Northern Ireland Assembly

I accept the Member's comments.

If every debate in the Assembly on major socio- economic issues were to become polarised along Unionist/ Nationalist lines, what kind of message would we be sending to the wider community about how the Assembly is going to conduct its business? Fortunately, there was cross-party support this morning. That is to the Assembly's credit.

The original vote on maternity services did not have cross-community consensus and could not pass the safeguards created under the agreement. If we keep going in this way the potential for deadlock is clear. Most issues facing the Assembly are about the future. They do not, and should not, have anything to do with our ancient tribal squabbles. The health of our people must come first, be it our newborn babies or people coming to the end of their lives.

In a sense, the debate has now moved on. It is now recognised that maternity services have been consolidated elsewhere in Northern Ireland. That has to take place in Belfast. The Jubilee site is no longer an option for maternity services. Indeed, it has been earmarked for a new cancer unit for Northern Ireland. I say to the Assembly that the sooner that vital facility is in place, the better for everyone.

Notwithstanding the court's decision on the procedures adopted by the Minister, Alliance still believes that the Royal Victoria Hospital is the best site for the Belfast and regional maternity unit. We are fed up with review after review, consultation after consultation, without anything being done to improve our health facilities. The main reasons are clinical. The existence of a full range of specialised paediatric services on the Royal site must be the decisive factor. Maternity services can be concentrated in Belfast, adjacent to and connected to the Belfast Hospital for Sick Children. Expert opinion suggests that maternity, neonatal and paediatric services should, ideally, be located on one site. A panel of independent experts, led by Prof Liam Donaldson, suggested that course of action. I take exception to the accusation made earlier that the outcome of their deliberations was predetermined.

For 90% of women, pregnancy is relatively straightforward. Significant problems arise in about 10% of pregnancies. One to 3 per cent of babies require neonatal intensive care. When complications arise, speed is of the essence. Transport from other hospitals not only adds time, but can create further complications.

Not every woman will give birth at the Royal, but surely it makes sense to maximise the number of births by providing easy access to specialised paediatrics? The United Nations Convention on the Rights of the Child states that decisions affecting children should be taken with their best interests at heart. That is central to our thinking when advocating a children's commissioner for Northern Ireland, as my Alliance Colleagues here will be doing later. Women require a service in which they feel safe and in control. Regional and national policy guidance for maternity and related services emphasises the need for woman-centred care, continuity of care and the provision of choice. A full range of gynaecology services can be found on the Royal sites. The Royal Maternity Hospital has the appropriate woman-centred service. It should therefore be possible to create on the Royal site a specialised maternity unit linked to paediatrics. I understand that the main reason for granting a judicial review of the Minister's decision was the failure to consult adequately with respect to gynaecological services. However, the point was missed that such services were available on both the Royal and the City sites.

Finally, there are some non-medical reasons for supporting the Royal Victoria Hospital. One is its relatively easy access to the road network. That, as has already been mentioned, is very important indeed. Another is the provision of parking. Policy appraisal and fair treatment (PAFT) analysis also suggests that the Royal option would increase the prospect of antenatal appointments being kept by women from deprived areas.

I must express disappointment at some of the phrases used and accusations made by Mr Berry, who moved the motion. In view of my party's earlier stance on that provision, we cannot support the motion and will abstain. We must be realistic. The Jubilee Maternity Hospital is no more. The new provision on the Royal site must go ahead. No more time-wasting - action is needed now.

On a point of order, Mr Deputy Speaker. I should perhaps have declared an interest while I was speaking. I was employed by the Health Service until I was elected to this body.

Thank you for that. The Member has set a very good example to everyone in the Assembly in declaring an interest that it is important for us to know of.

This remains a difficult debate, and the matter has yet to be resolved. My decision at the time was that the merger should not happen until we had a new purpose-built hospital, not solely for the women of Belfast, but a regional hospital with a neonatal unit. I remain very concerned.

I do not want to go over the arguments that I put to the Minister at Question Time two weeks ago, but it is important that we keep in mind that the process needs to be moved forward rapidly. There is overcrowding. Six thousand mothers and babies have been put into an old hospital, whose chief executive would agree that refurbishing it in order to bring it up to the standard for accommodating such numbers was all that was done. He was never in favour of it being a permanent solution. From speaking to him and his counterpart in the City Hospital, I know that they want a decision to be made on the siting of a new hospital.

Uncertainty creates many morale problems and there is an issue of morale attached to this decision at the moment. Having visited Ward D in the Royal Victoria Hospital, I never believed I would see such conditions. I gave birth myself in that hospital many years ago. The present conditions do not reflect the dedication of the wonderful midwives; they reflect the standards under which these people have to work. There used to be 17 beds. There are now 15 beds sitting alongside each other. There was no room to move. The beds were along the middle of the ward and there was one bathroom. I saw that for myself and it cannot be disputed. I have since been told that the midwives have to tear up blankets in order to have enough for the newborn babies. This is a new century, and no mother should have to watch that going on in a ward.

I remain deeply concerned that unless we move forward on this issue all we are doing is overburdening and stressing an already demoralised staff. We do not need a lengthy consultation process because many of the arguments are already there.

Members have reiterated the arguments on paediatrics versus gynaecology and obstetrics. Unfortunately it seems that the paediatricians had a very strong voice in the last consultations. One of the senior midwives tells me that they have visited brand-new, purpose-built maternity hospitals elsewhere in the UK and it is not the case that they have been located next to a paediatric unit. Consultants tell me that it is dangerous to move a sick baby. They say that one should stabilise the baby's condition and then carry out whatever surgery is necessary. They say that it is much more dangerous to move a sick mother and that intensive care facilities should always be where the mother is, particularly if urgent gynaecological surgery is required.

I want to pay tribute, as my younger sister almost died as a consequence of needing an urgent gynaecological operation, which was carried out speedily because the intensive care facility was close to the gynaecological ward. The evidence continues to point to the fact that gynaecology and obstetrics should remain close to mothers and the maternity unit.

I do not want this to be a debate about buildings; it needs to be about mothers and babies in Northern Ireland and their needs. The development has already gone ahead. Any location on the Royal Hospital site would not be close to the intensive care facilities and urgent transfers would have to be made across considerable distances. None of us wish to see fatalities rising as a consequence, particularly those during pregnancy, when we have done such wonderful work in reducing the numbers of deaths during childbirth.

We have heard from the oncologists - and there cannot be anything worse than being told that one has a gynaecological-related cancer problem and that treatment will be given at different sites. A leading consultant in Northern Ireland on gynaecology was asked whether it would be possible to provide the same quality of service to patients if all gynaecological surgery were to be performed on the Royal Victoria site rather than the City Hospital site. His answer was an emphatic "No". He said that such patients need efficient and fast treatment from a physical and psychological point of view. He added that a move from the City Hospital to the Royal Hospital would be a retrograde step.

We heard a great deal about a "seamless service" in the debate on the Further Consideration Stage of the Health and Personal Social Services Bill. The plea is being made here for a current seamless service, which would not be obtainable if the two units were to be separate.

I introduce that because when the project board sat down to look at maternity services, it found the issue of gynaecology so difficult that it left it for a future date. However, we cannot do that. All of us know and understand that if you need surgery, you should try to have as many of the people who are involved in those decisions as possible located on the same site.

We are talking about a women's hospital. Let us not concentrate on the small number of babies who are sick but on the large number of women who give birth under normal circumstances and whose outcomes are predictable. It is clearly the case that there are a number of unpredictable outcomes in relation to pregnancy, and that is when you need neonatal services to be at their best. I remain concerned about the neonatal services at the moment, having been told that they were closed to outside admissions on three occasions in December. One woman was transferred to the Royal Victoria Hospital from another hospital on Christmas Eve. There were insufficient cots, and so she had to be moved again to the Craigavon neonatal unit. That is not good for our regional neonatal services, as they are being told that they are simply taking the overload. Why can they not take women with babies at other times of the year? We are sending very bad messages to the regional services outside the centre, which is supposed to be the centre of excellence.

It is no reflection on those working in the Health Service. It is because we do not have sufficient neonatal nurses. They are having to try to be innovative in the way that they deal with very sick babies in the intensive care unit at the moment.

Medical negligence cases remain an awful issue. Let us not have a Health Service that has to pay out huge sums of money for medical negligence. We saw in the budget for health and personal social services last year that over £3 million was paid out. Let us be forwardthinking and try to plan for these emergencies so that we have services in place where surgery can take place effectively and efficiently.

Ms Carmel Hanna has already outlined the issue of accident and emergency departments. It was extremely unfortunate that this was brought in as a separate issue and, as the judicial review pointed out, a rather irrelevant issue in the end. The consultants make the point that since accident and emergency has remained on the City Hospital site, and since gynaecology services are also located on that site, we should integrate and co-ordinate them, and that it would be a disaster if we were to create isolated units elsewhere.

Another question is the biased and non-independent nature, not of the consultations but, initially, of the project board. If another one is ever established, it needs to be independent. There were three representatives from the City Hospital and nine representatives from the Royal Victoria Hospital, and it was chaired by the chief executive of the Royal Victoria Hospital. I am not at all disparaging of the roles of professionals in the Health Service. All I am suggesting is that there is a conflict of interest if you are the chief executive of one hospital and are attempting to make a decision on any site, move or merger. You cannot possibly be asked to do that if you are simultaneously putting in a business case for that to be on your own site. It is unfair to ask anyone to chair such a board and try to remain independent at the same time, never mind the fact that the numbers speak for themselves.

We have had the mistakes. Let us address them. They say that the meaning of silliness is to do more of the same and expect a different outcome. We cannot afford to do more of the same.

The other question is how much the judicial review of the Buick case and the more recent Hindes case cost. The figures are not based on any empirical evidence - I have asked those questions and am awaiting an answer. We know that it is expensive to take cases through the courts - those cases cost over £1 million. I am still waiting for a response from the Department. The Chairperson can confirm that when officials from the Department came to address us over a month ago, I asked for the figures. How often have we been taken to judicial review? We should not be letting the courts make these decisions. We should be attempting to be independent and basing decisions on clinical evidence and evidence from women, women's groups, community groups, midwives and many others who are working at grass-roots level in the Health Service.

I am not just making a plea for an integrated service, which is the most important priority. We also need to avoid following the project team's suggestion of separating pre-natal gynaecological services from post-natal services. That cannot be allowed to happen, because many gynaecological matters must be dealt with together. During the training of specialist surgeons in this field, no distinction is made between pre-natal and post-natal patients. Their expertise is derived from their experience in dealing with problems right across the spectrum.

When I read the judicial review I was also concerned about the breach of the need to be fair. This is a fairly damning indictment, and the issue must be addressed. There were neither notes, minutes nor records kept of crucial meetings. When we got devolution we promised that we would be accountable and transparent. Without transparency, how can we expect action groups to be well-informed? We need women to be active in our constituencies.

Finally, we should move quickly down this road, because the issue does not just affect Belfast City Hospital and the Royal Victoria Hospital. It has implications for the Mater Hospital, Lagan Valley Hospital, the Downe Hospital and the Ulster Hospital as well. In response to Mr McCarthy's final points, I must say that the vote should not have been described as being split between Nationalists and Unionists. I also voted in the Lobby, as I did on the Committee, for the Jubilee to remain open, yet Members know that I am from the Catholic community and am so perceived. It is time to move forward on this issue.

I will be concerned if the private finance initiative is to play a predominant part in this decision-making. As Members know, on previous occasions I have spoken out about introducing private finance into the National Health Service. If that is to be a part of the decision on a new maternity unit, I would like a debate on the matter to take place now rather than at the very last stage.

As a representative of a rural constituency without a maternity service, I support the motion, which calls for the retention of, or improvement work on, maternity services in Belfast. It should be carefully noted by the Minister, since the issue of Belfast's maternity services will not go away until it is addressed in a consistent manner. Northern Ireland and Belfast need a good maternity hospital. The saga of maternity service provision in Belfast will continue following the Minister's decision to issue a directive in favour of the Royal Victoria Hospital and her claim that the decision was her prerogative, which she said could not be challenged. This decision flew in the face of the recommendation of the Health Committee, which favoured the Belfast City Hospital as a site for the maternity hospital. The decision also highlighted the derisive way in which the Committee was treated by the Minister.

However, it transpired that the Minister's prerogative could be challenged in the High Court. I am not surprised by the Department's and the Minister's shabby treatment of Belfast's maternity services, for my area of South Tyrone has also been treated shoddily on this subject. My constituents in Fermanagh and South Tyrone received countless promises that the removal of services was merely temporary, yet every single promise to restore services was broken.

South Tyrone Hospital was promised a midwifery-led service, and it is still waiting for it. The Department of Health, Social Services and Public Safety has failed to address this very important part of the Health Service quickly, and this failing must be addressed immediately. The Department and the Minister are failing in their duty to ensure the equality of treatment envisaged in section 75 and schedule 9 of the Northern Ireland Act 1998.

The relationship between the Department, the health boards and the trusts is called into question - it has always been rather too convenient in the past to keep passing the buck. The Minister must take responsibility for the failure to provide adequate maternity services for the people of Northern Ireland, in the Belfast area and, particularly, in my area of South Tyrone. I would welcome the return of maternity services there.

This sorry affair of the problems of the Belfast maternity service is merely the tip of the iceberg, and it must be resolved quickly. This is too important an issue for the Minister to make a decision on it without referring to her Committee, the Executive and the Assembly. She and her Department are not infallible. I support the motion.

I call Dr Hendron, who, I think, will be speaking as a Back-Bencher rather than as Chairperson of the Health Committee. Is that correct?

It is sort of half-and-half, Mr Deputy Speaker.

First, I apologise for not being here for the beginning of the debate. I understand and respect the motion put forward by Mr Berry. I have spoken on this subject on many occasions in the Chamber, in the House of Commons and in other places over the last few years. I have not had an opportunity to study the judgement that this debate is really about.

This debate is a very important one, and the matter should have been resolved long ago. People talk about empire-building, and I do not want to point the finger at any one person or hospital. However, the senior staff of the Royal Maternity and City Hospitals could have had this resolved years ago. Nevertheless, as this important matter will be coming before the Health Committee, I shall make no further comment until then.

Go raibh maith agat, Mr Deputy Speaker. Dr Hendron has caught me unawares - he was so quick. I was trying to concentrate on the next debate. I am getting a beating for this morning, Joe!

The decision on the site for a new hospital for women and babies throughout the North has been due for a number of years, and the building of a new site will delay that decision. As a member of the Health Committee who voted in favour of the Royal Victoria Hospital, I believe that my decision then was the right one, and I uphold it. I based that decision on much evidence mentioned earlier today but also on presentations from a number of groups, in particular those from the Shankill Women's Centre and the Falls Women's Centre. They all pointed to the need for proper maternity services, and they indicated that the Royal was the best option.

The Minister made her decision based on what were the best options for parents and babies and on the clinical evidence which was presented to her. I would like to point out that the judicial review and the judgement were based on the consultation process and not on the decision on where maternity services should be placed.

After taking up her role in the Department, the Minister visited both the Royal and the Jubilee. We must give her credit for the consultation process she was involved in, because she did speak with interested parties herself.

A Member spoke earlier about the report and the recommendations from Dr McKenna and Prof Donaldson. It was pointed out that this acute hospital reorganisation project, which was set up in 1994, and headed by Dr McKenna, made 28 recommendations, 27 of which were accepted by both the City Hospital and the Royal. A second report was commissioned, chaired by Prof Donaldson, and he concluded that to provide the best possible services, maternity and paediatric centres should be side by side.

As Mrs Carson and John Kelly pointed out, we need to emphasise that this is the new regional maternity centre for everyone. We are talking about hospitals whose sites are 1·5 miles apart, and rural people do not have such a luxury. Not all Committee members endorsed the recommendations; the vote was 7-4.

Members have already spoken about confusion in the Health Service. This ongoing saga of maternity services in Belfast has added more confusion, not only to the staff but also to mothers and babies and families. As Monica McWilliams said, this comment is not intended as an attack on staff. Staff should be spoken of highly and congratulated at every opportunity for the work they do in maternity services.

I ask the Minister to take on board not only the views of the Assembly and the Health Committee but those of everyone involved in the consultation exercise. I am confident that she will do so. Go raibh maith agat.

Ní gá domh a chur i gcuimhne do Theachtaí gur ceist í seo atá á plé gan réiteach le roinnt blianta. Leoga, bhí sí á plé i bhfad sular bunaíodh an Tionól - rinne Mr Berry tagairt dó sin nuair a bhí sé ag moladh an rúin.

Nuair a rinne mé an cinneadh ní raibh ar m'aird ach leas na mban, na máithreacha agus na leanaí. Tuigim go maith an tábhacht a bhaineann leis an chinneadh seo a dhéanamh mar is ceart. Tá an t-ospidéal máithreachais cónasctha barrthábhachtach do Bhéal Feirste agus, mar ionad réigiúnach máithreachais, don Tuaisceart ina iomláine. Ní cinneadh é seo a rinne mé i mí Eanáir seo caite gan machnamh a bheith déanta agam ina leith.

Is é a bhí ar intinn agam mo chinneadh a bhunú go daingean ar bhreithniú cúramach gairmiúil ar gach - gach - eolas cuí. Agus mé ag cuimhneamh air seo, bhain mé úsáid as na freagraí mionchruinne a fuarthas mar chuid den bhabhta mór comhairliúcháin a rinneadh i bhfómhar na bliana 1999; bhuail mé leis na príomhghrúpaí tacaíochta don dá aonad máithreachais; chuir baill foirne an dá iontaobhas ábhar faoi mo bhráid agus labhair mé leo; agus thug mé cuairt ar an dá ospidéal.

Chuir mé cinntí anailís neamhspleách PAFT san áireamh go cúramach; rinne mé breithniú ar dhá bhreithmheas eacnamaíocha a coimisiúnaíodh go speisialta; agus bhain mé leas as a lán anailíse agus comhairle gairmiúla mionchruinne ó mo Roinn féin. I ndeireadh na dála, bhí sé de bhuntáiste agam go bhfuair mé comhairle ón Choiste Sláinte, Seirbhísí Sóisialta agus Sábháilteachta Poiblí a tháinig le chéile dhá uair i mí Eanáir le freagra a ullmhú ar iarratas uaim go gcuirfeadh sé a thuairimí ar an bhealach chun tosaigh faoi mo bhráid.

D'aontaigh muid gur ghá cinneadh a dhéanamh go práinneach; d'aontaigh muid gur ghá ospidéal máithreachais nua a fháil in áit ospidéil athchóirithe; d'aontaigh muid gurbh é an t-aon rogha idirlinne seirbhísí máithreachais a chónascadh san Ospidéal Ríoga Victoria; agus d'aontaigh muid nár cheart réiteach buan a dhéanamh den réiteach eatramhach. Níor aontaigh muid ar phointe tábhachtach amháin: an áit inar cheart an t-ospidéal nua a lonnú. Chuir an Coiste in iúl domh nach dtiocfadh leis teacht ar aon intinn faoi ach go raibh a bhunús i bhfách le hOspidéal Chathair Bhéal Feirste.

Thomhais mé agus mheáigh mé gach - gach - eolas a bhí ar fáil agam agus mé ag teacht ar an chinneadh a rinne mé. Is í sin an fhreagracht atá orm mar Aire. I ndeireadh na dála is é a bhí mar threoir agam nuair a rinne mé an cinneadh measúnú eolach a bheith déanta agam ar cad é ba sábháilte agus a b'fhearr do mháithreacha agus do leanaí.

I need not remind Members that this issue has been running unresolved for a number of years. Indeed, it predates the establishment of the Assembly, and Mr Berry made reference to its being a long saga during his opening speech. In taking this decision, my sole focus was the welfare of women, mothers and babies. I well understand the importance of getting this decision right. The combined maternity hospital is vital for Belfast and as the regional maternity centre for the North as a whole. When I made this decision in January of last year I did not make it lightly. My intention was to firmly ground my decision on a careful and professional consideration of all the relevant information. With that in mind, I drew on the detailed responses to the major consultation exercise undertaken in autumn 1999 - an exercise that was completed before I took office as Minister.

I met the main support groups for both maternity units; I received presentations from, and spoke to, the staff of the two trusts; and I visited both hospitals. I also took careful account of the findings of an independent policy appraisal and fair treatment (PAFT) analysis. I considered two specially commissioned economic appraisals, and I had the benefit of a great deal of detailed, professional analysis and advice from my Department.

Finally, I had the advantage of the advice of the Health, Social Services and Public Safety Committee. The Committee met twice in January 2000 to draw together a response to my request for its views on the way forward in that year. We agreed that a decision was urgently needed; we agreed that a new maternity hospital was required, rather than a refurbished one; and we agreed that, in the interim, the only practical option was to combine maternity services at the Royal. We also agreed that the interim solution must not become the final solution.

The location of the new hospital was the one significant area in which there was disagreement. The Committee advised me that it could not reach a consensus view, but it reported a majority vote in favour of the Belfast City Hospital site. In reaching my decision, I measured and weighed all the available information - that is my responsibility as Minister. In the final analysis, my decision was guided by my informed assessment of what was safest and best for mothers and babies.

Immediately following my decision, the Royal Group of Hospitals began work on a business case for a new maternity hospital on the Royal Victoria Hospital site. The trust had intended to bring its outline business case to the Department by the end of this month - January 2001 - but, following the court's ruling, work on this has been suspended.

When an issue such as this ends up in court, it is inevitable that plans will fall behind schedule and that there will be delays. In the debate today, Members have repeatedly spoken of the delay. I appreciate the problems arising from the continuing uncertainty over the location of the new maternity hospital, and I want to take this important development forward as quickly as possible. That is why, on 18 January, I announced that I have initiated work on the preparation of a further consultation process to help me bring about the required new maternity hospital, and, once again, I will be guided by what is best for women, mothers and babies. I have asked that this work be taken forward as a matter of urgency, with a view to getting further consultation under way in the spring.

I have some reservations about the basis of the judgement that overturned my decision, and I have thought long and hard about taking this matter to appeal. I am, however, particularly concerned, as are those who spoke today, about there being further unnecessary delay in developing the new maternity hospital, and I have concluded that to appeal that court ruling would not be in the best interests of those who rely on these services. I accept the advice given by Members in this debate that a new maternity hospital is needed soon. It is my responsibility, as Minister, to take this matter to a successful conclusion, and that is what I intend to do. That is important.

It has been suggested during the debate that the letter from the Committee to me in January 2000 led me to make an early decision. However, the need for an early decision had already been signalled well in advance of the letter. Everybody I met, including the Health, Social Services and Public Safety Committee, pressed me for an early decision. There is also a suggestion that the gynaecology issue has been driven by a decision of the Royal Victoria Hospital committee. That was not the case, as was made clear in the course of the judicial review. The decision to separate gynaecology had been taken by a previous Minister.

The separation of obstetrics and gynaecology was also raised. There was talk of the separation of pre- and post-pregnancy gynaecology and references to the proximity to intensive care and the factor of accident and emergency. In essence, obstetrics and gynaecology, although provided by the same individuals, are provided to largely separate groups of women. Gynaecology services are provided to women when not pregnant - or during the early stages of pregnancy - and obstetric services are provided to women who are pregnant.

Regarding the reference to separate populations of non-pregnant women, some will never become pregnant but may require gynaecology services. Others may require post-pregnancy treatment.

As regards the proximity to intensive care, both sites have access to that and this factor could not weigh in favour of either. With high-dependency beds in a combined maternity unit, it is thought that very few women would require an intensive care bed.

Does the Minister agree that the point about high-dependency beds was raised during the judicial review? A distinction was made between a high-dependency unit and an intensive care unit. The judge argued that there had been a slight bias in the Department suggesting that a better option might be put forward and, indeed, that a high-dependency unit could have been provided on either site. The judge suggested that, with the use of the word "better", there was a bias and we would be better concentrating our attentions on the potential of some women dying, even though it is a small number. Hence the requirement for intensive care as opposed to high-dependency care.

As both sites have access to intensive care services, and will therefore be able to cater for people who need those services, the factor could not weigh in favour of one site or the other. The high-dependency beds in a combined maternity unit would be able to cater for the larger number of women who would not need access to intensive care services.

On the question of the new factor of accident and emergency, I am committed to real consultation and I do expect that issues will arise out of the process. The suggestion that accident and emergency was the overriding factor, as opposed to just being a factor, is not correct. Its inclusion reflected that it was a factor and that it could make a difference to some women.

A significant number of serious conditions in early pregnancy, particularly ectopic pregnancy, may give rise to problems before a woman is aware that she is pregnant. Many women will present at an accident and emergency unit and not an early pregnancy clinic.

The link between gynaecology and oncology is important, as are other linkages. The care of women with cancer involves urgent, but planned, treatment in the main, involving multidisciplinary teams. These cases are quite different from the emerging gynaecology cases that are presenting through the accident and emergency department and coming in as emergency gynaecology cases.

As regards the urgency of maternal versus neonatal conditions, the availability of relevant expertise and facilities for mothers differs little between the two sites. The availability of the relevant expertise and facilities for sick newborns, however, differs significantly.

With regard to the withdrawal of neonatal services by paediatricians, the neonatal service at the Jubilee was inspected by the relevant Royal College, which determined that the service was not suitable for training junior medical staff, thus rendering it non-viable. That drove the change. It was not and cannot be for me as Minister to challenge the clinical advice of the Royal College.

Surely that same decision could have applied to the Mater and to many other hospitals. We do not have a new maternity hospital, and it might have been expensive in the interim to pay for the extra services to be placed at the Jubilee, but surely that would have been a better solution than closing the Jubilee at that stage.

Had the Minister finished?

No. I gave way to Prof McWilliams on that point.

With regard to the Royal College's decision at that particular time, Prof McWilliams will be aware that, following that inspection, the Belfast City Hospital made significant efforts to make good the difficulties that had arisen and to overcome the points raised, and was not able to do so. Had it been able to do so, there might have been a different outcome.

As regards the question of private finance, as with any major capital development, the first stage is the submission of a business case for approval by the Department of Health, Social Services and Public Safety and the Department of Finance and Personnel. I have already dealt with what has happened with that in the interim.

There is a comprehensive business case approval process in place that ensures, as is demanded in this case, that there is no presumption that private provision is better than public or vice versa. Objective assessment of all available options is required. Any agreement for the building of a new hospital will be subject to this process.

In setting in motion a new consultation process, it is important that I state publicly for the record that I am approaching this issue with an open mind. I will approach this decision as I would any other: in a totally professional manner. I am determined that the new process should be both open and transparent. It must take careful account of the legitimate concerns of all those with an interest in this development.

With that in mind, the team developing the new consultation process is arranging to meet the interested parties in the coming weeks to listen to their views and ideas on how the consultation should be carried out. My intention is to issue a fresh consultation document in the spring. This document will provide an opportunity for all those with an interest in this matter to register their views and contribute to the shaping and development of the new service.

Of course, the process will be the subject of detailed equality proofing in accordance with the current legislation. In taking this matter forward, I am more than happy to give due weight to the views of the Health, Social Services and Public Safety Committee and to the Assembly itself, alongside all the other inputs that, as Minister, I must consider.

In summary, my aim is to arrive at a decision that will provide the best and most sustainable maternity service for the women, mothers, and babies of Belfast and the North in the years to come. I am sure that Members here today join me in seeking to give substance to this long-overdue development.

This has been an interesting debate on a serious issue. Members raised many points and issues. One of the first Members to speak, Dr Esmond Birnie, made a good point. He said that the mother's interest and well-being was most important. We all agree with that. That is why I proposed the motion. I did not do it on a political basis, which some have accused me of, but for mothers' interests right across this country and because of the seriousness of the issue. The well-being of mothers is certainly not advanced if 40 staff have left the Royal Victoria Hospital and services continue to close because of this decision. Mothers, children and babies are not being dealt with properly. Ms Carmel Hanna, who supports the motion, clearly said that, at times, it has been a waste of the consultation period. We can all recall the hours that the Health Committee spent debating this issue. Many good points and arguments were put forward.

However, I want to remind Members across the Chamber that a majority on the Health Committee voted in favour of siting maternity services at the Belfast City Hospital. It was not a one-party issue. Some Members, particularly Mr McCarthy from the Alliance Party, said that it was a Unionist/Nationalist argument. Carmel Hanna and Monica McWilliams said that that was not the case. Perhaps it would be worthwhile to remind Members that Ulster Unionist, DUP, SDLP and Women's Coalition party members all voted in favour of the Belfast City Hospital site. Those Members who said that it was a Unionist/Nationalist argument were totally and utterly wrong.

As Carmel Hanna said, the new process must be completely open and accountable. Members such as Mrs Robinson asked why there were no notes or minutes concerning this decision. What are the Minister and the Department trying to hide? The Department, and the Minister in particular, will have to answer these questions, because she did not answer the questions raised in the Chamber today. Mrs Robinson said that the decision was suspect, immoral and clinically unsound. Those who support the Belfast City Hospital site stand by that conclusion.

One of the most interesting statements came from IRA/Sinn Féin Member Mr John Kelly. He said that I should not have said that there was a "monster of health" instead of a Minister of Health. I stand by those words. I would have so called any Minister who had made that decision. It came across quite clearly that some of these Sinn Féin/IRA Members - [Interruption]

On a point of order, Mr Deputy Speaker. Is the use of the word "monster" to depict another Assembly Member acceptable parliamentary language?

I would like to study that before making a decision.

It came across clearly in the Health Committee and in today's debate that Sinn Féin/IRA Members are nothing but glorified spokespersons for the Department of Health, Social Services and Public Safety. On every decision made, they jump behind their Minister and say "Yes, Minister. No, Minister." It has come across quite clearly time and time again.

Mr John Kelly, the Sinn Féin/IRA spokesperson, was concerned that I raised the serious matter of filth in the Royal Victoria Hospital's corridors. That comment did not come from me; it came from the nurses who are working in the Royal Victoria Hospital. I will give you an example.

On a point of order, Mr Deputy Speaker. If the Member had intended to quote from some source, he should have named the source in the course of his address. He should not be coming back now to make excuses for what he said.

I cannot accept that point of order. As the Member is making his winding-up speech he is entitled to make a quote. However, I ask him not to be repetitive.

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