First, I congratulate the Member on becoming leader of the Alliance Party and wish him well in the future.

Of the 17 integrated post-primary schools, 11 were oversubscribed and 6 undersubscribed. My Department will normally consider any development proposals put forward to increase integrated provision. I intend shortly to announce a change in the viability criteria for post- primary schools.

What is the average percentage of children admitted annually to grammar schools on the basis of first preference after the transfer test at 11, who subsequently pass GCSEs in five or more subjects at grade C or above?

I do not have that information to hand but will write to the Member.

6.

asked the Minister of Education what support he intends to give to the primary movement programme for dyslexic children.

(AQO 290/01)

It is essential that innovative research findings be evaluated properly in order to assess their usefulness to the local education system. Two education and library boards have trained teachers in primary movement, and, in conjunction with my Department's inspectorate, they intend to carry out an evaluation of the method's effectiveness on children with dyslexia. The findings of the evaluation will be made generally available.

I note that progress on this issue will be made in the future. In the meantime, what is being done in schools to target children with dyslexia?

Provision for children with special educational needs is the statutory responsibility of the education and library boards. It depends on the assessment made, and provision indicated, in each child's statement of special education needs. However, not all children with dyslexia will have such statements. The provision for children with dyslexia is broadly similar across all five boards. Most provision can be made in-school with supportive organisation and planning. Sometimes outside assistance is given by an education and library board reading centre or by peripatetic, or outreach, literacy support. That assistance may include advice or in-service training for the class teacher and the school's special needs co-ordinator.

Statements are made on some children whose learning difficulties are particularly severe. In such cases the additional tuition is extended, and information technology equipment may be provided.

7.

asked the Minister of Education if his policy of refusing funding to playgroups with less than eight children in the immediate pre-school year has been subjected to rural proofing.

(AQO 277/01)

In formulating their pre-school education development plans, pre-school education advisory groups are required by the Department to give particular regard to the needs of rural areas, where existing levels of provision tend to be lowest. However, the minimum group size requirement is one of the key features of the programme. It is designed to promote high-quality pre- school provision that has been applied consistently to all settings regardless of location. The pre-school programme involves an investment of £38 million over a four-year period.

The educational training inspector set the minimum number of children at eight. Given the effect of this number on the rural community, and on the service delivered by the health and social services, were other Departments' views taken into account in setting that number? How does the policy target social need when playgroups which have been assessed by the educational inspectorate as being of high quality face potential closure for failing to have the magic number of eight children?

The expansion programme is designed to promote the personal, social and emotional development of children. In order to facilitate this development it is important that children learn and play in a group of reasonable size. We must all be aware that voluntary and private centres in some areas are concerned about possible displacement. Officials continue to monitor the situation. The Department holds regular discussions with officers of the relevant pre-school education advisory group on specific cases where concerns have been expressed. However, the Department is not aware of significant or widespread problems.

There are many possible reasons why voluntary and private pre-school education and care providers cease to operate. Together with advisory groups, my officials and I take seriously our responsibility to ensure that the risk of displacement is minimised. An important part of this process is the provision of the pre-school database which sets out the numbers of children in an area in order to inform the decision-making process.

Does the Minister agree that, between the statutory and voluntary sector, people feel that there is now a two-tier system? When a playgroup drops in numbers, its funding is stopped automatically. Funding should be phased out to give the playgroup time to try to get new placements, because it is not given that chance at present.

Playgroups in the five education and library boards are responsible for dealing with pre- school education. There have been difficulties in developing pre-school education. I have met with people in the different sectors to discuss their experiences of transition. It must be remembered that this school year of 2001-02 has 85% provision. There has been an extraordinarily rapid move forward in the past number of years, given the circumstances. From the Department's point of view, flexibility must be provided, and we are prepared to do that. We are prepared to look at different interest groups' concerns, and, in consultation with the boards and the pre-school education advisory groups, to ensure that everyone gets a fair crack of the whip.

If everyone should get a fair crack of the whip, why do pre-school playgroups which fulfil the criteria, such as the cross-community playgroup in Kircubbin, not receive support or funding?

The mention of Kircubbin is music to Mr McCarthy's ears. I recently met a delegation involved in pre-school education in Kircubbin. Mr McCarthy accompanied that delegation. We are trying to resolve the difficulties. It is hoped that that will be achieved in due course.

8.

asked the Minister of Education if he will ensure the right of children and young people to be taught the history of the Cruthin Kings of Ulster and the British Imperium of Óengus, King of the Picts, in the tradition of the Brytenwalda.

(AQO 258/01)

The statutory curriculum is not designed to take up 100% of teaching time. Schools are free to teach additional topics as they wish. That allows them to teach other topics considered important in meeting pupils' needs. The programme of study for history makes specific allowance for schools to focus on topics of their own choosing. The Northern Ireland Council for the Curriculum, Examinations and Assessment (CCEA) is currently undertaking a review of the curriculum, including history. At this stage, it would not be appropriate for me to suggest to the council how any particular issue should be covered in the revised curriculum.

I asked the question because the Minister is descended from the ancient Cruthin kings of Ulster, as are Alban Maginness, Ken Maginnis and some of the finest DUP supporters in the Kilkeel area. Can the Minister ensure that the shared inheritance of Ulster and Ireland is given due prominence in the curriculum in future?

Many Members on the Benches opposite will be pleased to hear that I am descended from royal blood. That is an interesting analysis. History is an important issue and is something in which Dr Adamson takes a keen interest. The curriculum review provides an opportunity for the CCEA to look at all the different interest areas that Members, or others, may have. Several people have suggested areas of history that should be studied. The Member named but one - there are many others that people believe should be included in the curriculum. I have advised them to put their cases to the CCEA, which will examine them. It is hoped that, as a result of its deliberations, everyone will be given an adequate opportunity to learn, and appreciate, our combined history.

Question 9 is in the name of Mr McElduff, but he is not in his place.

10.

asked the Minister of Education what costs are associated with the scrutinies carried out by both the Qualifications and Curriculum Authority and the Education and Training Inspectorate on the regulatory functions of CCEA.

(AQO 273/01)

In a typical year, the Qualifications and Curriculum Authority conducts three or four scrutinies of specific subjects at an estimated cost of £5,500 per subject per year. The cost of inspection activity and other Education and Training Inspectorate involvement with CCEA is not calculated separately; however, the cost of the inspectorate's current three-year survey of the CCEA procedures associated with a sample of four GCE A level subjects will be approximately £50,000.

Unfortunately, time is up, so Mr Kennedy will not be able to ask his supplementary question.

Health, Social Services and Public Safety

1.

asked the Minister of Health, Social Services and Public Safety what plans she has to involve the private sector in providing transport services for patients travelling from hospital to home.

(AQO 256/01)

Go raibh maith agat, a Cheann Comhairle. Tá socruithe ag iontaobhais leis an tSeirbhís Otharchairr na hothair sin a iompar a mheastar a bheith neamhábalta de réir míochaine a gcuid socruithe féin a dhéanamh le taisteal abhaile ón ospidéal. Tá cuid de na hiontaobhais i ndiaidh socruithe breise a dhéanamh trí úsáid a bhaint as tiománaithe deonacha, as gnólachtaí príobháideacha tacsaí agus as seirbhísí príobháideacha otharchairr.

Trusts have arrangements with the Ambulance Service to provide transport for those patients considered medically unfit to make their own arrangements to travel home from hospital. Some trusts have supplemented those arrangements with the use of voluntary drivers, private taxi firms and private ambulance services.

I am, however, concerned that fully equipped accident and emergency ambulances are used for general transport. That is not an efficient use of those vehicles, and the private sector may well have a greater role to play than at present.

In April 2001 the journey of one of my constituents from Belvoir Park Hospital to Portstewart lasted five hours. This month a patient was to travel from Coleraine Hospital to a nursing home in Portstewart. An ambulance was called at 11.00 am, and the lady was told to be ready at 1.00 pm. The ambulance eventually arrived at 5.00 pm, so that lady waited all day to travel four miles. I should have thought that in urgent cases, when people are extremely ill, an ambulance was a necessity, but in a simple case where an elderly person is leaving -

Order. I must ask the Member to come to her question.

I am getting there, Mr Speaker. I am just slower than the rest of them.

Order. One thing that the Member is not is slow. This is an opportunity for questions to the Minister of Health, not for case notes. They are for the Health Service. Please ask your question.

Thank you, Mr Speaker. Does the Minister consider that if we did perhaps use the private sector, it could be money well spent? The Minister has already told the Health Committee that a modest saving could be made in the trusts and boards. Does the Minister agree that if we make a number of modest savings, we could end up with a major saving?

I invited the Member to write to me in April, and I reiterate that invitation today with regard to those questions. I am very aware that, due to the pressure on the system, some patients face unacceptable delays in receiving ambulance transport home. In some trusts, therefore, supplementary arrangements are being made with voluntary car drivers, private taxi firms or private ambulance services to ensure that such delays are kept to a minimum.

With regard to the financing of that, trusts need to ensure that their arrangements for the provision of services reflect efficient and cost-effective use of limited resources. That could involve the private sector where appropriate. The type of transport given on the day clearly depends on the clinical condition of the patient, and that information is normally communicated to the ambulance service by the clinician making the request for transport.

I have spoken on several occasions about the restructuring of health and personal social services. Members know that the Executive are looking at public administration. However, I warn people that these moves, when they come about, will not solve the problems of health and social services, which have been underfunded for many years.

What progress, if any, has been made in securing the provision of an air ambulance?

The cross-border pre-hospital emergency care working group is considering the case for an air ambulance service to cover the whole island. The group will review the location options for it. Those options include an air ambulance that would operate on a North/South basis with costs shared between Belfast and Dublin. The group is commissioning independent advice on the costs and benefits of such a service.

Question 2, in the name of Mr Dallat, has been withdrawn.

3.

asked the Minister of Health, Social Services and Public Safety to make a statement on the current financial situation of Homefirst Community Trust.

(AQO 269/01)

8.

asked the Minister of Health, Social Services and Public Safety to explain the variation in funding and the levels of services provided by different health and social services trusts.

(AQO 275/01)

Le do chead, a Cheann Comhairle, glacfaidh mé ceisteanna 3 agus 8 le chéile mar go bpléann siad le hábhair atá cosúil le chéile.

With your permission, Mr Speaker, I will take questions 3 and 8 together.

Maidir leis an staid airgeadais reatha in Iontaobhas Pobail Homefirst SSS, dar leis an iontaobhas faoi láthair go bhféadfadh sé tarlú go mbeadh róchaiteachas de £1·6 milliún a bheith aige. Chuir an t-iontaobhas plean teagmhasach faoi bhráid na Roinne ina raibh réimse roghanna faoi conas aghaidh a thabhairt ar an easnamh a d'fhéadfadh a bheith ann.

Maidir leis an dara ceist, tá roinnt cúiseanna ann a mbeadh difir ann i maoiniú agus i leibhéil seirbhíse ar fud iontaobhas. Is iad na príomhfhactóirí is cúis leis sin ná aois agus méid na ndaonraí a bhfuil siad ag freastal orthu agus leibhéal coibhneasta riachtanais sna daonraí sin.

Homefirst Community Trust projects a potential overspend of £1·6 million. The trust has submitted a contingency plan to the Department that outlines options to address the potential deficit.

There are several reasons for the difference in funding and service levels across trusts. The key factors that contribute to that are the size and age of the populations they serve and the relative level of need in those populations. The elderly, for example, make more intensive use of care facilities than the rest of the population. It is also accepted that levels of morbidity and need are higher in deprived areas. The profile of local services is sensitive to those issues, and the demand for acute hospital services has also shown a dramatic increase in recent years, which has created particular problems for those trusts that provide such services.

It is clear that a deficit of £1·6 million is significant for a community trust. Can the Minister estimate the costs that are currently incurred by acute hospital trusts because of problems such as bed blocking? Many other problems can occur; for example, in the field of psychiatry, the simple failure to provide community services when problems become more acute and must be dealt with by inpatient services is resulting in greater costs than there would be if the problems were dealt with by community-based teams. Homefirst Community Trust appears to be having to remove post-operative community staff. Is the Minister not concerned that, once again, the acute hospitals are wagging the entire departmental dog?

I do not agree with the suggestion that acute hospitals are wagging either a departmental dog or an entire service dog. They are part and parcel of an integrated service. I have stated in the past that all community services are important, and the Member will know that a community care review of services for the elderly is in the early stages of examining the impact of delayed discharge.

In recognition of the impact that that will have, I provided several million pounds in August for services in the community. On the difficulties that acute hospitals and health trusts are facing, 12 trusts have prepared contingency plans to address their deficits.

I have stated time and again, here and elsewhere, that the current financial position is based on a history of the failure of resources to keep pace with demand. I am therefore trying to secure additional funding for health and personal social services for the coming years from the Minister of Finance and Personnel and from Executive Colleagues. The funding is needed to address the specific cost pressures that all trusts face in coping with the unprecedented demand on our health and social services. I know that Members will be debating that issue, among others, in the debate on the draft Budget proposals that the Executive have brought forward.

What role does the Department have in ensuring equity of provision of services to all areas? Does the Minister acknowledge that services for care in the community are grossly underfunded in the Homefirst Community Health and Social Services Trust area? Does she accept that, irrespective of the causes, she and her Department are ultimately responsible for ensuring that there is equality in the provision of community care services to all areas in Northern Ireland?

The Department monitors the performance of trusts against the targets set out in their service delivery plans, which are agreed annually with their main commissioners - the health and social services boards. The plans are subject to endorsement by my Department.

Boards are responsible for funding health trusts to meet the costs of the services that they provide. The Department encourages the boards to use its capitation formula to inform their allocations, and it has produced guidelines to assist them in that task. The Department does not insist that the boards mechanistically apply the formula. However, I want to ensure that the boards use the formula to inform their decisions on how that formula should operate at local level. Under the TSN agenda, I expect the process to be refined, and, over time, the boards will be expected to demonstrate that resources have been applied equitably.

I recognise that there is a need to increase funding in community services, particularly in the Northern Board area. However, the Department's ability to address that issue is constrained by the overall level of resources available. I am aware that there have been ongoing discussions between Homefirst Community Health and Social Services Trust and the Northern Board on the levels of home-help provision and the resources available to the trust.

4.

asked the Minister of Health, Social Services and Public Safety when she will make decisions in the light of the review of acute hospital services.

(AQO 274/01)

9.

asked the Minister of Health, Social Services and Public Safety to indicate the timescale for completion of the decision-making process in respect of the review of acute hospital services.

(AQO 264/01)

Le do chead, a Cheann Chomhairle, glacfaidh mé ceisteanna 4 agus 9 le chéile mar go mbaineann an dá cheann le todhchaí seirbhísí ospidéal géarchúraim.

With your permission, Mr Speaker, I will take questions 4 and 9 together because they both relate to decisions about the future of acute hospital services.

Nuair a foilsíodh tuairisc an ghrúpa athbhreithnithe ar ghéarospidéil i mí an Mheithimh, d'eisigh mé an tuairisc le hagaidh tréimhse comhairliúcháin phoiblí a chríochnóidh ar 31 Deireadh Fómhair. I ndiaidh toradh an phróisis a mheas agus caibidil a dhéanamh le Comhghleacaithe ar an Choiste Feidhmiúcháin, is féidir moltaí ar an bhealach chun tosaigh a chur faoi chomhairliúchán. Tá súil agam bheith i riocht cinntí a fhógairt le linn 2002.

Following its publication in June, I issued the Acute Hospitals Review Group's report for a period of public consultation that will end on 31 October.

After there has been consideration of the outcome, and discussion with Executive Colleagues, proposals on the way forward will be published for consultation. I hope to be in a position to announce decisions in 2002.

Does the Minister accept that the sustainability factor should be a core consideration in any review strategy for acute hospital services? Given that the Hayes review considered accessibility only, will the Minister assure us that sustainability will now feature strongly in the Department's final deliberations on the future of acute services? Can she further assure us that the people of Tyrone will not be dealt a mortal health blow as a result of the Hayes review's proposal for the Tyrone County Hospital? The hospital's viability has been put in jeopardy. There seems to be a constant threat to its well-established and excellent range of medical and acute services, in particular its ear, nose and throat and renal dialysis departments and its associated supporting services, including its medical laboratory facilities.

Order. This is an opportunity to ask questions, not to make a speech about the undoubted benefits and qualities of Omagh. I think the Minister has heard the question.

Mr McElduff has put down a question regarding funding for the Tyrone County Hospital. The answer to that may well be of interest to Mr Byrne. The report that was issued for consultation contains far- reaching proposals that I will consider with Executive Colleagues. I issued the report for an initial pre-consultation period, to last until 31 October 2001, so that Members, the public, Health Service staff and those patients or prospective patients who will be affected by proposed changes can raise issues. At the end of that period I will examine the issues raised, including those that Members mention today and others that have been raised in letters to the Department.

However, I stress that no decisions have yet been taken or will be taken prior to consultation and that any proposed changes to the long-term future of our acute hospitals will be subject to an equality impact assessment.

I must reiterate one question that was asked by Mr Byrne, because the Minister has not answered it. Does the Minister agree that sustainability of hospital services is a key consideration in determining the future profile of acute hospital provision? Will she take that into account when considering the site for a new hospital for the rural west as part of a review of acute services in Northern Ireland? Furthermore, I note from an edition of 'the Irish News' of last week that pre-consultation meetings are to be held in Belfast this Thursday and in Londonderry on the 23 October. Can the Minister tell us when such pre-consultation exercises will be undertaken in the rural west?

I will contact the Member with details of any meetings that may take place in his area. Several factors were brought to my attention in the pre-consultation period and will be considered when we look at the overall picture. I stress that, at this point, the review is pre-consultation. Following discussion with Executive Colleagues and examination of any proposals for changes in the future, including the issues that the Member has mentioned, those proposals will be put out to consultation. All proposals will be subject to an equality impact assessment.

While we are awaiting the decision on the location of the new hospital in the rural west, will the Minister give an assurance that there will be no diminution of services in either the Tyrone County Hospital or the Erne Hospital? People in Tyrone County Hospital are fearful - and this has already been put to the Minister by a delegation - that someone is already implementing a report that is only consultative in nature but which is being interpreted as a final outcome. Can the Minister assure both hospitals that there will be no diminution of service in the meantime?

I can assure all those who have an interest in health and personal social services that I have made it clear that until more long-term decisions are made, I expect every effort to be made to maintain existing services. Where, for any reason, this proves impossible, any changes made must be the minimum necessary to ensure safety and quality, and must be temporary.

Go raibh maith agat, a Cheann Comhairle. Hayes addresses the issue of sustainability very well - people from those areas should read the report. The Minister said that the decision would be taken in 2002. Will she agree with me that it is vital, as far as services and sustainability in those hospitals are concerned, that the date be sooner - as early as possible? Can the Minister say how early the decision could be made?

Mr McHugh is the third Member to raise the question of sustainability. I reiterate that I will be looking carefully at the recommendations in this area, along with other recommendations and matters brought to my attention. I will of course want to hear the views of everyone affected by the proposed changes, as well as those health professionals who deliver the services.

I have stated clearly that following discussions with Executive Colleagues I expect to be able to make decisions in 2002 and that we will have proposals brought forward for consultation. I want to resolve the uncertainty about the future of our hospitals as soon as possible. As the Member knows only too well, some factors are completely outside my control, and they may influence the timing of decisions on these important issues. For example, if the former First Minister goes ahead with withdrawing Ulster Unionist Ministers from the Executive, that may delay both the consideration of the initial public reaction to the recommendations in the review group's report and also the planned public consultation on proposals for the way forward. The matter can only be discussed if there are Executive Colleagues. I cannot give people a guarantee, but I can explain my plans for the way forward. I am basing my timing on conditions that I have some control over.

5.

asked the Minister of Health, Social Services and Public Safety what percentage of hospital beds are allocated as intensive care beds.

(AQO 255/01)

Le linn na bliana 2000-2001 as an mheán de 8,600 leaba a bhí ar fáil gach lá, bhí thart ar 1% ainmnithe mar chinn dianchúraim. Is féidir cuid de na leapacha sin a athrú idir dianchúram agus ardspleáchas, ag brath ar an riachtanas.

During the year 2000-01, of the average of 8,600 beds available each day, some 1% were designated as intensive care. Depending on need, some of these beds are interchangeable between intensive care and high dependency.

I thank the Minister for her reply, though it is disappointing, bearing in mind some other statistics. In the USA, for example, around 10% of beds are designated for intensive care; Germany, I understand, has designated 5% of its beds, and the UK overall runs at around 3%. Can the Minister advise me of the current occupancy rate across Northern Ireland? Is it still above the recommended 70%? What steps have been taken and what progress has been made, if any, towards implementing the recommendations of the Chief Medical Officer's report with regard to the number of intensive care beds in Northern Ireland?

In percentage terms, it is difficult to make direct comparisons. There are different systems in different places. We looked at the Chief Medical Officer's recommendations, as well as the guidelines from the Clinical Resource Efficiency Support Team (CREST), and they suggest that between 1% and 2% of our acute beds should be provided for intensive care. Currently, the figure is approximately 1%.

I am committed to ensuring that all patients receive the treatment that they expect and deserve. That is why I asked the Chief Medical Officer to progress that review prior to the Assembly's first suspension. Demand for intensive care continues to increase as a result of recent advances in medicine and surgery. The increased provision of intensive care and high dependency beds of the past year, together with the plans for future expansion, will contribute significantly to the care of very ill patients.

We have increased the number of beds available. Of the 26 recommendations in the Chief Medical Officer's review of intensive care services, nine have been fully implemented and plans are in place to implement the remainder over the next three years. An extra 10 intensive care beds and 11 high dependency beds have been provided, and there are plans for a further expansion of high dependency provision.

Is the Minister aware that the lack of adequate numbers of intensive care beds has led to one of our top consultant surgeons leaving the Province? There was not enough work for consultants, due to a shortage of beds after surgery. Does the Minister recognise that many patients who require cancer treatment are taken into wards and starved the night before they are scheduled to have their operation, only to be told that the operation cannot take place because the intensive care bed that they require has already been taken? Does she further recognise that the extra beds that have been provided in the Royal Victoria Hospital will not meet those people's needs?

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