As the Minister has already said, we could ensure that the first priority for those who are responsible for sending patients home from hospital would be to have at hand the information for the patient's GP and a list of the patient's needs, medical or otherwise. It would not take a great amount of money to do that; it would not take a huge amount of administration. We are over-administered with 19 trusts, four boards, five agencies - a plethora of administration. It has also been suggested that we are going to set up four or five more committees in each board area. We need to adopt a sensible approach to what we can do in the short term to rectify the problem. It will not help to apportion blame or to throw money at the situation. Another consultation document will not help either. John Kelly hinted that if all those who are involved could get together to see what we could do in the immediate future, we could act immediately.

We need decisions at every level of community care. I recently realised that Homefirst Community Health & Social Services Trust, which is centred in Ballymena, is the largest community trust in the entire United Kingdom. When we examine the percentages, we see that Homefirst is being castigated because it cannot meet its needs. It covers one fifth of the entire population of Northern Ireland, so is it any wonder that we have problems? We need to focus on money and management. Although we can all say what system we should have, I appeal to the Minister and the Department to get together and stop blaming each other or anyone else. We need to see what we can do and then do it.

Many issues have been eloquently and adequately placed before the Assembly today. Indeed, no one has done that better than Rev Robert Coulter. I make a plea for one aspect because all the other areas have been well covered. In my constituency of West Tyrone the norm is for the family to care for aged relatives. Most Assembly Members welcome the fact that there are still those in the community who care for their elderly relatives. However, it is a punishment for one family member to do that under the present system. If people of working age give up their work to look after their elderly parents, they are reduced, even with income support, to giving 24-hour care on £77 a week. At the same time, they are further punished by having to give up their pension rights. In other words, they cannot receive any additional money. Family members are being punished for looking after their elderly relatives.

Although this is not the direct responsibility of the Minister, I appeal to her to deal with the matter. Through the single equality Bill and section 75 of the Northern Ireland Act 1998 we have raised the expectation that we will give equal treatment, and I presume that that involves pay. We should reward those carers not for 24 hours' work but for at least eight hours' work. They do not ask for anything more; it is reasonable that they should be justly rewarded. The expectations that were raised by the lovely glossy magazines on the subject might then be met.

In the past, I presented to the House, in a puritanical fit, a pile of health documents produced in the past five years, and weighing some 17 stone, which were written, published and printed at a cost of millions of pounds. I make a plea this afternoon that, in the extended family care system, those who give up work to look after their kith and kin receive an adequate and fair reward for their input.

Go raibh maith agat, a LeasCheann Comhairle. I welcome the opportunity to speak on the issue as someone who is not a member of the Committee for Health, Social Services and Public Safety. Mr Gallagher, who shares my constituency, has raised issues that are also of concern to me and to constituents. The Minister has a difficult job trying to deal with all the issues and to act accordingly. The main problem that affects the health system is the inadequacy of budgets.

Community care is a sensitive but vital issue in rural areas. Mr Gallagher said that we no longer have the service that we should have, which implied that in the past we had a service that we could be proud of. That is not the case. The Thatcher years resulted in 14 years' destruction of the Health Service. In the 1980s and 1990s the Tory Governments made 3% cuts, year-on-year. Those trying to deal with the cutbacks were told that if they did not run the hospitals, private managers - now known as "roving managers" - would be brought in to do the work for them. I do not think that that approach worked. The Labour Government seem to be taking the same approach by giving money with one hand and taking it away with the other, as is evident from the cutbacks in hospitals, bed shortages, et cetera.

The increased elderly population, particularly in Fermanagh, will create difficulties in the provision of community care. People live longer than before. Although diseases such as tuberculosis no longer affect people, today's hospitals treat patients for chronic diseases such as strokes, multiple sclerosis, Alzheimer's disease and drug-related illnesses. There are not enough nurses in our hospitals, and nursing staff are usually rushed off their feet. They do not have enough time to care for patients properly, with the result that staff become sick due to stress and there are twice as many people on the payroll to cover those absences. In addition, winter pressures, which affect older people more than anyone else, create an extra burden.

Those factors create massive pressure for the Minister, and much of that problem is inherited. Is the Department of Health, Social Services and Public Safety looking after the needs of carers? Doctors in areas such as Fermanagh find it difficult to get carers. They get neither time off nor relief from their job. The financial situation of homes creates a further burden.

The Budget did not allocate enough money, and people's health is suffering. Poor housing is also a factor in ill health. In my constituency of Fermanagh and South Tyrone, 17% of the housing stock is in poor condition. Dampness and inadequate toilet facilities also affect people's health, particularly stroke patients and those with serious illnesses. I join John Kelly in welcoming the 1,000 care packages announced by the Minister.

There is poor access to hospital day care in rural areas. Since bus passes for pensioners were introduced, elderly people have been told that they cannot take taxis to hospital - they must use the bus. However, in our area there are some routes that have only one bus a week. Even Rural Lift does not allow bus passes to be used.

On the issue of healthcare in border areas, an all-Ireland approach is necessary. North and South could work together, for example, Co-operation and Working Together (CAWT). There are natural hinterlands. Mr Gallagher will know that villages such as Kiltyclogher and other cross-border villages have worked together in the past. They did not look towards Enniskillen and places that are 30 miles away.

Specialists are a massive cost in rural care. Social workers may visit one area or one patient at home. Other workers, such as health visitors and district nurses, have to be paid for their mileage. These are costs that did not occur previously when one general health carer was able to assess a patient's healthcare needs. That situation could be considered on a cross-border basis, between the Department of Health and Children in the South and the Department of Health, Social Services and Public Safety in the North, in order to create savings and prevent duplication. In some cases, their base could be Letterkenny, which is a hell of a journey from border areas in south Fermanagh.

The Department of Health and Children in the South is trying to do something about it, although it inherited the health system in the 1920s from the British, which has not served the country well. They spent far too long working with the system rather than trying to dispose of it and have something better.

Is specialisation needed, with all its inherent cost? Of course there are issues such as litigation, changing times and skills to be taken into account. In the 1950s a patient undergoing a hernia operation, for example, might have spent four to six weeks recuperating in the hospital, whereas today it is a day procedure. In order to keep up their skills, surgeons now have to perform at least 50 appendix operations a year.

The Minister has also announced a timetable for the establishment of local health and social care groups and the ending of GP fundholding, which has a tremendous impact in my area on delivering care.

Rural proofing is needed in applying the Noble formula in relation to deprivation. Per capita, Fermanagh has £31, in contrast to places like Derry, which has £84 per capita under that formula. What impact will that have across other Departments? Will they follow the Noble formula as a basis? Voluntary groups will discover that they are losing out under this formula.

People in rural areas also face health problems. I am a member of the Committee for Agriculture and Rural Development, and it has been brought to the Committee's attention that farmers face problems such as stress, depression and even suicide arising from factors such as low income, isolation and a lack of future prospects.

What help or counselling was provided to families or individuals in the wake of the outbreak of foot-and-mouth disease? There was a helpline, but what follow-up help has there been in areas affected by foot-and-mouth disease, such as Newry and Armagh? What impact did the outbreak have on stress levels or the incidence of heart attacks, for example?

I have mentioned issues that involve three Departments. Health is a cross-cutting issue, which involves other Departments besides Ms de Brún's. Farmers' families need help, especially if they have not received help with their financial situations. Ms de Brún has inherited the problem, which has been brought about by a lack of adequate finance.

Mr Gibson mentioned the inadequate benefit payments for people who have given up work. Does he not agree that that is an issue for the Minister for Social Development? As I have said, cross-departmental issues are involved.

Go raibh maith agat.

The debate is timely, although its subject has exercised the Assembly time and again. It is 2002, and the situation is the same as it was in 2001. We rehearse the problems, because that is what we have - a plethora of problems. We had them last year, and we had them the year before. We have had reviews, and we have had consultation documents. We have had reviews of reviews and reviews of consultation documents - but when will the Department and the Minister make decisions? We rehearse the problems in our debates, but decision-making is lacking.

The Minister, as the person who leads the Department, is responsible for overseeing what happens in her Department. Every Department can rightly say that it needs adequate finances, but is that the only answer? Adequate finances have been provided across the water, but it has been like pouring water into a big hole - there has not been the required improvement in services to the public. We can see that happening in our Province. The Assembly has voted considerable amounts of money to the Health Service since devolution. However, when we ask whether we have we seen the corresponding improvements, the answer is "No".

The Minister gave us the age-old statement - which, of course, leans towards the Labour Party - that we should blame the Conservatives. They are blamed for everything, even though they have not been in power for five years. When will the Minister take some responsibility for her Department, instead of blaming everybody else? Blaming everybody else for the problem is a cop-out. The real problem with the Department is that there have been no decisions. There has been no decisiveness at the top of the Administration and at the top of the Department on how to make real changes with the money that has been allocated.

Let us not turn up our noses at the amount of money that was allocated. Certainly, it is insufficient, but, when money is provided, improvements must be seen, and that has not happened.

It is true that we have an increasingly elderly population. It is also true that many of those elderly people feel totally deserted. They feel that politicians and the Administration have let them down. They worked hard, and, with the rest of the people of the United Kingdom, they built a service that was second to none. They were promised that they would be looked after from the cradle to the grave, but they have not received that care. In fact, at the most vulnerable time in their lives, they feel more deserted than ever.

Let us examine community care packages. If we want to know what community care means, we should ask the public. In reality, it means that people are thrown out of hospital into the community. Care packages are promised, but they are not provided. Rev Robert Coulter mentioned a case in his constituency. In my constituency, an 80-year-old lady who needed continual treatment was forced to leave hospital. She was sent home to be cared for by her 86-year-old brother, who was also ill. She was thrust back into the community.

The Assembly has discussed getting people out of hospital and back into community care. I believe in community care - we want to keep people in the community. However, it is not enough to use the verbiage without providing proper care for such people. That is not a criticism of those excellent workers in the Health Service and the community who are trying their utmost. Many are at their wits' end to know exactly where to go next, and whom to go to next, because such a demand is placed on their time. They cannot cut themselves into a thousand pieces.

We have rehearsed the problems, and that is only right because we must bring this need before the Assembly constantly. The Department and the Minister of Health, Social Services and Public Safety need to take responsibility, because the Assembly cannot rely on the vision that the Minister recently published in the press. There is no vision. There is a verse of scripture, which Mr Coulter will know very well, that says:

Without a clear vision for the Health Service and community care, people will die. That is what is happening. So many elderly people await operations that I sometimes believe that there are those who almost hope that a person will die before the operation is performed, such is the crisis that the Health Service is in. The reviews and consultation documents are about how to close hospital facilities rather than meet the need in the community.

Some people have been sent to France for operations. I suppose that the next thing is that they will be sent to Russia, because they cannot have operations in Northern Ireland. That is a disgraceful situation that must not be allowed to continue. It is not only due to a lack of money, as one Member pointed out. Need must be targeted, and a vision must be carried through. Real decisions that will make a difference to Northern Ireland's community care and Health Service need to be taken. My hon Friend Mr Gibson talked about glossy documents. I am fed up looking at glossy documents that tell us how wonderful the provision is. Less should be spent on glossy documents, and more money should be put into getting people the operations and the community care that they need. I assure the House that that would go down much better with the people than documents that tell us what provisions there are for the elderly.

At the start of 2002, many families, as well as many elderly people, feel deserted. The burden is on them. I strongly believe that families have a responsibility for their elderly. That has always been a trait of good Ulster people - they cared for their fathers and mothers and sought to do their best. However, many families are being pushed over the limit; they are being used and abused. Whenever they look for help to enable them to keep their parents at home, they are faced with a blank look and no help at all. Many people in Northern Ireland feel that not only is the Health Service in crisis, and that the community care packages are in a critical situation, but that the Minister of Health, Social Services and Public Safety has no idea what the answer is. That is the worst situation of all. There must be decisive decision-making and a clear vision of where the Health Service is going in the future.

I thank Mr Gallagher for his timely motion. I trust, as the year progresses, that we will see a true change for good in the lives and health of our people.

Go raibh maith agat, a LeasCheann Comhairle. Ba mhaith liom mo bhuíochas a ghabháil leis an Uasal Gallagher as ucht na nithe tábhachtacha seo a chur faoi bhráid an Tí.

D'éist mé go cúramach leis na pointí fiúntacha a luaigh Comhaltaí le linn na díospóireachta agus is ábhar imní agam é chomh maith na deacrachtaí atá ann ag riar ar an mhéadú atá ag teacht ar éilimh ar phacáistí cúraim phobail.

Is eol do Chomhaltaí gur chuir mé cuid tionscnamh suntasach ar bun i réimse an chúraim phobail le linn na bliana seo caite. Sa bhliain airgeadais reatha leithroinn mé £2 mhilliún sa bhreis go sonrach do sholáthar cúraim phobail le 230 pacáiste breise a chur ar fáil os cionn an mhéid a bhí beartaithe, agus an bhliain airgeadais seo chugainn beidh fáil ar 1,000 pacáiste breise cúraim phobail.

I thank Mr Gallagher for bringing these important issues to the Floor of the House. I have listened carefully to Members' valuable points and share their concern about the difficulties in meeting the increasing demand for community care packages.

I will try to respond to many of the points. However, that will be difficult at times, as some very sane Members called for a fundamental re-examination of the Health Service on the one hand and for no more reviews on the other. Members also called on me to allocate more money to virtually every sector in health and social services but also to act within my existing budget. There was also a call for greater information to be given on what is available, and in the same debate there was a call for an end to documents and leaflets outlining what is available.

Members are aware of several significant community care initiatives that I have taken in the past year. In the current year, I have allocated an additional £2 million specifically for community care provision to deliver an additional 230 care packages over and above planned provision. Next year will see the introduction of a further 1,000 community care packages. The elderly, as the main users of community care, will gain substantially from that. More people will be cared for at home and in other community settings, and there will be a reduction in delayed discharges from hospital.

The packages will be a mixture of domiciliary and residential care and will go a long way towards easing the difficulties that are experienced by some people in getting access to support services in the community. I stress that I understand the extremely important point that community care is not just about delayed discharges from hospital or preventing people from going into hospital - it is about looking after the whole range of needs of those outside hospital.

Since I came into office, I have initiated five major reviews, as well as a routine quinquennial review of the Mental Health Commission. Members know that very distinct and specific actions have come from those. Comments made by Annie Courtney and Rev William McCrea about the reviews were rather unfortunate. Aside from the routine five-yearly review of the Mental Health Commission, two of the five major reviews were initiated within weeks of my taking office and have resulted in significant actions and benefits.

Following the pressures on health and social services during the outbreak of the flu-like illness in the winter of 1999-2000, two of my first actions as Minister were to ask the Chief Medical Officer to review intensive care provision and the chief inspector of social services to review community care. As a result of detailed information gathered during those reviews, extra intensive care and high-dependency beds were made available in the acute sector - a total of 33 since I came into office.

A total of 230 extra community care packages were provided this year, with 1,000 more to follow in the next financial year. 'Facing the Future: Building on the lessons of winter 1999/2000' recommended a comprehensive review of community care policy. I endorsed that recommendation in October 2000. A project board with an independent chairperson was set up to conduct the review - users, providers and carers were represented on it. In July, August and September 2001, extensive consultation took place, which took on board the views of statutory and independent sector providers, voluntary organisations and the health and social care professions. The objective was to identify barriers to the delivery of community care services, to identify good practice in place across the North and to implement recommendations for short-term improvements. From the outset, we have not only sought extra resources in that area but have examined what could be done to improve existing areas, for example, we have sought to build on good practice. I welcome the comments made on major initiatives and on the good practice that has been employed in some trusts. I shall consider the review's findings.

Although the review is ongoing, action has been taken to identify a range of good practices in place in trusts and, where appropriate, to put similar schemes in other places across the North. People will see that, where improvements can be made quickly, necessary action will be taken.

Those who were in residential and nursing care homes before the introduction of community care in 1993 were given preserved rights to special rates of income support to meet the costs of their care. However, they were not included in the new health and social services care arrangements at that time. Those residents are now being brought into care management arrangements, which, along with the transfer from social security of the related funding, is intended to give help and reassurance. Those people will, for the first time, be subject to an assessment of their needs under the care management arrangements, and, where necessary, those care needs will be met in a more appropriate manner.

The payment of residential allowance to those in independent sector accommodation who receive state assistance with their costs also went unchanged at that time. That created a perverse incentive to place people in care rather than keep them at home. That allowance will end for new residents but remain for those currently in receipt of it, and that will involve a funding transfer from social security. That funding will allow the trusts further flexibility to consider care at home rather than in a residential care setting.

I am aware of the difficulties in recruiting and retaining staff. The poor pay and conditions still experienced by many front-line care workers make it difficult to attract and retain staff. I shall continue to examine the scope available for providing additional funding from my allocation to address that matter.

On the statutory side, staff recruitment is a matter for each trust. I am aware that trusts continue to attempt to recruit staff as the need arises and to address recruitment and retention. Those issues will be addressed by a departmental working party that is currently developing a new health and social services workforce plan.

Another important point raised during the debate concerned delayed discharges. Delayed discharges show the difficulties faced by health and personal social services, especially when there is increased demand on services. The level of delayed discharge can peak during the winter months, but it now proves to be a more persistent feature of the pressure on services all year. We have seen the need to create additional services in the community to allow the earlier discharge of patients who are improving, so that they can be cared for in a proper nursing environment outside hospital. We are moving to address that need with whatever resources become available.

It is also necessary to support primary care with more resources, so that GPs and other primary care professionals can do more to deal with patients in the community and to prevent their being admitted into hospital. The recorded number of patients waiting for care packages in the community stands at over 400 at any time. The Department recognises that it is not simply a matter of solving one aspect of the problem; there must be an integrated and holistic approach, which it is taking.

Health and personal social services have piloted several local projects and schemes to make their community services more responsive. Examples include rapid response nursing, hospital at home, intensive community care and home from hospital schemes that provide intermediate care in the community and prevent inappropriate admissions to hospital. Such step-up and step-down initiatives have developed good practice and demonstrated innovation. The challenge is now to replicate that type of scheme across the North and to provide the necessary funding to ensure that they are successful. That is something that the Department will attempt to do while working within the overall budget.

Health and social services boards and trusts have operational responsibility for the assessment of the need for nursing home and residential care in their areas, and they constantly review the beds available against that assessment.

In some areas there are difficulties with the provision of residential beds in the independent sector. However, I am advised that regionally there does not appear to be a shortfall in the numbers needed. There are three different types of providers of residential care beds: the statutory sector accounts for 36%; the private sector accounts for 43%; and the voluntary sector accounts for 20%. Approximately 95% of nursing home beds are provided by the private sector. The remainder is provided by the voluntary sector.

Several Members mentioned the difficulties faced by people who are involved in running nursing homes in the independent sector. The Department of Health, Social Services and Public Safety examined the fees structure in the independent sector and reported in May 2000. As a result of that report, over the last two years fees were increased by more than the social security uplifts. I fully recognise the contribution that the independent sector makes, and if Mr Cedric Wilson were still present, I would assure him of that. I will continue to explore ways of providing further increases within the available resources.

Several Members asked what the additional 1,000 community care packages would mean. They will prevent inappropriate admissions and speed up the discharge of improving patients. However, they will also provide for the needs of those in the community whom the trusts are trying to help at present. I assure Members that trusts will look at local and individual circumstances in their areas.

When considering the parity of such funding, it is unfortunate if Members quote the funding that is available to bodies such as the North and West Belfast Health and Social Services Trust without making it clear that funding for community and hospital services in that trust area also includes the funding for Muckamore Abbey Hospital. However, there are differences in community care from trust to trust, depending on the specific needs that the boards and trusts must assess.

The cost of keeping people in hospital rather than in the community is a given. The Department knows that, clearly, that must be addressed. However, it is equally clear that the only way in which it could instantly make a massive change - by putting all funding into the community sector - would stop people from receiving treatment in hospital because, in the interim, the hospital's overheads remain.

Therefore we need a service with the flexibility to make the moves that are needed. During the 1980s and the 1990s, £190 million - in today's terms - was taken out of both hospital and community sectors. That robbed the service of that flexibility. This measure will save money in the future. We have been working to provide 230 extra packages this year and 1,000 extra packages next year. We will continue to make as much as we can of the available resources in a holistic manner. We hope to be able to make progress in this area.

The money that I have received since I came into office was also mentioned. Five sixths of that money is spent on the rising costs of existing services. People need to look at the extra money in that context. The rest of the money is all that can be used to build up services.

I am keen to ensure that the standard of care and provision is maintained and improved. Not only have we taken immediate action, but the consultation document 'Best Practice - Best Care' sets out proposals for a framework for setting standards; securing local accountability for the quality of services delivered; and improving monitoring and regulation.

Many people who receive community care services to manage their lives depend on the care and support of a carer. It is estimated that there are 250,000 carers here and that there is a carer in 18% of households. Carers enable many thousands of vulnerable people who need support to continue to lead independent lives in the community. At the same time, carers reduce the amount of input that social services and other agencies need to make. It is essential that we act positively to protect the interests of carers and foster a climate in which they can continue to care for as long as they wish and are able to.

It is important to state that many carers carry out their roles because they wish to do so. However, we must foster a climate in which they can continue to care for as long as they wish and are able to do so without jeopardising their own health or financial security and without reducing their expectations of a reasonable quality of life. Therefore, in recognition of the role of carers in delivering health and personal social services, I commissioned a strategy for carers in October 2000. Officials have now developed proposals and recommendations, working with, and in close consultation with, the major carers' organisations and carers themselves, including those mentioned by Members in the debate.

I recently received the report with recommendations for services that will support carers in the valuable work that they do. I join with other Members in commending those who carry out that tremendous caring role. I have made it clear that I want a strategy that will contain practical measures that will make a real difference to carers here. I am determined to make a reality of the strategy. One measure that I have already indicated to the Assembly is my intention to allocate funding breaks for carers in 2002 and 2003.

Members will also be aware that I recently introduced a Bill to the Assembly to give health and social services boards and trusts the power to provide services to carers to improve their health and well-being. We must give the boards and trusts the power to do this. I will also continue to argue for the extra resources that are needed and ensure the provision of those resources when I can.

It would not have been right or proper to introduce a Bill without providing carers with the right to an assessment. The right to an assessment does not alter the trusts' existing legal responsibilities. As with all services for which people are assessed - whether those are in coronary care, care in a hospital or care in a community setting - we want to be able to provide the services and have the resources to do so at the right level.

Health and social services were given priority in the Executive's revised Budget for 2002-03, which has enabled the Department to prepare to tackle some of the current serious problems in the community and hospital sectors. There was a proposal to inject additional funding into community care next year, and £4·5 million has been allocated for the introduction of free nursing care from October 2002.

Subject to the necessary legislation being passed through the Assembly, measures to facilitate free nursing care will be carried in the health and personal social services (No 1) Bill, which will be introduced in the Assembly in the coming weeks. I have asked the chief nursing officer to set up a group to examine how the need for nursing care can be assessed professionally and in a manner that can be understood clearly by the public and with a minimum of additional bureaucracy. That group will report to me with recommendations in sufficient time to allow the necessary consultation and to introduce the required legislation to implement the agreed recommendations by October 2002.

The proposals that I have outlined will pave the way for free nursing care in all settings and will relieve some of the financial worries of those cared for in nursing homes. Further improvements have been made to the charging system for care, and the ending of the income support preserved rights scheme will bring around 1,700 existing cases fully into care management, allowing those people's needs to be assessed for the first time and met in the most appropriate manner. The ending of the residential allowance and the transfer of the related funding will allow trusts more flexibility in considering care at home rather than in residential settings. I have provided funding for an additional 230 care packages this year and a further 1,000 care packages next year. All those proposals are already underpinned by appropriate funding in 2002-03. As additional funding becomes available, I will introduce other measures that are part and parcel of clear plans that I have for the way forward for the service.

A member of the Committee for Health, Social Services and Public Safety stated that Scotland would provide free nursing and personal care from April 2002. That statement is incorrect. Scotland's latest plans are that that care will be delivered from July 2002, and we shall see how that progresses. It is unfortunate that we have not been able to move as quickly on that issue as others have elsewhere, but we have had to work with the funding that is available to us. I am delighted that we now have the funding to provide free care.

The Executive are currently conducting their own review of the future of public administration structures here. I reiterate that it makes sense to take any review of health service structures forward in the context of the Executive's stated intention to bring that forward and to examine the outcome of the initial consultation on the acute hospitals review, which also mentions structure. The Executive must decide whether some of those issues are taken forward separately or simultaneously with aspects of the public administration review.

However, I must make two important points. First, administrative and clerical staff carry out a range of duties related directly to patient care, and the provision of support to professional staff means that more professional time can be devoted to patient care. Therefore, administrative and clerical staff clearly play a key role in healthcare provision.

Secondly, no amount of restructuring will provide £190 million, which is today's equivalent of the amount that was taken out of the health and social services budget in the 1980s and 1990s.

The setting up of the Assembly provided a new beginning. When I came into office, many issues needed to be addressed; Members were aware of that. We can now make progress together on many of those issues: on the one hand, we can take immediate action to deal with immediate problems, while on the other we can draw together the strands of different examinations, initiatives and some initiative reviews to create an overall regional strategy, as I reported to the Assembly and the public. I would welcome the opportunity to engage Members further in this debate.

I acknowledge the fact that the Minister was present at the debate for more than two hours, which is a considerable demand on ministerial time. The issue is not the responsibility of one Department only; it involves serious cross-departmental matters, such as transport, housing, culture and leisure, and employment and learning. In addition to housing, Mr McHugh mentioned cross-border issues, which form an important part of improvements to care in the community for those who live adjacent to the border.

All Members' contributions were well made and highlighted the key points involved. Mr Berry was the first to draw attention to bed blocking. He referred not only to the problem of patients' having to wait on trolleys in corridors, but to the importance of having places and funding for nursing home beds, which are known as "step-down beds". If trusts had the available resources, they could move people from hospitals to those beds, thus helping to avoid the serious pressures of recent weeks and previous winters.

Respite care, which was mentioned by Mr McCarthy and Ms McWilliams, gives carers a break and eases the demands on them by enabling the person that they are caring for 24 hours a day to stay at a facility for a few days. Carers favour such facilities, but at present our provision is sketchy. Many of the available respite facilities are located far from carers' and patients' homes, and that can result in stress for a patient who is moved there. There is considerable dissatisfaction with our respite care provision at present.

Mrs Courtney and Ms McWilliams mentioned primary care. It is an area that I hope will receive more concentrated attention in the coming months and years.

Paul Berry, Alan McFarland and Annie Courtney referred to the closure of nursing homes, and the Minister made it clear that more than £4 million will be available for the provision of nursing care from October 2002. The waiting lists, and their implications that seem to clog up the system, were outlined by Cedric Wilson, among others. Rev William McCrea's perspective on people who depend on community care was well articulated, and he reminded us how unsatisfactory it is for people to experience shortcomings. It was useful to be reminded how the users of the service feel about it.

One inescapable problem, which was highlighted by John Kelly, was the increasing number of elderly people, which is a trend that is set to continue. Rev Robert Coulter, among others, referred to the breakdown in communications and the difficulties arising from that.

In some instances patients are discharged too early from hospital. Many of them have to return to hospital, and that compounds the problem. Jim Shannon pointed that out. The matter of giving up pensions and benefits was raised by myself and developed by Oliver Gibson. John Kelly said that a strategy is one thing, but the strategy in itself is of no use if we do not have resources to back it up. We cannot argue with that, but at the same time we cannot get hung up on which comes first - the chicken or the egg, the strategy or the money.

In the Health Service we can always take steps to improve the quality of service, and that applies to every other area too. However, we can tackle the unwieldy structures that were referred to and that are a problem in some cases. Many Members gave examples of how we can tackle the inefficiencies and the inconsistencies, as well as the information deficit. I gather, from comments that have been made, that the point has been taken. I hope that we will improve in that regard.

Does the Member agree that you cannot have any eggs if you have no chickens?

Yes, but I do not want to digress. Suffice it to say that there is room for improvement in every organisation, and we hope that it will be ongoing. There are particular points to which we want priority to be given. The Minister made helpful comments with regard to additional money to improve the situation around high-dependency beds. More people in residential nursing homes will qualify for assessment; that is very helpful too. I did not quite pick up the Minister's point about the community care review, but I look forward to reading it in Hansard.

I thank all Members for their contributions. It is clear that there is a recognition from everyone that we are not dealing with numbers and lists, but with people. There is a sense that we all share this responsibility.

On a point of order, Mr Deputy Speaker. Several questions came up during the debate that related to the Office of the First Minister and the Deputy First Minister and the Executive. Will you forward a copy of today's Hansard to them?

If the questions to the Office of the First Minister and the Deputy First Minister have already been put on the Order Paper, I would not be happy about trying to add to those now. Is that what the Member is suggesting?

No. Several questions were raised today directed to the Office of the First Minister and the Deputy First Minister. Can you ensure that a copy of Hansard is sent to them?

That certainly will be done.

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Oral Answers to Questions

First Minister and Deputy First Minister

I wish to inform the House that question 14, in the name of Mr Eddie McGrady, has been withdrawn and will receive a written answer.

1.

asked the Office of the First Minister and the Deputy First Minister if it has received a report from the Independent International Commission on Decommissioning; and to make a statement.

(AQO 611/01)

We have not jointly received any reports on decommissioning. However, the Independent International Commission on Decommissioning (IICD) has reported to the British and Irish Governments six times during last year, and those reports have been published. The latest report, dated 23 October 2001, explained that, following a meeting, the IRA representative proposed a method for putting IRA arms completely and verifiably beyond use. The IICD witnessed an event that it regards as significant, in which the IRA put a quantity of arms completely beyond use. The material in question includes arms, ammunitions and explosives.

I thank the Deputy First Minister for his reply. The concern of many Members is that we should have a process rather than a one-off gesture. In the light of that, is the Deputy First Minister aware of how many meetings have taken place since 23 October between the IICD and the representatives of the IRA?

Mr Weir refers to a concern felt by many Members. First, with regard to the number of meetings that have taken place since the report, I refer the Member to my answer that the First Minister and I have not jointly received any reports from the IICD. We would not expect, by way of our offices as First Minister and Deputy First Minister, to receive any reports from the IICD other than those that are made to the Governments and subsequently published.

2.

asked the Office of the First Minister and the Deputy First Minister what measures it would consider introducing to help address any Unionist alienation in West Tyrone.

(AQO 603/01)

The Belfast Agreement directly addresses the problem of alienation in Northern Ireland wherever it occurs. All parties to the agreement have recognised the birthright of all the people of Northern Ireland to identify themselves and to be accepted as Irish, British or both. The agreement also guaranteed that Northern Ireland's status as part of the United Kingdom shall not be changed, save with the consent of a majority of its people. It also affirmed the parties' commitment to mutual respect, civil rights, religious liberties and equality of opportunity for everyone in the community. The Programme for Government makes clear our commitment to the practical implementation of those guarantees, in particular through our policies for community relations, equality and tackling social need.

Is the Minister aware that when one speaks to people from the Unionist community on the streets of Omagh and in the villages of West Tyrone one realises that they feel as though they have been demonised - they feel very alienated? There are 90 unsolved murders in West Tyrone that are never mentioned except by local representatives. This weekend the community felt that the Teebane massacre, in which eight workers were killed on their way home from working in my town, barely got a mention, except by their relatives. Also, in Enniskillen residents of my constituency of West Tyrone were murdered, and there have been multiple murders on the Omagh to Ballygawley road - [Interruption].

Order. This is an opportunity for the Member to ask a supplementary question to his question - not to make a statement, much less a speech.

In view of the fact that the Unionist community of West Tyrone feels totally alienated, what will the Minister do to help to restore some confidence to those people?

I understand the point that the Member makes, and I appreciate people's feelings with regard to, for example, the Teebane massacre and the others that the Member mentioned. When people see the publicity given to other cases there is inevitably an element of reflection. However, the Member will acknowledge that one of this morning's newspapers devoted a double-page spread to the commemoration service that took place at the weekend for the Teebane massacre, so the matters are not forgotten.

As to the question of unsolved murders, it would be helpful if the police would sometimes give us an indication of which cases they have closed the files on. A large number of incidents in Northern Ireland are formally regarded as unsolved. Although the police have closed the files, they know who were responsible, and they know that those persons are no longer in a position to be made amenable - many of the perpetrators are now themselves dead. It would be interesting to know just how many cases have been cleared up and how many have not. That would give an entirely different perspective on the matter.

Generating confidence within the community as a whole is very much at the forefront of all our actions in the Administration. The primary way in which we hope to give that confidence is by delivering good administration and demonstrating to people in Northern Ireland that everyone can be included in the arrangements if they so wish. We regret that in some cases people feel excluded. However, that is in part due to the poor quality of leadership offered to them.

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