Northern Ireland Assembly

The Minister did not comment on the four points I am going to raise on the spending issue. No additional money has been given to elective surgery in the last four or five years. Therefore, extra demand affects GPs and primary care. Elective surgery has been cancelled over and over again in hospitals across Northern Ireland. To consider the debate sensibly and positively, one must take that point into account when talking about fundholding.

The second point is that there are fewer hospital procedures - meaning operations and other types of procedures - with increased, higher-than-inflation costs. That puts more demand on primary care. The Minister has tried to reduce waiting lists, but only with token money. The main money went into acute services, and we understand the reasons why. However, that put more pressure on fundholders.

On the question of overspend in hospitals, the Royal Victoria Hospital was mentioned earlier as having a massive overspend. Belfast City Hospital is in the same situation. Almost all the hospitals have overspent.

Let us take the Eastern Health and Social Services Board as an example. Let us say that it has a contract with a main hospital and things get to the stage where the hospital has overspent. The board will then state that no more money will be forthcoming. However, GPs are buying per item of service - that is not normally the way it is expressed, but factually that is what the situation amounts to. Therefore, if the hospital is overspent it will use fundholders to bail it out.

To look at the problem from another angle, if someone presents themselves at hospital with chest pain or with acute symptoms of cancer, can a general practitioner tell a patient that his budget does not allow for the patient's care? There is no way that that can happen. The Minister did not address those points. It was all about pushing at the primary care people and it is costing money. The hospitals are costing money. The way they are run - by trusts and boards in Northern Ireland - is what is costing money.

The acute hospitals review is coming up shortly. With respect to acute hospitals, the Health Service is in a mess and the situation goes back for many years. Hospitals and primary care are interwoven.

The Minister mentioned overspend and she also spoke about perpetuating inequalities. I think I have addressed those points. There has been chaos in many hospitals, with people lying on trolleys. If the amendment is defeated there will be chaos in primary care. I do not want those who are opposing the amendment, including the Minister, to wash their hands and walk away from that responsibility.

The Health Service boards have been around for years and have been running practices as non-fundholders. Have they succeeded? No, they have not, and we are moving backwards instead of forwards. This is not a sectarian debate, it is one about the future of primary care affecting every man, woman and child in Northern Ireland. The proposals are top-down, not bottom-up. The Prime Minister and others talked about a primary-care-centred Health Service. That is not happening here, but was in the 'Fit for the Future' document.

The Minister put great emphasis on the point that she would give a remit to the boards. However, we know a wee bit about remits going to the boards. Remits were made to children's services - we discussed them in the Health Committee. I wrote to the Minister about the fact that money that should have been ring-fenced was being earmarked for children's services. This is a criticism not of the Minister but of the system. In her reply, she said that the applicable word was "earmarked", not "ring-fenced". If the Minister is going to give remits and funding to the boards, she may advise them on what they should do, but the boards will do what they feel is necessary if their hands are tied financially. Most of the money is given to acute hospitals, but I will not repeat that point.

The Minister said that pilot schemes are a different issue. That is correct in the context of the debate on this legislation, but they are very much part of the issue. I believed - and most people in primary care believed - that the pilot schemes in Northern Ireland were to be the centrepiece for a new primary-care-led health service. Therefore they are very much part of this discussion. It would have been a positive move if the Minister had indicated that the pilot schemes, which have had outstanding results, were to be continued.

This is not a sectarian debate; it is about the future of primary health care. The people of Northern Ireland deserve the best - for heaven's sake, let us give them the best.

Question put, That the amendment be made.

That concludes the Further Consideration Stage of the Bill, which now stands referred to the Speaker.

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North/South Ministerial Council: Ministers' Attendance

During a statement by the First Minister and the Deputy First Minister at the Assembly sitting of 22 January 2001, Mr Ian Paisley Jnr put forward a reason for the non-attendance at a meeting of the North/South Ministerial Council of the Minister for Regional Development. Mr Paisley indicated that the Minister's non- attendance was in line with his election commitment to oppose "North/Southery".

Subsequently, Mr Maskey raised a point of order, asking whether the Minister would be in breach of the Pledge of Office by adhering to party manifesto commitments rather than to the Pledge of Office. I undertook to give a ruling.

Ministers are legally bound by the Pledge of Office set out in schedule 4 to the Northern Ireland Act 1998. Once nominated as Ministers, and having accepted the nomination, they must, under section 18(8) of the Northern Ireland Act 1998, affirm the Pledge of Office before taking up office. The obligations contained in the Pledge of Office are therefore legally binding and override any contrary political commitments.

I remind the Assembly that to date I am unaware of any situation in which a Minister who has been nominated to attend a meeting of the North/South Ministerial Council has declined to do so. In such circumstances the Minister is likely to be in breach of the terms of the Pledge of Office. Comments from Members who are not Ministers cannot be taken as an indication of a Minister's intention, irrespective of the party affiliations of the Members involved.

I understand that the High Court recently ruled on North/South Ministerial Council attendance, and I shall be studying this ruling with interest.

Finally, with regard to the remit of the Speaker, I should remind the House that, while it is open to any Member to challenge a Minister's alleged failure to attend if he or she so wishes, it is not a matter on which the Speaker will rule. The move can be made in a number of ways. A Member may table an Assembly question, written or oral, to ask the Minister about his or her alleged non-attendance and/or his or her future intentions; a Member may apply for a judicial review for it to be determined whether the Minister's alleged decision not to attend is in conflict with the obligations of the Pledge or Office; or a Member may initiate the procedure for exclusion provided for in section 30 of the Northern Ireland Act 1998.

I trust that that clarifies the position.

Mr Speaker, have you received notice from the First Minister that he intends to come to the House to make a statement about his failed sanction on Sinn Féin/IRA following the High Court's decision this morning?

I have received no requests from any Ministers to make statements. As a member of the Business Committee, the Member will be made aware of any statements that arise.

Maternity Services

I beg to move

Maternity service provision has been an important issue for some time. The debate on this issue began in 1994 with the acute hospitals reorganisation project under Dr McKenna. Out of that exercise came the 1996 maternity services paper, which looked at the two options - location at Belfast City Hospital or at the Royal Victoria Hospital, with either refurbishment or a new block. The recommendation was that maternity services should be located at the tower block of Belfast City Hospital for clinical reasons - and I want to stress that point, for the clinical arguments have become somewhat clouded of late. Those clinical reasons were that the key services, namely gynaecology, neonatology and obstetrics - and other related services - would be kept together.

This was accepted by the then Health Minister, Mr Malcolm Moss, and finalised in 1997. Unfortunately, management at the Royal Victoria Hospital adopted a typically self-centred and empire-building attitude and raised a row over this decision, and the result was that a review was undertaken under Liam Donaldson in 1997. From the start, it was evident from both the membership of this committee and the fact that its remit was widened - after some petty lobbying - that this review would reach one conclusion only: location on the Royal Victoria Hospital site. Every argument, either fair or foul, which could be used to back the Donaldson line has been and is being followed, and that has been the difficulty with this issue since 1997.

For example, the ridiculous argument has been put forward that sick babies would die if maternity services were to go to Belfast City Hospital. That allegation is not only unfounded, but completely and utterly untenable. If it were true, there would be no maternity services in Northern Ireland.

Instead of decisions being made on sound, logical and clinical grounds, other criteria are being used, and the decision to locate maternity services at Belfast City Hospital has thus been overturned.

However, the flawed nature of that decision meant the matter's being taken to the High Court by Mrs Claire Buick, and the court ruled in her favour that the decision had been procedurally unfair.

In the course of making his ruling, the judge quoted Donaldson's view that on clinical arguments, Dr McKenna was right. The judge that said it was "understandable and justifiable". That point also needs to be emphasised, because we are given the impression that neither Dr McKenna nor anyone else knew what they were talking about. The result was yet another consultation exercise that began in July 1999, and another report was published - and if ever there was a slanted document, this was it. Every possible red herring was dragged into it, while obvious issues were ignored. There were references to other linkages that were never spelt out. In short, it was a cover-up - and an expensive one at that. This was a consultation exercise that did not consult. This was a document that was short on hard evidence.

It was, and remains, extremely disconcerting that the entire consultation process was interfered with by clinical blackmail. I use those words deliberately. The decision by paediatricians to withdraw cover from the City Hospital was a deliberate move to coerce the Department and circumvent the overwhelming clinical evidence that favoured the City Hospital.

As clinicians have done elsewhere to good effect, they demonstrated that the only thing that matters is the policy of a clinical group - everyone else can go to pot. They wanted the Jubilee closed and decided that the way to achieve that was to go on a form of strike.

Following the equally flawed consultation process, we were then treated to the rather bizarre situation of a new Minister of Health, using all her narrow sectarian bias, deciding that maternity services were to go to the Royal Victoria Hospital. Unfortunately, it has been a ministerial decision that was wrong - clinically, socially, politically and legally. The Minister's decision to close the Jubilee, in the face of every rational and clinical argument, has resulted in a shambles that has turned our maternity services into what could be termed a joke, if it were not so serious.

It was a bad decision for our mothers across the country - hence the enormous campaign against the closure of the Jubilee. The Jubilee philosophy was an enormous benefit that has been destroyed.

It was a bad decision clinically. The Minister was unable to furnish a single rational, coherent and intelligent clinical argument in favour of her decision.

It was a bad decision politically. The Health Committee, on which I serve, voted overwhelmingly to retain the Jubilee. The Assembly also debated the issue and voted to retain the Jubilee. Yet, the Minister of Health, Social Services and Public Safety chose to ignore that.

Finally, it was a bad decision legally. A High Court challenge to her decision rightly followed. That demonstrated once again that the decision was flawed. Twice there has been a High Court decision on this issue. Each time, the Department has been found guilty, though in the recent case it was the Minister who was found guilty.

The motion calls on the Minister, in view of the decisions of the Assembly Committee and the Assembly itself, to give due weight to the High Court ruling that overturned her decision. I remind the Assembly of the need to obey the law, the need to give due respect and regard to the Health Committee and ultimately to those mothers and clinicians, all of whom argued in favour of the City site from the beginning of this process.

There is a growing body of evidence that this Minister has only one objective - to ensure that any service that can be relocated to the Royal Group of Hospitals will be placed there. It seems that we are going to see the very same wrangle over dermatology. I make that statement about the Minister on hard evidence. The Minister, in announcing her decision on maternity services, said that it was done on the best clinical advice. Some questions need to be asked of the Department. Where is that advice at present? What was that advice? Who gave the advice in the end? All of this remains hidden. I challenge the Minister and the Department to give the public the information that she and her Department have so far refused to divulge. We all wonder why.

This is decision-making by fiat, not decision-making following the normal rules of clinical, democratic and rational debate. Let us not ignore the cost of this decision. Forty staff have left the Royal as a result of the closure of the Jubilee. Services are continually being closed because of staff shortages. The wards are filthy, and mothers who are used to the level of care at the Jubilee are finding themselves treated increasingly as nothing more than clients who are to be moved out as quickly as possible.

Some warned not only that the closure of the Jubilee would be a disaster but that the short-term decision would also become a long-term millstone. Where is this new building that was promised? Where is the excellent service that was promised?

What we get instead is money slipped into the budget of the Royal Victoria Hospital to try to help it out with its wild spending spree. We get fobbed off with more and more reviews that never seem to come to any conclusions. We get public money squandered on bad health decisions that are defended in court - public taxes defending the indefensible - when it ought to be spent for the benefit of those from whom that tax was lifted.

The Jubilee should never have been closed. The Assembly needs to regain control of the situation to see that every step is taken to send all services to the City tower block or to see that a new block is built at the City Hospital for the right clinical reasons, not for narrow political self-interest. The current Minister of Health has become the "monster of health", fully evidenced in her irrational decision to close the Jubilee without any firm replacement, in the face of every sound argument.

Finally, I want to return to a statement from the Belfast City Hospital consultants. They quite clearly say:

It is important that we listen to the words of those professional people and the consultants, who know more than, possibly, everyone in the Chamber. They also went on to say:

The motion calls on the Minister to act in accordance with the Assembly Health Committee, the Assembly itself and, ultimately, with the High Court. I commend it to the House.

This morning the Chairperson of the Health Committee said that the matter being discussed then should not be treated in a sectarian manner. That applies to this debate equally. The priority, as all Members in the House would agree, is the interests of the baby and the mother. That can and should transcend both Unionism and Nationalism, and particular constituency interests.

The fact that we are returning to debate this motion, which was considered almost exactly a year ago in the House, suggests major problems both with the content of the Health Minister's decision and with the manner in which she carried out that decision - as ably described by the proposer of the motion. The Minister on that occasion managed to override both the majority preference of the Health Committee and what was shown subsequently to be the majority of opinion in the Assembly.

Over a century ago a particular Prime Minister, Lord Salisbury, said that we should never trust experts. In this case, since most of us, including myself, have no particular medical expertise, we have had no alternative but to listen to the many experts in this field. They have, of course, sometimes given conflicting advice. It has to be said - I suppose I differ a little from Mr Berry - that strong clinical cases were made in favour of both options, which were an integration of the services on the site of the Royal Hospital or, alternatively, at the Belfast City Hospital location.

We should also recognise and pay tribute to the high quality of the service previously offered at both the Royal Maternity Hospital and the Jubilee, though there were some distinctive elements between the two locations in the manner in which maternity services were provided.

Nevertheless, and notwithstanding all that, I considered the so-called expert advice, and I found that the most convincing arguments were those which said that maternity services should be beside a major centre for women's health care, including cancer, rather than being physically beside a children's hospital. As the proposer noted, that principle was recognised in the 1997 McKenna Report. It was not really challenged in the subsequent Donaldson study. Indeed, it is consistent with practice elsewhere in the United Kingdom.

Both options have their attractions, and neither is ideal. However, I believe that the balance lies with the City Hospital, because of the likely flow of mothers requiring other medical services, as opposed to the probably smaller movement of babies between a maternity hospital and the Royal Belfast Hospital for Sick Children.

I will conclude with two general points. First, Ministers must not be allowed to become feudal lords, exercising unaccountable power in their own fiefdoms. The outcome of the debate on the Further Consideration Stage of the Health and Personal Social Services Bill is perhaps significant in this context. Secondly, it is right to give attention to the issue of the distribution of maternity services. However, we must recognise that the House will have to move on to consider what can be done about other medical specialisms and activities, which by all reports are facing pressure and are close to breaking point.

I support the motion. It is a marker, which indicates that when the Assembly comes to finalise or approve the building of a new integrated, modernised maternity service in the city, that it should be on the Belfast City Hospital site.

I support the motion. One year ago, less a day, we were debating the siting of Northern Ireland's regional maternity hospital. We are back debating the same issue today. What a waste of time and resources. Is there any point in further consultation?

The Minister stated that it was her decision that the regional maternity hospital would be located at the Royal Victoria Hospital site, adjacent to regional paediatric services and near to the accident and emergency department. I did not agree with her then, and I do not agree with her now. More importantly, the judge in the most recent judicial review of the case did not agree with her decision either.

This time, it is essential that there be an open and accountable decision-making process. That was not the case previously. The judge said that it was somewhat unusual for the Department not to create minutes, notes or any other records of meetings held with medical, nursing, economic and legal advisers. Furthermore, the consultant obstetric staff at the Jubilee Maternity Hospital asked to see the clinical evidence upon which the Minister made her decision. However, this request was refused. The information only came to light in the judicial review.

The Minister emphasised that the choice between the Royal Victoria Hospital and Belfast City Hospital sites was a close one. In the final analysis, she concluded that maternity services would be more clinically effective if located adjacent to regional paediatric services and the accident and emergency department on the Royal Victoria Hospital site. Despite the prolonged consultation process, the Minister allowed the advocates of the Royal Victoria Hospital site to introduce a new factor at the last moment - proximity to accident and emergency services. However, those advocating the Belfast City Hospital site were not given the same opportunity. The proximity of accident and emergency appeared to have perhaps become the deciding factor.

However, if a woman requires emergency admission while pregnant, she does not go to the accident and emergency department for treatment. Instead, she goes to the early pregnancy unit for specialised care. The proximity or otherwise of an accident and emergency department is fairly irrelevant.

Central to the Belfast City Hospital's case was the proximity of the majority of gynaecological services and gynae-oncology. The Donaldson and McKenna Reports also agreed that that was an important factor. That is also the view of the Royal College of Obstetricians and Gynaecologists. However, the Department's advisers did not think that it was a strong argument.

There also seemed to be a presumption that gynaecological services would eventually go to the Royal site. The clinicians in the field - practising obstetricians and gynaecologists - believed that proximity to the adult intensive care unit was very important for critically ill mothers. On the other hand, the Minister's advisers thought that high-dependency beds, which would be in the maternity unit on either site, would suffice. The clinicians in the field would certainly take issue with that. The latest report by the Royal College of Obstetricians and Gynaecologists nowhere states that paediatric services need to be beside maternity services.

This time last year we had two maternity hospitals that were both excellent, though perhaps different in ethos. Where do we go from here? We are on a merry-go-round of reports, consultations and judicial reviews, which are all sucking up funds that should be used for women and babies. This time round, I ask the Minister to listen and approach the issue with an open mind. We want the best regional maternity services for all women and babies.

I commend my Colleague, Mr Berry, for tabling this motion down for debate. The decision to close the Jubilee ranks as one of the most ill-thought-out decisions a Minister has made so far in this Assembly. The High Court decision makes very sad reading. In fact, the more I read it, the more amazed I am that anyone could have been so blinded as to actually defend the closure of the Jubilee.

The judge noted that it is the Minister, Barbara Brown, to whom Parliament has entrusted this decision. The judge repeated the view that the three key services of maternity, neonatology and gynaecology should be kept together, that Donaldson had agreed to that, that it was a central issue, and, further, that the Department itself had accepted that very point, only to come back later on and say that it did not consider that it was a strong argument. That demonstrates that it knew that it was a very strong argument but, in order to back the Minister's decision, it had to reverse that view and say that it was not.

Even more interestingly, it transpired that the origin of the idea of separating obstetrics from gynaecology came from the Royal in order to justify its intention to have maternity on its site. To make matters worse, gynaecology has been thrown into confusion as to where it ought to be. Hardly good medical practice. The judge put it much better. He said:

Here we have either a Minister making decisions based on half of the facts or a Minister being deliberately misled by her Department. What heads have rolled over that? Who was responsible for failing to tell the Minister? The judge said:

To make matters worse, we have an argument based on accident and emergency services thrown into the equation. We were told that that was the clinching argument. Nowhere else in the world and in no other clinical body of evidence has that argument ever been used. However, here we have it, and it came from the management of the Royal. When it comes to specious arguments, the management of the Royal can do it in a style that no one else can. It is no wonder that the judge said that

The Royal was allowed to introduce a new factor without giving Belfast City Hospital any opportunity to consider it. Had the Minister understood what was happening she would have immediately thrown it out or extended consultation on the point. However, she failed to do that, and we all know why.

Had that been all, it would have been bad enough, but what follows is quite extraordinary. A letter about maternity services from Dr Hendron on behalf of the Health Committee created a frenzy in the Minister's mind that a decision had to be reached as soon as possible. The judge drew attention to the "unusual decision"

How can that be? What prompted such a decision? Could it be that there was information that the Minister did not want recorded, knowing full well that her decision was suspect, illegal, immoral and clinically unsound?

The judge also ruled against the Department on the intensive care unit argument, saying that

What a damning indictment of the Minister and her entire Department as it scratched around for something - anything - that would get the Jubilee closed.

Even that is not the end. The judge summed up by saying that the Minister

The Minister was persuaded

Thus the Minister's decision was quashed.

It is imperative that the Minister undo the damage that she has inflicted on maternity services. She has destroyed the best maternity centre in Belfast - the Jubilee - which had a philosophy that is found nowhere else. It was a mother's dream. Mothers had choice and control, but that has been taken from them. The Jubilee's breastfeeding programme was the best in the Health Service. Its ethos of childbirth ensured that, unlike elsewhere, mothers were mothers and not machines. Now nurses are demoralised, staff are leaving by the score, and what have we got so far? Nothing.

If it were any other Minister or party, I would feel confident that the lessons learned from the judicial review would allow the proper outcome to be realised: a first-class maternity service based at Belfast City Hospital. However, given the nature of the individual and the party she represents, she will totally disregard the judge's findings, the Health Committee's majority vote in favour of the Belfast City Hospital site and the Assembly's support for the City. So much for a new beginning.

Undoubtedly, the Minister's party will be demanding reinstatement to the "North/Southery" following the court decision in its favour today. Likewise, we demand that she and her party - in light of the recent judicial ruling against her decision - immediately act and redress that decision. I support the motion.

Go raibh maith agat, a LeasCheann Comhairle. I listened attentively to what Dr Birnie said, and I agree that this ought not to become a sectarian or political debate. However, when I hear words like "the monster of health" being mouthed by a member of the DUP I find it difficult to come to any other conclusion than that this is a politically motivated debate entertaining a degree of sectarianism from that party. I cannot explain in any other way why that kind of language, which we are unfortunately too familiar with, should be reiterated in the Assembly. I do not intend to play sectarianism with the DUP or its representatives here today.

It is a year since we discussed this matter - a year that has been spent in the courts battling over an issue that, as I said at the time, Belfast is fortunate to have. Coming from a rural constituency where we do not have maternity services, or at least we have a very meagre maternity service, I find it astounding to see people arguing over the siting of two hospitals within kicking distance of one another, and whether they should have a maternity service.

The judicial judgement that overturned the Minister's decision was based on the process and not the actual decision. I listened to the radio this morning and was reminded that Baroness Denton made one decision and Tony Worthington made another decision. The Belfast City Hospital versus the Royal Victoria Hospital has been kicking about for a very long time. Perhaps we thought we had resolved it at last.

We heard talk about the overwhelming majority in the Committee, but there was not an overwhelming majority in the Committee. The Committee voted 7 to 4. A year ago the Committee Chairperson, Dr Joe Hendron, said:

To suggest that there was some kind of overwhelming unanimity about the location of this hospital is to be totally misleading about the debate that ensued over the provision of such a critical area in the lives of mothers.

To use words like "filth" about the Royal Victoria Hospital can only have the most detrimental effect on the mothers who go there. It can only have a detrimental effect on the people of west Belfast to insinuate, comment or make a statement that somehow the Royal Victoria Hospital is a second-class service; it is redolent of days that we thought were behind us. It is, in many ways, a political debate clothed, as usual, in the kind of sick hypocrisy that we get from the DUP. I said that I was not going to get involved in mixing it with the DUP but unfortunately one is led tentatively off the path - c'est la vie.

A LeasCheann Comhairle, I said that this is too serious an issue to be used as a political football. I said here last year that

That was last year, and what do we have today?

I continued:

I would like to think that that is still the mind of the Minister.

As other Members have done, I remind the Assembly that tomorrow it will be one year since we last debated this issue. One year on, it seems that little progress, if any, has been made towards the creation of a central maternity unit joined with a specialised paediatric unit. In fact, we seem to be going backwards. Who suffers because of our inaction? Mothers and children, of course - and, indeed, fathers.

This saga has been going on for at least eight years and has been subject to widespread consultations, numerous reports, and now several judicial reviews. In a sense, the motion is meaningless and superfluous. The Minister cannot do anything other than comply with the rulings of the courts and, to be fair, she has not indicated that she is going to do anything differently. It could be said that the motion is little more than a pathetic attempt by the DUP to score political points against its opponents - namely, Sinn Féin. If we had a DUP Health Minister - and that could have been the case had the DUP had the courage to accept the portfolio - would there be the same opposition? I very much doubt it.

When the Alliance Party voted on the issue, it sided with the Minister's decision to relocate maternity services to the Royal Victoria Hospital. However, every Member of the Assembly labelled Nationalist voted to support the Minister, while every Member labelled Unionist voted against the Minister. If every debate in the Assembly on major socio-economic issues becomes polarised along Unionist/Nationalist lines, what kind of -

On point of order, Mr Deputy Speaker. I want to put it on the record that, although perceived as a Nationalist, I did not support the siting of maternity services at the Royal.

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