6.

asked the Minister of the Environment to provide an update on his plans to designate Raloo Village as a conservation area.

(AQO 1449/00)

The Member raised this question with me in the Assembly last June. I reported then that the Department's resources for this area of work were already fully committed, and I could not, at that stage, indicate when work on this project might start. That continues to be the case. No further resources have been allocated to that area of work, and I am unable to say when I might be able to do so. I should, however, like to make the point that the Larne area plan 2010 states that my Department

The Minister is aware of the determination of residents of Raloo village. Even as we speak, the construction of new developments is damaging the ancient and historical nature of the village. If the Department is going to be thran, I assure the Minister that the residents will be even more thran. A small amount of money is needed to carry out this project, and it is about time that it were made available in the present financial budget.

When considering planning applications for development in Raloo, the Department will take into account those matters that are of relevance to the village's potential as a conservation area. I appreciate the Member's concern that the work on the designation has not yet started. I am sure that he will understand that the Planning Service must operate within the confines of its available resources.

The Programme for Government gives priority to reducing the backlog in planning applications and progressing the area plan programme. I believe that those are the right priorities, given the resources allocated by the Executive to the Planning Service. I subsequently investigated the residents' concern that buildings had recently been erected on the basis of outline planning permission. I can confirm that there has been no building on outline approval only.

Mr Berry's name appears next on my list. In his absence I will move to the next question.

8.

asked the Minister of the Environment to detail (a) those agencies that are involved in the monitoring of water quality in Larne lough and (b) which agency takes the lead in managing the water quality of the lough.

(AQO 1487/00)

My Department's Environment and Heritage Service is the lead agency for water quality management in Larne lough. It is also responsible for monitoring rivers which discharge into the lough and the regulation of effluent discharges to it. Under the EC Shellfish Waters Directive (79/923/EEC) the Environment and Heritage Service also monitors the waters of the designated shellfish area in Larne lough. It uses the Industrial Research and Technology Unit of the Department of Enterprise, Trade and Investment for sampling and laboratory analysis.

It is also responsible for identifying non-consented discharges to Larne lough. It is assisted in these duties by staff from the Northern Group Environmental Health Committee and the Fisheries Conservancy Board. All data that are derived from the monitoring programmes in the Larne lough catchment are available from the Environment and Heritage Service.

Is the Minister aware of the continuing increased levels of pollution in Larne lough, as determined by shellfish sampling, and that that emanates primarily from sewage from the Department for Regional Development's Water Service? Is he also aware that there may be a need for tertiary treatment to protect the shellfish industry in the lough? Will he ensure that this is drawn to the attention of the Department before it forces the closure of the lough and, ultimately, becomes liable to prosecution under European legislation?

Following public consultation, part of Larne lough was designated under the EC Shellfish Waters Directive in November 1999. Monitoring data is being collected to determine whether water quality meets the requirements of the Directive. In future, standards for discharges into the lough will need to be set at levels that will enable the water quality standards required by the Directive to be met.

I understand that a shell-fishery company operating in Larne Lough has expressed concerns about the impact of water quality on its business. However, since the matter is currently the subject of litigation against the Water Service of the Department for Regional Development, it would be inappropriate for me to comment further.

Standards of effluent discharges from Water Service waste water treatment plants are set by the Environment and Heritage Service of the Department of the Environment and placed on the public register. Those standards are being progressively reviewed in line with the standards and target dates set out in the EC Urban Waste Water Treatment Directive. By the end of 2005, all treatment plants will have standards and targets that meet the requirements of the Directive.

9.

asked the Minister of the Environment to give an assessment of waste management difficulties, particularly the problems associated with the disposal of fallen animals (excluding those culled as a result of foot- and-mouth disease) in many parts of Northern Ireland.

(AQO 1436/00)

Following a detailed assessment of the significant waste management difficulties facing Northern Ireland, the Department of the Environment published a comprehensive waste management strategy in March 2000. a copy of which is available in the Assembly Library. Fallen animals are not currently covered by the strategy, because they are classified as agricultural waste and do not come into the controlled waste regime. However, the EC Waste Framework Directive requires the extension of the control regime to agricultural waste.

The Department of the Environment and the Department of Agriculture and Rural Development will collaborate in the preparation of an agricultural waste strategy. It is planned to have that strategy completed and incorporated into the overall waste management strategy at the first review point in 2003.

I am advised that a fallen animals liaison group, involving officials from the Department of Agriculture and Rural Development, the Department of Health, Social Services and Public Safety, the Department of the Environment and representatives from local government, has been investigating that issue. The matter is currently being reviewed by that group to take account of the new EU proposals on animal waste.

Does the Minister recognise the difficulties that are caused in rural district council areas when fallen animals are callously dumped by farmers at, or near, skip sites? Often, members of the public contact councillors about this, and they, in turn, request that environmental health officers examine those sites. That causes a great problem for district councils, officials and council workers who may have to rectify the situation. Will the Minster give an assurance that he will make provision for collaboration and consultation with district councillors so that a more effective policy can be developed?

That is an important question. I have been well aware of that problem for a number of years in my council, just south of where Mr Byrne comes from. The fallen animals are generally under the terms of the EC Animal Waste Directive. That is a matter for the Department of Agriculture and Rural Development.

I acknowledge that some irresponsible farmers have sought to evade their responsibilities by dumping carcasses on roadside verges, in waterways or on publicly owned land. That is undoubtedly a reprehensible practice. Aside from the nuisance and unsightliness it causes, dumping carcasses in that way can have implications for health. Accordingly, information on dumped carcasses brought to the attention of my Department is passed to the relevant district council. The problem of dumped carcasses has formed part of the deliberations of the fallen animals liaison group to which I have referred. That is primarily a matter for the Department of Agriculture and Rural Development. I assure Mr Byrne that we will liaise where we can. However, when a health issue is involved, the district council must take responsibility.

Can the Minister give any idea of the cost that results from the dumping of cattle in sensitive areas and in waterways? That is a problem in the Fermanagh and the Shannon/Erne Waterway areas. What is the extent of the cost to the Department of the Environment, and how is it financed?

I cannot give any costs off the top of my head. It is very difficult to have the information collated and to give a definitive cost. If I can establish what that cost might be, I will write to the lady in question and inform her of the situation as it stands.

It is the responsibility of the environmental health department of the district council, and it will take its costs into consideration. I will write to the Member if I receive more information.

10.

asked the Minister of the Environment to detail the action he is taking to counter the continued expansion of roadside advertising hoardings and to make a statement.

(AQO 1459/00)

The Department's policy on roadside advertising hoardings is set out in policy design principle 9 of the Planning Strategy for Rural Northern Ireland. In that there is a presumption against the display of advertisements in open countryside to protect the rural landscape and prevent traffic hazards. Under the Planning (Control of Advertisement) Regulations (Northern Ireland) 1992, the display of a roadside advertisement is an offence unless the consent of my Department has been granted. In assessing whether to initiate court action, my Department is guided by legal advice, the impact of advertisements on visual amenity and any road safety issues identified by the Department for Regional Development. If, after assessment, my Department concludes that an advertisement is unacceptable, it normally takes court action. At times, persuasion can work.

Does the Minister agree that the erection of such hoardings should be subject to planning legislation? When going from Belfast to Bangor you are inundated with hoardings of different kinds, in fields or by the roadside. North Down has a special task force looking into that. Will the Minister consider that for all areas, because sooner or later the tourist industry will complain.

Time is up. The Minister will not be able to answer the questions now, but I am sure he will send a written answer instead.

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Public Health/Health Inequalities

I welcome today's debate on inequalities in the Health Service of which there are too many, and I am pleased that the Executive are determined to tackle them all. I will point out some that exist in Northern Ireland.

Preventable measures are most welcome. The effects of radon gas cause more than 60 deaths a year in Northern Ireland. I am disappointed by the lack of urgency to tackle that problem, although I am thankful that the issue of smoking is being tackled.

I would like to draw the Minister's attention to the problems that cancer patients experience in Belvoir Park Hospital, where equipment often breaks down. Everyone knows that machines fail, but the machines in question are not due to be replaced for a long time, so cancer suffers wait longer and travel further for vital treatment. They should not have to wait one hour longer, let alone days or weeks, for treatment. Action should be taken immediately to see that machines are modernised and replaced frequently.

We are also deficient in our treatment of rheumatoid arthritis. That is a debilitating disease that can strike at any age. Drugs exist to treat this condition but are not available in some instances because of the cost. We must not sentence sufferers of that disease to pain and disability as a cost-saving measure. If drugs are required, patients ought to receive them. Those are only two instances of inequality in healthcare that have come to our attention recently, and no doubt there are many more.

The debate gives us an opportunity to discuss care for the elderly. As we grow older and our bodies become more infirm, we face more obstacles in our daily lives. That is wrong and unjust.

We do not need additional obstacles in our health system. Unfortunately, that is exactly what happens. We know that older patients are often placed at the bottom of waiting lists. Their concerns are not being met properly. They do not receive first-rate services in all instances. That is a disgrace and should not be tolerated. It seems that age can become a deciding factor in whether one lives or dies. That is an inequality that we must overcome.

Thanks to the recommendations in the Sutherland Report, we hope that nursing care will be free in all nursing homes from October 2001. Those most in need will get help. Westminster has recognised that nursing care must be provided as a matter of course. However, it has not embraced another Sutherland Report recommendation that said that personal care must also be freely available, determined only by need and paid for by the general taxation. The fact that they have not accepted that recommendation is unfair and will mean that there will be inequalities.

Growing old should not mean growing in fear, worried about how one will pay the cost of living in dignity. For many years, the elderly in our society have been afraid that with ageing, they will be forced to sell their homes or their possessions and use any money that they have saved to provide for the basic help that they may need as their bodies grow infirm. To combat that fear we must embrace the Sutherland recommendations in full. Nursing and personal care must be made available based on need and nothing else.

In many ways, the problems faced by our elderly are part of the larger problem of an inadequately funded care in the community programme. Westminster has not provided the resources that are necessary for people to be taken care of in their homes, whether they need that help because they are disabled, mentally ill or elderly. The Government have declared that the need that is brought on by age does not entitle one to basic help in living a dignified life. In that way, they do not have to fund it. Surely that is an inequality and is wrong.

We should not make the lives of our elderly any more difficult by denying their basic right to having their needs cared for, but that is what we are doing at present. Current practice is simply not good enough. We place people in nursing homes because they need help, but our system cannot provide that help to them in their own homes. They spend nights in the hospital because there are no support staff to assist them when they are discharged. In short, our system is not based on their needs, wants or desires, but gives them a service that they may not want. It is most unfair.

The Government's response to Sutherland's idea of providing care based on need is to argue that although they have the money to do this, making personal care universally free is not the best use of resources. They prefer not to spend money to ensure that our elderly can lead lives that are as independent and fulfilling as possible. That is contrary to what every Member of this House stands for. Surely we in Northern Ireland can do better.

If the Executive want to fulfil their pledges on inequality and targeting social need, they must act in the best interests of the elderly in our population. Denying free personal care is not unfair just to the elderly. It is specifically unfair to those, for instance, who suffer from Alzheimer's disease, a medical condition that leads to more and more disability and inability to care for oneself. Dementia is a symptom of that disease.

Currently, the Government refuse to fund the care needed to alleviate that symptom. That is in complete contrast to how it treats the symptoms and outcomes of any other disease. That response by the Government says that because someone is old, they do not need to provide the necessary personal care. The person can provide it him or herself. That surely must be totally unfair and unjust. We must and can do better. We must treat the elderly with respect and dignity but also fairness. We must provide for their needs. We must implement the Sutherland report as far as possible, to provide free personal care and support to our elderly and the people who care for them. We must bring that measure of equality to our Health Service.

Finally, I wish to support the many things that Members said this morning about equality in the Health Service, which the Minister also mentioned. Now that we have the opportunity, let us do it now. I also welcome the Minister for Social Development's contribution to the debate. Together all Departments have a duty to stop all those inequalities, and I am sure that they will eventually be successful. On my party's behalf, I support the motion.

Through the Programme for Government we hope to have joined-up Government here. The Department of Health, Social Services and Public Safety will take the lead in health. I welcome the Executive's commitment to the Programme for Government, through which all Departments will work together to tackle the causes of preventable diseases and disability. A holistic approach to that should reduce serious pressure on hospital beds and help to reduce waiting lists. However, what is the action plan that will enable that admirable objective to be realised?

Reducing inequalities in the health status of different groups is an excellent aim, but of what groups? We have to find out yet, have we not? How many groups will be identified, and how will the inequalities be tackled? A list of the groups of people who feel excluded from equality of treatment is extremely large. Will pensioners have true equality of treatment, and how will ethnic minorities be treated? Will they get equality? What about our poor practitioners who do not speak the language of many of the ethnic minority groups who are now here? I am talking not only about the Irish language but about Koreans, Portuguese and other minorities.

What about expectant mothers? Will they have equality of access to maternity services across Northern Ireland? What about Fermanagh and South Tyrone? No later than last Monday, an expectant mother from south Tyrone gave birth in an ambulance as it travelled to Craigavon. That was our fear when the South Tyrone Hospital was closed down, and it is coming to pass.

About a year ago, we were told that ambulance staff were being trained in obstetrics, and I asked whether we were to expect mothers now to have children at the side of the road. Well, that is what we have heard about already. As a result of the heavy emphasis in the health strategy that favours urban areas to the detriment of rural ones, incidents such as that will happen again and again. There is too much emphasis on urban areas, and that affects our ambulance call-out times.

The Ambulance Service needs to be considered, because it is a bit thin in rural areas. There was a critical accident last weekend in Fermanagh and South Tyrone, and the ambulance took exactly 21 minutes to arrive - not 20 or 22, but 21 minutes, so it escaped censure. That is too fine a line to have in a serious emergency.

Much has been said about the need for equality in health matters in areas of economic disadvantage. Centralisation by health authorities is compounding the problems by differentiating between urban and rural areas. That is especially highlighted because practically all major hospital services are located east of the Bann. That has brought about inequalities in the entire area west of the Bann, not just for specific groups but for the whole population there.

Equality of provision is vital if we are to create a healthier population, but I wish to know exactly what action plan the Department of Health, Social Services and Public Safety will use to bring this about. How will that Department co-ordinate with all the other Departments? Reducing inequalities in our health status must also include reducing inequalities in the provision of medical care, and that must also extend to reducing administration in hospitals and addressing the perception that patients are numbers to be processed rather than people to be tended.

Hospital hygiene and nursing staff care need to be of the highest standards to reduce the risk of patients contracting infections.

With the involvement of all the Departments in that review I look forward to a reduction in our health inequalities. The Department's efforts should concentrate on Northern Ireland. Northern Ireland has to look at its own problems and put its house in order before looking at the problems in the Republic of Ireland.

I support the motion and look forward to increased equality of treatment west of the Bann as well as in the rest of Northern Ireland. I also look forward to seeing an example of joined-up government.

I welcome the Programme for Government's commitment to interdepartmental co-operation in addressing the underlying causes of preventable disease and disability. However, there is little evidence of such Departments getting their houses in order to eliminate current inequalities, never mind interdepartmental co- ordination to tackle those issues.

Northern Ireland has a significantly higher proportion of people with disabilities per capita than the rest of the United Kingdom. As such we need to develop and implement a comprehensive package to deal with the basic factors behind the issue. As has been mentioned, there is still a high incidence of health differentials between the rich and the poor. If one looks at a map of Northern Ireland and marks out the areas of high unemployment and poverty, it is evident that those are the areas that also suffer the greatest disadvantage in healthcare, low awareness of preventable disease, poor diet, less health education and poor access to health services that are taken for granted in areas that are better off. All those issues are interrelated.

Statistics show an increase in incidences of asthma and coronary and respiratory illnesses in those areas.

The Minister of Health, Social Services and the Public Safety and the Deputy Chairperson of the Health Committee, Mr Gallagher, have mentioned many inequalities in health status. However, there are also inequalities in provision between the health boards. Patients in the Southern Health and Social Services Board can avail of a neurocybernetic prosthesis system for epileptics, while those a few miles up the road in the Eastern Health and Social Services Board cannot. Why is that?

Infertility treatment is also class-oriented, because many couples on low incomes cannot access it because of the high costs of private treatment.

Other areas of long-term illness, or hidden long-term illness such as rheumatoid arthritis, do not receive the same type of funding or attention as chronic long-term illnesses such as the cancers. Will the Minister set out a strategy for dealing with patients with those long-term illnesses and provide the funding for the treatment of rheumatoid arthritis and other less recognised long-term illnesses? Limited respite care for people with disabilities, the elderly and those suffering from long-tem illnesses is causing much distress.

Care in the community is underfunded and often varies greatly between geographical areas. The Assembly must look at the low rates of benefit for carers. Despite extensive savings on resources and their invaluable contribution in caring for their relatives and friends, many carers suffer extreme financial hardship and are caught in the poverty trap because they have to depend on the benefits system.

Carers contribute much to the community and deserve support and recognition for their work. Without them the pressures on an already overburdened system would be impossible to cope with. Over the years, with the reduction in social services provision for care in the community, these people are often left with sole responsibility for someone who is ill or disabled. The carer can become isolated and suffer from low self-esteem and low self-confidence. Caring for someone should be recognised as a profession and not taken for granted because it is seen as a family responsibility.

Carers are often put on hold or are totally forgotten about when caring for a relative or friend. They deserve our respect and recognition. They need support in return for their invaluable contribution to society. None need that support more than the growing number of children who, from a young age, take on the responsibility of caring for a parent, or even parents, through circumstance rather than choice.

Day care for people with learning disabilities is essential and is a basic human right. It should be mandatory to reduce social exclusion and to provide people with training and more job opportunities. The impending crisis we face as a result of the reduction in European funding, means that many voluntary and community groups in the sphere will cease to exist. The increased pressure on existing service provision and on the individuals concerned could cost society dearly. Closer co-ordination between the Department of Health, Social Services and Public Safety and the Department of Education is needed to alleviate that hardship.

The Deputy Chairperson of the Health, Social Services and Public Safety Committee talked about immunisation and vaccination. However, 5,000 children across Northern Ireland have neither been tested for tuberculosis nor given the BCG vaccination. Admittedly, there has been a drop in the number of cases of TB here, but there are still instances. We could easily find ourselves in the same situation as a town in England that had an outbreak of TB not so long ago. What action is the Minister's Department taking to address that?

Many of the issues cannot be taken in isolation. They are not just health issues but have to be viewed in terms of human rights, equality, education and social development. They need to be tackled on an interdepartmental basis. I support the motion.

I support the motion and welcome the statement by the Minister. I commend the Executive on their initiative for an interdepartmental approach to healthcare. The concept that health is the sole domain of healthcare practitioners has been around for far too long. It is great that the consultation document 'Investing for Health' recognises that the health of the community is the concern of the whole community. The old maxim that prevention is better than cure is very relevant today. The Executive's initiative to involve all Departments in making health central to all our activities should be supported by everyone.

Health education must begin at primary school, or even at nursery school. Children should be brought up to believe in their community's health, not just in their own or in their family's health. When that attitude is instilled in the mind early in life - although it may take some years to develop - it will result in the health of the community becoming central to everyone's thinking.

However, there are one or two problems. Consider the pollution in some of our rivers and in our countryside. Private companies are correctly penalised for creating that pollution, yet Government agencies escape with an apology when raw sewage escapes into the rivers. Will the Minister and the Department see to it that Government agencies do not get away with polluting the countryside, leaving private companies to pay the bill?

I am a little cynical about the boards working in partnership. People in the trusts, and particularly the regional hospitals, tell us that they cannot get the boards to agree on the amount of money to be given to update essential equipment. How will the Minister and her Department make sure that the boards will work in partnership? A new spirit of co-operation among the boards, rather than one of competition, will guarantee the health of the community.

It is not just the environment. The whole of the Health Service in Northern Ireland needs to be looked at from top to bottom, or vice versa. It is an indictment of the nature of our Health Service when we are told that some cancer patients will die without even seeing a consultant, or when we are told that someone had to sit for eight hours in an accident and emergency unit because that was the only way that the GP could have that patient seen by a consultant. Something has gone sadly astray.

We are faced with the increase in the elderly population. That will demand greater powers for the Health Service if we are to cope. Yet I am encouraged; 'Investing for Health' - the health of the community - is something to be commended. I commend the Department, the Minister and the Executive on the initiative. Together we go forward to a better and healthier community.

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