I thank Mr Poots for proposing the motion. Given the seriousness of the problem, five of the six MLAs in the constituency wanted to sign it. We are united on the issue. However, the Standing Orders state that only two names can go on a motion.

The Lagan Valley Hospital is a vital asset to Lisburn and the surrounding area. The hospital and its staff have served the area very well over many years.

Lisburn Borough Council recently spearheaded a campaign to save the Lagan Valley Hospital from imminent closure. That threat passed, and the addition of a day procedures unit and the refurbishment of the accident and emergency department seemed to show that the future of the hospital as a fully operational acute hospital was safe.

I am not a sceptic by nature, but I am not optimistic that there will be adequate future funding for the Down Lisburn Health and Social Services Trust, of which Lagan Valley Hospital is an integral part.

As Mr Poots said, the proposal to close ward 14 was a big shock to the people of Lisburn and the Lagan Valley area. Like Mr Poots, I appeal to the Minister to ensure that funding is provided to ensure that this closure does not happen.

Mr Poots referred to the Hayes Report, which I support as a useful consultative document for the future of hospitals. It does, however, contain two proposals that are completely unacceptable to us and to the people of Lagan Valley. The report proposed the closure of the maternity department and the accident and emergency unit. That is inconceivable in an area such as Lisburn. Lisburn Borough Council is the largest borough in Northern Ireland, second only to Belfast - it is bigger than Derry. It is inconceivable that such an area could be left without maternity and accident and emergency services. The Belfast Area Plan predicts that the population of the Lisburn Borough Council area will increase from 115,000 to over 200,000 over the next 15 years. It is unthinkable to leave an area of that size without those facilities, but that seems to be the direction that we are going in.

The funding of the Down Lisburn Health and Social Services Trust will determine the future of services in the Lagan Valley Hospital. The trust has a potential deficit of £1·56 million, and extra resources are needed. Several factors have led to the deficit, and although Mr Poots has mentioned those, I shall spell them out. Pay awards have been set at 3·7%, but funding is set at only 3·5%. As the pay awards must be adhered to, the funding will have to be found from other sources or the number of staff will have to be cut.

The trust carried out the Telford exercise with regard to nursing staff levels. There is a shortage of 223 nursing staff in the trust. This is a recipe for disaster. Considering the fact that it would cost £3 million for the trust to employ its full complement of nurses, it is clear that the Down Lisburn Health and Social Services Trust is inadequately funded.

Other vital factors must be addressed. The price that the trust pays for heat, light and power has increased by over £250,000. Money to pay for this must be found from savings or an increased grant. As the Chairperson of the Public Accounts Committee, I am not convinced that enough is being done to make these savings.

Foster care services have increased, and there has been a reduction in the income from GP fundholders, because the scheme is being phased out. Although most would agree that the fundholding scheme was misconceived from the start, an interim system should be put in place to allow such deficits to be met.

Mr Poots has already mentioned the pressure on winter beds and the fact that they must be retained until May. The trust is severely underfunded. If the full complement of nursing staff were available, that shortfall in funding would be even more acute. All trusts are under instructions to break even in this and subsequent financial years. If the Down Lisburn Health and Social Services Trust is to do so, it will have to make choices. Those choices are now under consideration.

The issue of a single ward in the Lagan Valley Hospital, although very important, is not the only issue. The Minister, her officials, the Eastern Health and Social Services Board and the trust must come together to provide adequate funding for the Down Lisburn Health and Social Services Trust and the Lagan Valley Hospital.

The trust now has a dilemma as to how it should proceed. Cuts are one path that can be taken, but they lead only to loss of efficiency and, sometimes, to loss of life. We may be seeing the last few years of the present health services system. That matter will no doubt be debated in the Assembly in future. Today we can only deal with what is on the ground - an over-stretched system that cannot cope. I ask the Minister to meet with her officials, the Eastern Health and Social Services Board and the directors of the Down Lisburn Health and Social Services Trust, as a matter of urgency, to resolve this ongoing and very difficult problem. I support the motion.

I support the motion. Like Mr Billy Bell, I also represent Lagan Valley.

I do not need to tell the House that there is a serious risk that underfunding of the Lagan Valley Hospital will lead to severe cutbacks in services offered there. The result could be devastating for the local community and for staff morale. A recent report from the trust's director of nursing has shown that it has a shortfall of 223 nursing staff.

In order to comply with the Department's instructions not to incur a deficit - and because of the reduction in income from GP fundholders as fundholding is phased out - Down Lisburn Health and Social Services Trust will have to make savings by cutting back on services. Mr Poots said that in the last four years the trust, and Lagan Valley Hospital in particular, has, unlike other hospitals, kept within its budget. It is a sad fact that there was no incentive and no recognition of its good financial management. That only adds to the low morale in the trust.

The increased costs of heat, light and power have also been mentioned, and they are having an effect on the trust's already strained budget. There are proposals to close 13 medical beds, which are part of the winter pressure proposals, and to cut some of the 26 beds for general medical and inpatient services for elderly patients. I ask the Minister: what will happen to the elderly and the infirm? Where can they expect to go for treatment? Will they have to travel to Belfast and to other hospitals? What effect will this have on their families, many of whom already suffer financial hardship? Having to travel further to visit relatives in hospital will put them under more financial pressure.

Possible cutbacks in community care programmes would have a disastrous effect on the most vulnerable in our society. Many people with disabilities and their families depend on care in the community to maintain them in their own homes, and for respite care. What a slap in the face it would be for carers who are already stretched to the limit, with little or no recompense for the valuable contributions they make by caring for their families and friends.

We have already seen £100,000 taken from the mental health budget for acute services in Down Lisburn Health and Social Services Trust, and I have repeatedly asked the Minister when this money will be returned. My fear now is that when it is returned it will not go back to mental health services but will be prioritised and given to some other crisis in the trust.

Some of my Colleagues mentioned the Hayes Report, and the issue of downsizing the accident and emergency facilities and the total loss of the maternity services. Again, I have to say to the Minister that this will create further hardship for families who are already living under pressure. The Hayes Report recommends a quality of care, safety and affordability - I do not see much evidence of these qualities at present in the amount of funding being given to Down Lisburn Health and Social Services Trust. Unless there is a serious undertaking from the Department to fund services in the Lagan Valley area adequately, there will be no care at all. I therefore support this motion.

I stood in this Chamber in 1983 when the Eastern Health Board produced a document called 'Developing Hospital Services'. At that time there was a question mark over the whole future of Lagan Valley Hospital. Since then, during crisis periods, Lisburn Borough Council has mounted campaigns, which up to now have been successful.

My Colleagues representing Lagan Valley have given a clear account of the present dilemma facing the hospital. They have mentioned the problem of funding - or lack of funding - in the Down Lisburn Health and Social Services Trust, which is going to prevent the trust from carrying out its duties over the current financial year and into the foreseeable future. This is not something that the trust can put right on its own.

The Down Lisburn Health and Social Services Trust has been efficient in carrying out its duties. If extra funding is not provided in the short term, cuts will have to be made in the services provided. My Colleagues have already outlined where the extra costs have come from, and I want to examine how these costs will have to be met. We all attended a public meeting in Lisburn a few weeks ago. Ward 14 was mentioned earlier in the debate, but this is only part of the dilemma. The options open to the trust include the closure of medical beds, which is part of the winter pressure proposals, and the reshaping of general inpatient services for elderly people in the Lagan Valley. These options would lead to the closure of up to 26 beds and compromise the hospital's capacity to deal with winter pressures. This would put pressure on other parts of the trust and on other hospitals in the Eastern Board area and create a back-up effect across the board area.

Other possibilities would be the reduction or postponement of the trust's capital schemes and the reduction of its community programmes. This would lead to a further increase in the trust's waiting list for community care. Such reductions in activities, coupled with less staff recruitment, delay in service development and the wholesale diversion of money might allow the trust to balance its books. That is not satisfactory. To place the service in general, the staff in particular, and ultimately the patients - mainly, in this instance, the elderly - under such strain is something that we as public representatives must try to avoid.

I understand, and the Minister is no doubt aware, that the trust has been placed in the top 40 hospitals in the United Kingdom. The trust performed particularly well in the area of patient experience. This is a tribute to the entire staff, who deserve credit for a magnificent effort. Those tools can be provided only with sufficient funding and with adequate annual increases to take account of inflation and growing needs. This debate was initiated by the proposed closure of ward 14, and it is good that it is taking place. However, the efficiency of Lagan Valley Hospital as a provider of services for the foreseeable future is at stake. It faces an uncertain long-term future, and there will be long and hard debate on the issue. Members and other public representatives have already voiced their strongly held opinions.

However, that debate is for another day. Lagan Valley Hospital must be adequately funded, and it must be allowed to carry out its functions in a manner befitting a hospital with a long and noble tradition. I hope that the Minister will take note of this and that the representatives and people of the Lagan Valley area are not being taken for granted as they have been in recent years.

Go raibh maith agat, a LeasCheann Comhairle. Tuigim an imní a léirigh Comhaltaí faoi dhruidim thuairiscithe bharda 14 in Ospidéal Ghleann an Lagáin. Tá sé tábhachtach mar sin de go bhfreastalaím an deis cúlra na ceiste seo a mhíniú don Tionól agus cuid de na hábhair a tógadh a shoiléiriú.

Tá síorbhrú ar ár n-otharlanna, rud a léiríonn méadú ar éileamh ar sheirbhísí agus na fadhbanna áitiúla le hacmhainneacht i gcuid de na hotharlanna.

I appreciate the genuine concerns expressed by Members about the reported closure of ward 14 in Lagan Valley Hospital. It is therefore important that I explain the background surrounding the issue, and that in doing so I help to clarify some of the matters raised. There are continuing pressures on our hospitals, and this reflects the general increase in demands and services as well as local capacity problems in some hospitals.

Whereas in the past those pressures were generally seasonal, they are now a year-round phenomenon and indicative of the serious underfunding of our health and social services over recent and successive years. I have consistently stressed that without significant additional funding our hospitals will continue to struggle, and I hope that I can count on the support of all Members in arguing the case for funds to build the capacity of our hospital and community services.

While recognising the need to secure adequate funding for our services as a whole, it is also imperative to ensure that the resources currently available are distributed according to the needs of the community. My Department uses a weighted capitation formula to ensure that boards are allocated their fair share of available resources in line with the relative needs of the population. It will never be possible to fund all needs, but such an approach at least ensures that areas with the same level of need are allocated an equal share of resources.

The capitation formula is subject to continual review and approval, and, as a result, a revised formula was implemented on a phased basis from 2001 to 2002. The Eastern Board uses the Department's formula to allocate resources to its four localities. The board's latest assessment, which does not yet take into account the most recent changes to the formula, indicates that by comparison to its equitable capitation share the Down Lisburn locality is underfunded by £2·8 million.

The assessment has been influenced by factors such as the recurrent impact of phase 1 at the Royal Victoria Hospital, the Mater Hospital new-build scheme and the Ulster community hospital pilot. However, I am informed that the Eastern Board is committed to addressing locality underfunding through continued skewing of new resources, and the 2001-02 plan for new service funds will improve the position.

Managing with limited resources calls for constant prioritisation and re-prioritisation by boards and trusts. In the current financial year, and in planning its services, Down Lisburn Health and Social Services Trust reported that it had overspent by about £1·5 million. As a contingency to deal with this overspending, one of the trust's options was to close ward 14 in the Lagan Valley Hospital. However, as a result of further discussions in the trust that option is no longer contemplated.

Mr Poots stated that up to 57 beds might be closing at Lagan Valley Hospital. I am unsure where Mr Poots got that figure.

It is certainly not in line with figures that I have been given. Ward 14 is an elderly-care ward with 36 beds, 10 of which are set aside for patients with dementia; the other 26 are medical beds. I have been told that the package of measures under consideration at Lagan Valley includes the relocation of 18 medical beds from ward 14 to the main hospital. This will have the advantage of ensuring that they are nearer to facilities that will assist diagnosis of acute elderly conditions. The 10 beds in ward 14 for dementia patients will remain unaffected. This should assure Members that there is no question of discriminating against elderly patients in this area or others.

Overall, there will be a net reduction of eight beds. I have received an assurance that this will not be immediate, but that the reduction will be carefully managed over time. I have made it clear to the board and trust that my priority remains the provision of safe and effective health and social services for all users. Any changes made in Lagan Valley Hospital will have to reflect this.

In relation to the concerns about winter pressures, planning for next winter is still at an early stage. The Department is due to meet with winter pressure co-ordinators shortly to discuss this and will be considering matters such as the Lagan Valley Hospital situation then.

Comments were made about moves to nursing-home care. I have been assured that the hospital operates a strict discharge policy. Decisions to move patients into nursing care are taken by a team of clinicians, social workers and other professionals who determine the right form of care for an individual and only in that context.

On deficits, all trusts must achieve financial stability so that my Department, like others, can live within its departmental expenditure limit. Throughout 2000-01, several trusts, including the Royal Group of Hospitals NHS Trust and the Ulster Community and Hospitals Health and Social Services Trust, developed recovery plans to achieve this aim. As part of the process each trust produced a savings plan agreed with its host board to achieve efficiencies and help balance the books. The majority of these plans do not affect care services. All trusts have also been told that deficits should not be allowed to develop, and if they do arise, contingency arrangements should be made to address them. However, I emphasise again that these actions are needed in great part as a result of the serious underfunding of our health and social services over successive years.

Ms Lewsley raised the Down Lisburn Health and Social Services Trust's financial management. I personally spoke to it about this on a recent visit to Hillsborough.

Members raised a variety of points about the recommendations made in the acute hospitals review group's report. I refer Members to the points that I made in the House yesterday. To assist me in considering the substantial issues involved, I will be inviting public and professional reaction to the report. I emphasise that no changes will be made prior to consultation.

I hope that I have effectively dealt with the points raised by Members today. I thank all who took part in the debate and hope that I have managed to address their concerns. My officials will scrutinise the record of the debate, and if I missed any points, I will write to the Members concerned.

The inspiration behind the tabling of this motion was, as has already been said, a public meeting that was held in the Lagan Valley Hospital some time ago. At that meeting it was pointed out to those who attended - and representatives from Lagan Valley were there in force - that a threat was hanging over ward 14 of the hospital, which is used by elderly people. One of the options was that 26 beds would be closed. This angered not only the representatives for Lagan Valley but relatives, friends, staff in the hospital and everyone we met that evening.

There was a palpable feeling of anger and distress that anyone should consider treating those most vulnerable in our society, because of their age and their frailties, as a soft touch by closing wards and chucking them out of their hospital beds into facilities that were non-existent.

Mr Poots has already said that there is a dearth - a scarcity - of residential care beds and other beds in the Lisburn area. As the Minister knows, the money is not available in the community care budget to enable the elderly to be cared for in their own homes. The sense of outrage was palpable. We recognised that we had a short time in which to take action. I am delighted and proud that all of the elected representatives have joined together in one voice, with party politics put aside and people power coming to the surface to say "Enough is enough; we will not allow this to happen to the elderly in the Lagan Valley Hospital."

I have heard what the Minister has said, and unless I am just hearing in one ear - namely my right one - she said that the closure of ward 14 is no longer being contemplated. If that is the case, then I say, "Victory to the people of Lagan Valley, victory to their elected representatives, and most importantly, victory to the vulnerable and the frail in our society."

This highlights an issue that goes further than this debate today. It highlights - and the Minister has already referred to it - the need for all of us to think deeply about our priorities. We are all elected representatives in an Assembly that has budgeting power and budgeting authority, and we allocate taxpayers' money. It is incumbent on every one of us, sitting on our respective Committees, to question seriously how money is being spent through this Assembly.

I have the privilege of holding a position on the Public Accounts Committee. Other Members and I have been astounded, annoyed and horrified at the wastage of money in this system. We must get it right. We are currently looking at a new bid procedure for 2002-03. Is it more important to the overall goals of this Assembly that more money be spent, for example, on a new computer, or on the protection of beds in our hospitals where people are sick and dying? Is it not more important that we ensure that people are not on trolleys in our hospital corridors, rather than ensuring that there is enough money for animal health compensation? It is not more important that people's health is put at the top of our overall priorities, and that we give real and careful consideration to cutting through the type of bureaucracy that allocates money to a Department, where it is fixed, tied and locked in? Instead, we should be trying to create flexibility so that, for example, if there are pressures in the winter that would make a difference between life and death, a department can be opened up and money made available to deal with the need as it arises at any given time.

It is fundamentally wrong that planning, heritage and animal health have priority over people. We must protect those who are most vulnerable in our society. I put at the top of that list those who have served society, those who have seen the passage of time and have clocked up the years in their life.

They are the ones who have to be at the top of our list of priorities, and if we miss that, we miss our raison d'être and the purpose of the Assembly. As we enter this new era of Budget allocation, each of us has a responsibility to ensure that people are at the top of the pile, not an afterthought. We must ensure that the elderly in particular are not seen as a soft touch, as chattels that can be pushed from pillar to post. That is the message that should come from the Assembly today.

On a point of order, Mr Deputy Speaker.

Unless you can direct me to a specific Standing Order, I will not take it. To which Standing Order are you referring? Please sit down.

I have had the last word. I am happy.

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