report identified the need for a number of local hospitals that would provide general acute services to the local population. These hospitals would be located in Coleraine, the Daisy Hill Hospital in Newry and in the southern part of the Western Health and Social Services Board area.

Two years ago the Western Health and Social Services Board brought the new hospital scenario one stage further and conducted a review of acute services that examined six models of delivery. The aim of the review was to find, through extensive public consultation, the model that would best meet the public's aspiration for accessibility to services, including an emergency hospital in the south-west of Northern Ireland. The Western Health and Social Services Board concluded in the subsequent report, 'The Way Forward', that acute services in the western area should be provided through a pattern of services based at Altnagelvin Hospital and a new hospital located in the south-west. Omagh District Council's response to the review also endorsed the need for a new area hospital, but in the meantime there should be strong interim arrangements to maintain the existing level of services.

Since the publication of the Western Health and Social Services Board's report, there has been a crisis of confidence among the population in the south-west because the Minister of Health and her Department appear to be avoiding the need to make a decision. The Minister and her Department have increased the level of anxiety and uncertainty around this issue. Many people in west Tyrone believe that the Department was dithering and delaying taking any decisions by commissioning, in July last year, a further review of acute services.

However, now that the independent review group will soon be publishing its report, it is important that we do our utmost to ensure that the people of the south-west receive the best possible standard of acute services provision. It is imperative that the review group should endorse the Western Health and Social Services Board's proposal for a new hospital in the south-west and that the Minister support its recommendations.

The people of West Tyrone must have access to the key acute services and rapid access to high-level specialist care. Any proposal for a new hospital must make the best available use of clinical practice and resources and should be located in an area that has the necessary infrastructure and public services.

As regards the need for joined-up Government, the Minister's decision must also be made with reference to other Government policies and the requirements of the equality legislation, which states that the Department must ensure that effective health and social care services are available to everyone in Northern Ireland. The Minister must also refer to the requirements laid down by New TSN, which requires that resources be targeted to the areas most in need.

The Omagh and Strabane district council areas have been designated as suffering from high levels of social deprivation and long-term unemployment. The Robson index highlights Strabane as the most deprived district in Northern Ireland.

When making her decisions on other Government policies, the Minister of Health, Social Services and Public Safety must address the issues of spatial equity and sustainable development. The Regional Development Department's strategic framework document, 'Shaping our Future', designates Omagh as a major service centre. It identifies Omagh as a town with strong potential for growth, and well equipped to develop as the major service centre for the west of the region.

Omagh has a population of 25,000, and outside of Derry it is the largest urban centre in the north-west of Ireland. The population of the entire district, which is now almost 48,000, has grown by 20% in the last 30 years and the population in the rural hinterland is approaching 150,000. Therefore any recommendation made by the review and any decision taken by the Minister should capitalise on the existing infrastructure, must be accessible and should make best use of the existing logistical, administrative and business support services in the region.

The people of the south-west need certainty on this crucial issue from the Health Minister and her Department. They want the Minister to have the courage to make a speedy decision and end the endless series of reviews. She should pay a visit to the Tyrone County Hospital and the Erne Hospital and show her solidarity and commitment to patients and medical staff in the south- west region.

The Minister, with the rest of the Executive Committee, signed up to the draft Programme for Government. It included a commitment to make a difference for the better to the lives of the people of Northern Ireland. When the independent review group publishes its report at the end of the month, the Minister's final decision will be a key test of her own and her Department's resolve to fulfil the terms of her pledge of office, the requirements of the equality legislation and the commitments given in the draft Programme for Government to reduce health inequalities in the marginal and rural parts of Northern Ireland.

Mr Gibson:

I support the motion. Mr Byrne dealt historically with the majority of the background relating to the local hospitals. He rightly said that Tyrone County Hospital lost its maternity services in 1994. Unfortunately for Erne Hospital, the predictions that were made on the numbers that would use its maternity services did not develop as anticipated. As a result, Erne Hospital is limping along - and I used that expression yesterday when asking a question of the Minister.

Tyrone County Hospital is limping along. Services are leaking away on a casual ad hoc basis. That is despite the Minister's assurances yesterday - which I was delighted to hear - that she wanted to ensure that services were maintained in the interim. However, that has not been the case.

On the last occasion that I visited my GP, he was in a temper because he had referred one of his patients to a medical facility without knowing that it had been taken from the hospital. The patient had arrived at the Tyrone County Hospital only to discover that a decision had been made to take the facility from it. Nobody knew whether the facility would be available at Erne Hospital, Altnagelvin Hospital or Craigavon Area Hospital. The patient was left in limbo until, after a series of telephone calls, somebody discovered where the service was available.

In the east of the county, South Tyrone Hospital has been virtually closed down.

At present Counties Tyrone and Fermanagh have a population of 200,000, who are more or less dependent upon the Tyrone County Hospital and the Erne Hospital. However, the vast majority of the services are dripping away from those hospitals. The staff feel demoralised, people have held street rallies, but they feel as though no one is listening. We made a presentation to Dr Hayes and his review group, and we were not just talking locally or parochially. We were making a point about good, genuine acute services for the whole south-west of the Province. It would take that amount of people to make one sustainable and viable unit. We are quite reasonable about that because we had a similar arrangement whereby the psychiatric facilities for both counties were based in one hospital. Therefore there is a historical precedent for the two counties to join and operate in unison.

Representatives from both counties made a presentation to the Department of the Environment for the 'Shaping Our Future' document. It is not new for co-operation and determination to come from both counties.

People made their case to George Howarth just before the Assembly recommenced last May. We thought then that he was ready to issue a determination, and we were rather surprised when the new Minister announced another review. However, we are quite content to wait because we hope that it will only be another year. We also hope that there will be a favourable consideration at last that will give encouragement and heart to the 200,000 people who now expect, in the age of equality, not only transparency and justice but also equality of opportunity and availability of a good Health Service.

People are prepared to make the 140-mile return journey from Omagh to Belfast to receive very specialist care. However, we do not see why a new provision in the south-west of the Province should not equally have a number of specialities. Not only do we have the facilities for a good acute service, but we also have the location and the population to support it.

This is an opportunity to make a hospital available in the south-west of the Province, which is attractive because it can provide quality and attract consultants of calibre. Tyrone County Hospital has a number of specialities. Its ENT section is known nationally and internationally. Specialities in kidney dialysis - chosen because of the need to centralise that service in the west of the Province - are reckoned to be equal to anything in the rest of the world.

Therefore we are talking about people who have already acquired a high level of expertise. We can bring those people together with other experts in the various fields of medicine. The south-west has every good reason to expect a favourable outcome. After Easter I hope that the Minister will be able to encourage us with a favourable announcement.

6.45 pm

Mr P Doherty:

A LeasCheann Comhairle, there should be a co-ordinated strategic approach to the planning and delivery of acute services in West Tyrone. That would allow for the development of structural health care plans, accessible services and centres of excellence. Greater co-operation would also make better use of resources, build clinical expertise and deliver accessible services for patients and families.

Another issue is that many of the inequalities in the provision of acute care are a direct result of the fragmentation of planning and the parochial nature of boards. With the four area boards limited to overseeing the planning and delivery of acute services for their respective areas, there can be no overall strategic approach. Responsibility for planning and funding must be removed from the present board structures and given to a regional acute planning service established within the Department. The service would then have the widest possible remit to develop, in co-operation with other bodies, centres of excellence and co-ordinated regional services.

The Department must also develop regional patterns in the siting of acute care. Such an approach could be expected to provide major benefits that would obviate duplication of services and produce savings through the sharing of resources. That would also enable cross-border co-operation on high technology, leading to the distribution of complex and expensive procedures to designated centres of excellence throughout the island, as well as a greater responsiveness to the more isolated communities, such as West Tyrone.

Levels of planning should be clear, transparent and inclusive, and must uphold both the letter and ethos of equality legislation. I believe that in the planning, funding and siting of acute care in West Tyrone, the Department should establish a body comprising service users or their representatives, trade unions and the full range of health care professionals. The cross-border approach could be developed under the aegis of North/South co-operation, reporting to and accountable to the North/South Ministerial Council. Alternatively, the body could report to the respective Ministers.

The concept of accountability should not be solely applied to the central planning, funding and siting of acute care facilities. There should be greater accountability in the management of local hospitals and greater openness and transparency in hospital management. Trade unions and service users should be included in the management of hospital care. Unelected and unaccountable bodies are not the way forward. The Assembly and its associated Committees could provide oversight and help to assure the accountability of the Department. The structure of all aspects of acute care must be less bureaucratic and more cost-effective.

It must be accepted that an inaccessible service is not a quality service. Just as targets for waiting lists for in-patients and waiting times at accident and emergency units are used to evaluate the quality of service, it is incumbent to develop and implement such a target for accessibility. The Health Department must take account of the realities facing people in rural areas who need access to acute services. Their difficulties are of a cross-cutting nature, relating to time and distance - poor road infrastructure, lack of car ownership and, thus, dependency on public transport, which does not always exist or operate at the most appropriate time.

There are difficulties in achieving a balance between the accessibility of services and the provision of modern, high quality standards of care. However, the quality of care one receives cannot depend on where one lives, so Omagh must have acute hospital services.

The increase in waiting lists and the decrease in quality care stem from the reduction of the number of beds, the closure of hospitals and increased seasonal pressures. The current configuration of services within the hospital settings must be questioned. If care can be delivered locally, it should be. I accept the need to concentrate some services so that specialist teams have access to a wide range of clinical and technical backup. However, I see no reason for the majority of regional services being sited in Greater Belfast. Such a high concentration inside this limited area does not reflect an equitable and accessible hospital service.

In siting acute service care, one needs to take cognisance of the interface between the acute-care sector and community-based services. Some of the consequences of the proliferation of trusts and the preserved incentives of the internal market are particularly evident in this area.

The abolition of both the internal market and unaccountable, unrepresentative quangos is a prerequisite to the establishment of an accessible and equal health service. There should be an effective integration of service and a smooth transition between health sectors reflecting patients' needs and the effective use of resources.

The review group must address the endemic underfunding of the Health Service and the piecemeal planning which wastes resources and duplicates management. A LeasCheann Chomhairle, recent cases have shown that quotas are not a true measure of quality. They promote the attitude that the attainment of specific targets is more important than the treatment of patients. They have been the driving factors behind acute-service reviews and the withdrawal of acute services from some areas. Some services have been removed from hospitals, not because there is no need for them, but because there was not the requisite number of patients to meet arbitrary quotas set by the Royal Colleges.

Madam Deputy Speaker:

I have received no notice that any other Members wish to speak.

The Minister of Health, Social Services and Public Safety (Ms de Brún):

Go raibh maith agat, a LeasCheann Comhairle. Caithfidh mé Joe Byrne a thréaslú as an tsaincheist thábhachtach seo a thógáil le díospóireacht inniu.

Is maith a thuigim tábhacht ospidéal áitiúil leis na comhphobail a bhfreastalaíonn siad orthu. Ar na mórdhúshláin a bhéas fúinn sna blianta seo chugainn beidh le tógáil ar a dtraidisiún de sheirbhís áitiúil le linn dúinn a chinntiú go dtig le hothair teacht a bheith acu ar thogha na míochaine nua-aimseartha.

Aithníonn an Teachta cé chomh tábhachtach agus atá mo shainchúram aireachta agus tábhacht obair na seirbhísí sláinte agus sóisialta. Aithníonn sé chomh maith go bhfuil tionchar an-tábhachtach ag cinntí de chuid an Choiste Feidhmiúcháin, agus fáiltím roimhe sin.

Tá eolas agam ar thíreolaíocht an cheantair agus tuigim an ról lárnach atá ag na hospidéil san Ómaigh agus in Inis Ceithleann i saol agus i leas a gcomhphobal féin. Ní sainiúil iad na deacrachtaí atá ag ospidéil bheaga atá ag iarraidh réimse leathan géarsheirbhísí a choinneáil. Leoga, tá deacrachtaí ag ár n-ospidéil bheaga foireann a earcú agus a choinneáil, agus ag an am chéanna riar ar éilimh a bheith ag síorfheabhsú chaighdeáin seirbhísí. Tá dúshlán fúinn teacht ar réiteach idir an feabhas a thóraíocht agus ionrochtaineacht ár seirbhísí a choinneáil, go háirithe dár ndaonraí tuaithe.

Caithfidh ár seirbhísí tógáil ar fhorbairtí sa mhíochaine, i dteicneolaíocht nua agus i ndrugaí nua má tá siad le riar ar riachtanais sláinte ár ndaonra sa todhchaí. Is minic a thig brú ar sheirbhísí a lárú in éineacht leis na forbairtí seo, mar shampla i gcóireáil ailse.

Mar sin féin, caithfimid na deiseanna a aithint atá ag teacht as na teicneolaíochtaí nua agus as an chleachtas chliniciúil nua-aimseartha le cúram agus le cóireáil a dhílárú agus a locáil trí úsáid teilemhíochaine agus tríd an líonrú chliniciúil nua-aimseartha. Féadann siad seo brí úr a chur faoi sheirbhísí sna hospidéil bheaga a bheadh scoite ina n-easpa. Tuigim a láidreacht atá an tacaíocht do na hospidéil áitiúla seo agus d'ospidéil eile; tacaíocht a chuir Teachtaí i bhfriotal go solabhartha le linn na díospóireachta. Is cúram domh bhur gcúraim faoi bhrúnna ar ospidéil áitiúla agus tuigim bhur n-eagla go bhfuil siad faoi chrann smola ag easpa treorach soiléire faoi sholáthar seirbhísí sa todhchaí.

Ba é seo an fáth ar chuir mé an t-aithbhreithniú ar sheirbhísí géarospidéal ar bun faoi chathaoirleacht an Dr Maurice Hayes. Tá a fhios agam gur thionóil sé agus a fhoireann cruinnithe sna comhphobail a dtacaíonn ár n-ospidéil bheaga leo.

I congratulate Mr Byrne on raising this important issue. I appreciate the importance of local hospitals to the communities that they serve. One of the real challenges facing us in the coming years is to build on the tradition of local service, while ensuring that patients have access to the best that modern medicine has to offer. I welcome the Member's acknowledgement of the vital importance of my portfolio and of health and social services. As he acknowledged, it is not merely a question for myself, but of the importance that the Executive places on the Health Service in its decisions. I know the local geography and appreciate the central roles that the hospitals in Omagh and Enniskillen play in the life and well-being of their respective communities. I share many of the concerns that have been expressed and agree that local communities must play a part in the development of services in their area.

The difficulties that small hospitals face in seeking to maintain a broad band of acute services are not unique to these hospitals, and Members have recognised that. All our smaller hospitals are confronted by the dilemma of how to recruit and retain staff and how to meet the demand for continuous improvement of standards. The challenge is to balance the necessary pursuit of excellence with accessibility, especially for rural communities. Our services must build on developments in medicine, technology and drugs if they are to meet the needs of our population. Such developments frequently exert pressure for the centralisation of services, as in the case of cancer treatment. However, we must also be conscious of the opportunities to decentralise and localise care offered by new technologies, such as tele-medicine, and modern clinical networking. Such developments breathe fresh vigour into otherwise isolated services at smaller hospitals.

I appreciate the strength of support for these and other local hospitals; it has been eloquently expressed by Members today. I share the concerns about pressures on local hospitals and the fears that they have been blighted by a lack of clear direction in respect of future service provision. That is why I set up the review of acute hospital services under the chairmanship of Dr Maurice Hayes. Dr Hayes and his team have held meetings in the communities served by our smaller hospitals and have had fruitful discussions with many community groups and individuals about the future of acute services and how they might develop.

I await the report with great anticipation. Its publication will furnish us with an opportunity to debate afresh how our services must develop, but, while the review is ongoing, it would be inappropriate for me to make advance comment on the way forward. I expect to receive the report in the spring and intend to consult fully on it, before coming to any conclusions. In the meantime, I expect trusts to maintain their current acute services in our smaller hospitals, unless that would seriously compromise patient care and treatment.

7.00 pm

At any point where services are not to be maintained, any transfer of services must be temporary. I am not clear about the reference made by Oliver Gibson to a specific case, but if he wishes to write to me I will be very happy to take the matter up with him.

On the other points raised by Members, I share their desire to ensure the availability of a good acute Health Service. That is what I expect to come out of the acute hospital review. I believe that it is important to build on the strengths of our current services and staff. I am absolutely committed to developing open and transparent Health Service arrangements that actively involve, and listen to, local communities.

Mr Byrne in his opening comments referred to 'Putting it Right'. That paper reflected the views of Ministers at that time in relation to the pattern of services. It does not necessarily reflect my views, and I have said before that I want to take a completely fresh look at these issues. Had it not been for the four-month suspension, I would now have been in post for a year. In that period I have taken on board the questions that need to be tackled. I have very proactively taken forward some of the concerns mentioned by Mr Byrne in his opening speech. These include the question of the health of our population and the need for a public health strategy that goes wider than the Health Service, the question of the future pattern and development of primary care services, and the very critical question of acute hospital services.

Reference was made to North/South linkages, and Pat Doherty referred to the need for an overall strategic approach. I agree totally that we need to develop a regional view of acute services. There are no boundaries in my thinking, and no boundaries have been set in the terms of reference of the acute hospitals review. We need to look at ourselves in this broader context and to build arrangements in the interest of all our people.

On North/South development, I am committed to building up effective linkages, and that is included in the terms of reference of the acute hospitals review. I am consequently open to any suggestions that Members may wish to put to me regarding the construction of cross-border partnerships that can work in the interests of patients.

With regard to the review of administration that is being taken forward, and any consequent changes and structures, my first priority, after the years of uncertainty, must be to set an appropriate direction for our hospital service. The form of administration required to operate such a service should be influenced by its functions, as determined in the light of the acute hospitals review. I would stress again that there is no question of my avoiding a decision. I have acted decisively to address this and other issues in the short - and somewhat difficult - period of suspension.

The points raised by the Member regarding waiting lists and winter pressures are matters that I have vigorously tackled. I can confirm to Joe Byrne that any decisions taken as a result of the independent review will be in line with the principles of TSN, and they must be assessed and equality proofed in line with section 75 of the Northern Ireland Act 1998.

On the question of rurality, I absolutely recognise the specific problems facing rural communities. I am prepared to take those into account in developing the required acute hospital strategy for the future, and, therefore, the issue is referred to in the remit of the acute hospitals review group. Reference was made to other Departments, and I trust that my Colleagues in the Executive are taking similar steps to ensure that their strategic planning takes account of the interests of rural communities. That point was certainly taken forward in our discussions on the Programme for Government.

Looking to the future, I am committed to creating a new and better hospital service. I will build on the report of the acute hospitals review group to stimulate an open and informed debate on the way forward.

At this stage I cannot say any more about the outcome of this process. I can say that I am committed to creating a modern and effective hospital service which will meet the needs of our population in this new century; a service which will provide a standard and quality of care comparable with the best in Europe; a service that will use technology in the interest of its users. We need a service that takes account of the overall needs of our population, which must, and will, include those people who live in rural areas.

Adjourned at 7.05 pm.

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