Will the Member give way?

No, I do not have enough time.

I listened to Members who raised the issues of duplication, administration costs and the waste of resources. That is the system that the Minister inherited, and that is the system that both the Minister and the Executive must try to change. It is a shared responsibility, and the Executive must rectify the mistakes of the past by working with the Minister.

There are two fundamental facts that we cannot change in a short space of time. In the past 30 years, the Health Service has been starved of hundreds of millions of pounds. A culture of bureaucracy has developed as a result of the Thatcherite agenda, the internal market and the trusts that have taken money away from front line services and primary and acute care. As an added complication, we have too few nurses, doctors and paramedics. At last the Executive have begun to respond to the Minister's demands for more cash. However, during the lifetime of the Assembly, the Minister has only been allocated a fraction of the amount that she bid for, and that is the responsibility of all Members of the Executive.

I welcome the chance to participate in the debate. I support the amendment. Go raibh maith agat.

I thank Carmel Hanna, John Kelly and Sue Ramsey for bringing this important matter before us today. It is the opinion of a great many people that the Health Service has been in crisis since Thatcher got her hands on the reins of power over two decades ago. That infamous British Prime Minister, with her Tory dogma, did away with hospital beds and staff throughout the National Health Service left, right and centre. She created unlimited management structures and introduced fat cats who were only interested in feathering their own nests. As Rev Robert Coulter said, she created huge bonuses for selected medical professionals. All those policies were to the detriment of the ordinary men, women and children who require decent health provision when they fall sick.

Today, those disastrous policies continue to haunt the Health Service. Everyone who tries to maintain any semblance of giving their best is undermined by the lack of funding, staff, space, equipment, drugs, et cetera. I have heard of an occasion when a patient asked for an extra pillow. The patient was told that the hospital had none to spare, and that one would need to be brought from home or bought. That is the state of affairs in the Health Service - it is disgraceful. There are many more such instances, and nurses and ancillary staff could tell other stories that would make the Department of Health hang its head in shame. That must stop now.

For many years, the waiting list to be admitted to hospital has been increasing at a faster and faster rate. However, the waiting time for patients to see their GPs has also been increasing alarmingly. That situation disadvantages the ordinary patient, and causes enormous anger and frustration.

The same shortages exist across the whole range of health services. There are shortages in cancer care, in services for people with learning difficulties and in services for the elderly. The list goes on and on. Despite the extra funding that is poured into the Health Service, we are going further down the road towards a situation in which we will be unable to provide a reasonable service to the community.

The public cannot understand why the Health Service has deteriorated to such a dreadful extent. Is it because of the need to cater for modern, almost self-inflicted wounds, such as illegal paramilitary activity, drug and alcohol abuse, drink-driving accidents, et cetera? Such modern-day activities must soak up a significant amount of funds, hospital beds, and doctors' and nurses' valuable time. An audit of self-inflicted health disorders might prove useful, and might be an appropriate way to prevent such accidents happening in the future. The resources could be redirected to those who fall sick, and who expect and deserve a nursing service that can make them well again.

Some time ago, the Government adopted a policy of care in the community. That was accepted as the way forward. Unfortunately, once again, insufficient funding was put in place to ensure that that policy ran smoothly. There are currently more than 70 people in the Ulster Hospital who should be out in their communities. However, due to the lack of funding for community care packages, those beds in the Ulster Hospital are still occupied. The result is ever-growing waiting lists, which creates unnecessary suffering. That state of affairs is probably replicated across Northern Ireland. I appeal to the Minister to do as much as she can to ensure that improvements are made.

I pay tribute to those people in rural communities who are fighting to keep their local hospitals open. They must continue campaigning. My constituency lost Ards Hospital and Bangor Hospital. At the time, we were promised that the Ulster Hospital would provide the same services. However, that was 10 years ago. Those services were never provided at the Ulster Hospital, and we are left in this predicament. Rural communities must be warned that the same will happen if their local services are closed down. I appeal to the Minister to get on top of the situation. It is not her fault - she inherited the problems. However, she has the opportunity to do something about it, and I ask her to do so.

I thank Ms Hanna for tabling the motion. Unfortunately, unbearable pressures impinge on the Health Service all year round. The current crisis is the result of years in which no decisions were made and there were too many reviews that promised action, yet failed to effectively deliver on those promises because we were unable to develop appropriate mechanisms.

Funding for the Health Service in Northern Ireland remains inadequate. It must be distributed equitably across the Province, not only to selected hospitals. The proposed investment in the service is only a drop in the ocean; significant long-term investment is needed. Putting money into the Health Service during the year is not a solution to funding problems. The service must be properly resourced, and managers must be aware of the level of resources available, so that the service can be properly planned, run and maintained. Craigavon Hospital, the Ulster Hospital, Altnagelvin Hospital and the Royal Victoria Hospital currently require major investment to upgrade and update facilities, estate and infrastructure in order to manage the current and expected growth in demand.

We need an urgent commitment to development on the Craigavon site, which alone requires £80 million. Although that amount will help to address the hospital's long- term problems, it will not alleviate the current pressures.

Unacceptable trolley waits are a stark example of hospitals' lack of capacity. The issue was highlighted in an article in the 'Belfast Telegraph' on Saturday, 8 December 2001, which reported the story of an 81-year-old woman who waited on a trolley for 22 hours in the Royal Victoria Hospital. It read:

When her son asked when his mother would get a bed, he was told that 21 patients were on the list before her. Her son rightly says that he is enraged and bewildered, but pays tribute to the hospital staff for doing a marvellous job in difficult conditions. Surely those unacceptable trolley waits represent an unsafe environment for patients and staff and must be tackled urgently.

It is simply appalling that there were 27 trolley waits of more than 18 hours in Craigavon Hospital two weekends ago. The staff in the accident and emergency unit work under difficult conditions due to the long overdue and ongoing building work in that department, and they are to be admired for their level of commitment and service.

Bed capacity problems are evident across the Province. The main hospitals do not have the beds, staff or resources for the number of patients that currently require treatment. That is evident in the long and growing waiting lists. The main hospitals in Northern Ireland have the biggest demand for services, yet some of our smaller hospitals have less demand and much shorter waiting lists. That discriminates against people waiting for treatment at the larger hospitals.

The Hayes review highlighted new management structures for hospitals, but that is likely to take years to implement. Can the management teams of the various hospitals work together more closely to ease the inequalities in accessing the service?

The pressure on acute hospitals has been well documented. In Craigavon, more than 90% of admissions are emergencies. Therefore, little elective or planned work can be carried out. However, the waiting lists are shorter in neighbouring hospitals such as Lagan Valley Hospital and Daisy Hill Hospital. Surely it is time to utilise the under-capacity in some of those hospitals. The Minister must acknowledge that, with limited capacity across all hospitals, necessary emergency work must be a priority. Alternative measures must be found to manage the planned work and reduce the unacceptably long waiting lists. That would affect the current policy of short-term waiting list initiatives that manage relatively few patients and that do not make a long-term difference.

We need a long-term sustainable plan as to how to more effectively manage elective surgery. It is apparent that the legacy of downgrading some hospitals has fuelled a crisis in others. That has been the case in my area, where Craigavon Hospital has taken over the workload of South Tyrone Hospital. The Health Service is always blighted by bad publicity and there are difficulties in recruiting nursing and medical staff. Experienced staff are leaving because of low morale and lack of job satisfaction, and that, in turn, impacts on the remaining staff and makes it difficult to sustain even current levels of care. That matter must be addressed urgently if safe care and quality of care are to be maintained and improved. In spite of all that, Craigavon Area Hospital Group Health & Social Services Trust is to be congratulated on its new Macmillan building catering for cancer day patients. The planning of the building involved staff input, which resulted in a clearly patient-centred and congenial environment. The provision also avoids the need for many people in the area to take that long haul to Belfast.

The Hayes report sets out a view of the way ahead for the Northern Ireland Health Service, yet there is no sign of it being seriously considered or discussed with a view to implementation. The Health Service needs to take immediate decisions on the way forward. Decisions have been postponed for far too long. The service, as we have already said, is in a state of crisis, with pressure all year round, never mind the impending additional winter crisis. Repeated reports, consultations and reviews, et cetera, without the necessary action being taken to rectify the identified problem, only compound the crisis. The situation is not acceptable - our people deserve better. The service needs urgent action, not more promises. I support the motion.

Today for the first time, I voted against the Budget - probably the only designated Nationalist to do so. I voted against that Budget because the Executive did not take sufficient account of the Assembly's concerns over the Budget's allocation to health. I felt that I could not continue to highlight the concerns of my own constituents - and the concerns of those whom I visit outside of South Belfast - on that matter, and then come to the Chamber and say that sufficient money was being made available.

We are only addressing the issue of money. However, if the resources continue to remain so inadequate, then all we can see in the future is more of a run-down service. When I became a Member of the Assembly, and when devolution came to Northern Ireland, I certainly thought that we could uphold the standards of the National Health Service, and tell people that we could bring them a decent quality of life and good services on the ground. I still hold on to that hope. However, unless we make health the number one priority in the Executive and in the Programme for Government, we are only creating more rhetoric among ourselves by believing that what is handed down to us in the Budget will fix the problem.

Dr Hendron said that both he and I had visited the Ulster Hospital a few weeks ago. We hoped that changes would have taken place by now. However, we have once again found that there are 73 delayed discharges - the equivalent of three hospital wards. Three full hospital wards have patients in them who are waiting to be discharged. As a consequence, the back-up that we saw that morning - 29 people on trolleys - occurred again this morning. We found that the ambulances could not go out because their trolleys were being used. The ambulance staff, the nursing staff, the medical staff, and those on the wards were all in crisis. They were managing one crisis on top of another to the point where they were under incredible stress. They were considering closing the hospital to admissions that morning.

That is not the type of Health Service that we should be establishing in Northern Ireland at this time of year. If that situation continues, people will seek jobs elsewhere; they will leave the service and morale will decrease further. We know what the solution is. We know that if we can get acute care, community care, domiciliary care and residential care all working together in an integrated Health Service, we shall be able to start releasing the boiling points before they actually blow the whole system wide open. However, we have not even begun to put that package together.

I welcome the announcement by the Minister of the 1,000 community care packages, and I sincerely hope that she is not once again in the position of having to take money from elsewhere in the service to provide those additional packages. Those servicing the provision of community care packages tell me that they are having to wait until a client dies before another package can be offered. They wait for an elderly client to pass away, thereby freeing up a care package. That is an incredible position in which to put any practising professional.

An enormous concern is that 20 independent residential homes closed in the past year. The cost of domiciliary and nursing home care has increased, but the Health Service has been unable to increase fees to recover that deficit. That has resulted in a huge argument about nursing care and consequent closures. That sector used to be described as being a profit-making one, but now providers cannot break even. At a time when the elderly population is increasing, nurses and social services staff cannot find them places in those homes, because those homes have gone. There is an increasingly vulnerable community of over 80s, who are looked after by the over 60s. We cannot find places in nursing homes for the over 80s, so if the over 60s get ill, both groups will end up in hospital.

The waiting list target to constrain the hospital waiting list to the March 2002 level by March 2003 must be changed. We do not yet know the March 2002 level, but we know that there is a current list of 56,000 people, and that is rising. One reason for that increase is that tonsillectomies had to be cancelled because instruments needed to be decontaminated.

The needs and effectiveness evaluation must be carried out urgently so that we can understand the source of those difficulties. A serious task force is needed to relieve those pressure points so that people can integrate and co-ordinate their services in a way that at one time was possible. I appreciate that, in moving the motion, Ms Hanna has realised the seriousness of the matter; I shall support it and the amendment.

Day after day, those who work in the Chest, Heart and Stroke Association telephone us to tell us about an emergency or about a patient in a dire situation. There are 600 people on its waiting list, an increase of 50% in the past five years. The organisation pointed out that more than twice as much money was available in England than in Northern Ireland, despite the Minister's announcement in October. Therefore, the backlog and that organisation's current concerns cannot be addressed.

There is a shortage of intensive care nurses. More perfusion technicians, who are responsible for the control of blood supplies during operations, are urgently required. There is a shortage of anaesthetists and many other specialists. We recently visited the trauma and orthopaedic surgeons in Musgrave Hospital, who told us that young professionals are waiting abroad to come home to take up those posts, but that they cannot be attracted back. Others leave because not enough specialist operations are carried out to keep their skills up to date. That must be addressed.

I am opposed to the top-slicing of the Department's budget in the Executive programme funds. It is not good practice to allocate three years of funding for a service that should be funded from the core mainstream budgets. Those include the brain injury unit or the medium secure hospital at Knockbracken Healthcare Park. Those facilities should be core-funded, but the services with inescapable pressures that receive non- recurrent funding must be made recurrent; they should be made mainstream. That is the reason why I did not support today's Budget. We must avoid duplication, tighten up the administration, integrate the services and increase those funds urgently.

I support the motion. The Assembly has heard some excellent speeches today from Ms Hanna and Prof McWilliams, among others. Essentially, they have addressed the factual situation. We now know that the Health Service is on the brink of disaster, that there are huge waiting lists, and that oncology, cancer, heart, stroke and orthopaedic acute services are, in many cases, on hold. There is no development; people are dying. We must address the concepts behind this crisis. Only by thinking about why we are here and how we can possibly emerge from a bad situation, which all are agreed now exists, can anything be done about it. The speech that I shall make in this limited time is entirely different from the one that I anticipated making. The anticipated one was essentially factual, but the facts have been more than adequately covered.

Let us look at what the speeches that have been made, the motion and the amendment tell us. The SDLP motion essentially urges the Minister of Health, Social Services and Public Safety to take urgent action, placing the responsibility for doing something about the situation on the Sinn Féin Minister. The amendment suggests that there is not enough money and that the Minister is not to blame because her Department is under-resourced. Mr Kelly tells us that what it should do to cure that is finalise in full the bids of the Minister to the Department of Finance and Personnel. The suggestion is that it is the responsibility of the Minister of Finance and Personnel, as he is not providing sufficient resources for the Minister of Health, Social Services and Public Safety to do the job.

The Rev Robert Coulter then got up on behalf of the Ulster Unionist Party - the party of the First Minister and three other Ministers in the Executive. He suggested that the whole structure needs to be reviewed. We have a large and expensive Department, four boards and 19 trusts, which makes us grossly over-bureaucratized when compared to the likes of Birmingham, which has a similar population and one trust.

What does all this mean? It means that the fundamental structures of Government - not of health - lie at the source of our indecision and difficulty. John Kelly asked why we do not take a leaf from the book of Charlie McGreevy, the Minister for Finance in the Republic, who has a 10-year spending plan for the rehabilitation of medical facilities in the South, or even Gordon Brown. Mr Kelly fails to realise that those people, whom he wants us to emulate, are masters of their financial resources and not merely the dividers of a limited cake provided by someone else.

Mr Kelly calls upon us and the Ministers to think about collective responsibility. Collective responsibility has always been missing from this form of devolved Government. There is no such thing as collective responsibility. That is why the SDLP suggests that the Minister of Health, Social Services and Public Safety is to blame and Sinn Féin suggests that the Minister of Finance and Personnel is to blame for not providing sufficient funds. That is also why the largest party, the UUP, has asked the Department of Finance and Personnel's strategy - the audit trails cannot be identified, let alone followed.

If we want to cure the problems in the Health Service we must look at the structures of Government. That is where it all begins - with the failure to have any collective responsibility. We need a First Minister who can take responsibility, say where money is going to be spent and direct policy. Instead, we have a collection of disparate warlords, all looking after their own portfolios.

I recall Prof McWilliams once talking about people ganging up on the Minister of Health, Social Services and Public Safety. That is what happens all the time here, because there is no collective responsibility, and without it, in this failed and defective system of Government, one will never get the facilities to address core problems such as there are at present.

We must set up an emergency committee that consists of the First and the Deputy First Ministers, the Minister of Finance and Personnel, the Minister of Health, Social Services and Public Safety, and the Chairperson of the Health Committee to devise a form of sub-collective responsibility to avert catastrophe in the Health Service. That must not be a committee for putting matters on the long finger. It must be done as a matter of urgency; the responsibility cannot be buck-passed.

I was appalled to hear the Rev Robert Coulter suggest, in his best Presbyterian minister manner, that everybody else was to blame. All Ministers are to blame; each looks after his or her own portfolio. That is where the problem begins.

Of course we are under-resourced. I support the Minister in doing what she can with limited resources. Of course Ms Hanna is correct that draconian measures must be taken to prune the excessive bureaucracy in the Health Service. From the beginning of history where bureaucracy has flourished, whether it was in Mandarin China, the Byzantine empires of the East or more latterly in Communist Russia, efficiency and delivery suffer where the citizen requires it. The detriment is in direct proportion to an expanding bureaucracy. If that problem is to be dealt with, start at the top. Prune the bureaucracy, introduce some form of sub-collective responsibility and inject a degree of urgency into a committee to tackle a problem that has been so brilliantly and so eloquently dealt with by the Members whom I have commended.

We move into the second round. Members must reduce their contributions to seven minutes. That will leave eight minutes for the winding-up speeches on the motion and the amendment. The Minister will have 30 minutes to speak.

I support the motion and the amendment. We all realise that it will take a cash injection, or a series of cash injections, to help our beleaguered Health Service.

However, if we are to make progress we must do it in a two-track system. Of course there must be more money, but there are matters unrelated to money that the Minister and her Department can deal with. It is time for action. We have been given examples of how people are suffering. The waiting lists are growing, people are being forced to suffer, to wait and, in some cases, almost beg for necessary surgery. Others, who cannot afford it, are being driven into the arms of private practice and must spend a great deal of money in order to ease their suffering.

We are all aware of the suffering of those who await heart surgery. Elderly people wait for hip replacements and fracture surgery. Even young people must wait for tonsillectomies while their health and education suffer.

Elderly people in particular are being kept in hospital for no clinical reason, at a cost of up to £900 per week. The explanation for that is that no money is available for a home help service, which could provide safety and comfort for people in their own homes. That could be provided at a cost of £100 to £150 per week. Increasingly, people who are unable to return home are being told that no money is available for placement in a residential nursing home.

Quite simply, the arithmetic does not stack up. There is something perverse about a Health Service in which, potentially, £800 per week is being spent to keep a person in hospital, while at the same time that person could be kept at home for £150 per week. We are told that that money cannot be found, and there is a lack of funds within the crazy maze of trusts that we continue to tolerate. Nobody can deny the claim that there is bed blocking. It exists and it is a direct consequence of the mess that our Health Service is in.

There is a pressing need, particularly in rural areas, for satisfactory out-of-hours medical services. The travelling distances imposed on the people in my constituency who require a general practitioner out of hours are far in excess of anywhere else in Northern Ireland. People have to make round trips of 60, 70 or 80 miles after 5.00 pm or at weekends. That is not a quality service. Steps should be taken to correct it immediately, because people in rural areas are entitled to equal treatment.

I want to refer to the Hayes report. For years, hospital staff throughout the North of Ireland have been uncertain about their future. Many staff have told me - and perhaps other Members have also been informed - that the Hayes review was another unnecessary review. However, it was undertaken after devolution, and we all accepted that we could put up with it. We now have the report from the independent, expert and representative body, but it has been put aside. We are told that it will not be acted on until some time in the future. We owe the dedicated medical and ancillary hospital staff in our hospitals some certainty about their future. We should not wait any longer, and we should act on the recommendations of the Hayes report.

Common sense, immediate decisions and money are needed to sort out the growing crisis. People are fed up with reviews and consultations; it is time to end the prevarication. The community needs actions and decisions. I ask the Minister to tackle the issues that I have outlined. Most importantly, none of us should lose sight of the fact that we are talking about the health and well-being of our families, our neighbours and the community. We are not talking about customers, numbers or lists. We are talking about human beings who deserve all the care and attention that society can give to alleviate their suffering.

I rise to support the motion.

Everyone must accept that the National Health Service is currently in crisis. The realities of the community health and social services sector and of our hospitals cannot be disputed.

During the course of my constituency work I have come across many issues of concern. There is a huge question mark over what the Department of Health, Social Services and Public Safety actually does in its oversight role of boards and trusts. Why did it take 18 months of lobbying before the Department accepted the views of the community, politicians and trusts that there was a shortage of places for speech therapy training? Why has this only recently been increased from 20 to 30? Sadly it will be a further three or four years before these students qualify, take up posts and address this need. I welcome the fact that this is now being done, but why did it take so long? Manpower planning should have been a basic part of the Department's role from the start.

Nursing training is another area where, again, there were deficiencies. Over a decade ago Northern Ireland exported nurses. The numbers in training were then virtually halved. Everyone is aware of the shortage of nurses, but only recently have the numbers been gradually increased. The result is that we are now paying extra for agency nursing. The Department needs to look collectively with the boards and trusts at ways of introducing additional flexibility and retaining more of the existing nursing staff.

The inappropriateness of the current relationship between the system of boards and trust has been brought home to me, again, through constituency cases. I have been told by women whose husbands have been in hospital that they wanted to come home to be closer to their families but were unable to do so. This is bed blocking. In answer to questions in the Assembly, the Minister advised me that, as I suspected, large numbers of people are blocking beds in acute hospitals. On 31 August 2001, 12% of the beds in United Hospitals Health and Social Services Trust were blocked. Many patients who wished to return home were unable to do so, as the funds were not following the patient. That is what should be happening, rather than giving block funding to certain areas and not having flexibility. It costs twice as much, perhaps even three times as much, for an acute sector bed compared to a bed in the community.

As someone who lobbied for additional funds for community health and social services, I was particularly pleased that in the Budget which we have just passed, 1,000 additional healthcare packages are to be provided in the subsequent year. However, there is a need now, and we must all watch the situation carefully. There is a huge Department, four boards and 19 trusts. Apart from the inherent inefficiency, that is also delivering inequality.

When I asked the question on the average expenditure per person in different health and community trusts, huge variance was exposed. In the South and East Belfast Trust it is up to £540 per person; in Down Lisburn Trust it is £329 per person; and in my area Homefirst Community Trust spends £369 per person. With that difference in funding comes huge inequalities and variation in the delivery of services.

From what my Colleague and other Members have said, it is clear that the Health Service as it stands in the Province at the moment is an absolute shambles. It is clear that the Minister is making no effort whatsoever and making no progress in reforming it - and fundamental reform is what is needed. I urge both Sinn Féin and the Minister to get out of office, find someone who can do the job and let us see the Health Service that Northern Ireland deserves.

I share much of the frustration expressed. There is a need for inequality to be addressed. The Minister has to be aware of what this inequality is delivering. In my area, which had a £1·6 million deficit during the first six months of this financial year, services are being cut and waiting lists extended. Recently I was contacted by a family who care for a disabled relative. They had organised to move from a house to a bungalow. However, when they went to move, they found that, despite previous co-ordination, no home help was available initially.

That severely disabled man might have had to go into a nursing home, for want of home-help assistance for one hour a day. The proper care in the community was not being provided, and additional expenses to the public purse could have been incurred.

Occupational therapy is another area of concern. When I chased up the case of a constituent, I was told that priority cases are taking some six months to be seen by occupational therapists. It is not the therapists' fault - they have tried to prioritise and to ensure that the important cases are seen quickly. Because of the lack of resources, morale within the service is going down. The constituent whom I mentioned was in need of a wheelchair, but in October there was no money available in the Homefirst Community Health and Social Services Trust area to provide basic wheelchairs. We are not talking about rocket science - money has to be made available for basic services.

I mentioned the issue of inequalities earlier. The need for basic facilities for the disabled is not even being addressed. I know of another disabled person who needed an occupational therapy assessment to have a ramp installed at his house to give him the basic human right of access to and from his home. He is living alone, and luckily he has a very good neighbour who has been helping him. That occupational therapy assessment took an undue length of time.

Basic services in the community must be provided. Like many people, I am concerned about the amount of money that has been put into the Health Service and the fact that there is little in the way of reforms to show how that money is being spent. The general public want more money to be invested in the Health Service, and that has rightly happened, but we need to have confidence that the money is being well spent. We need transparency, so that we know what the money has been spent on, and that it is providing value for money.

I understand, with concern, that the Northern Ireland Audit Office has not been able to approve some of the accounts. Why not? Surely we ought to know where the money is going and what it is being spent on. We must get value for the patients and improve the service to our constituents.

Yinst mair A maun speik up for the Depairtment o Halth, Social Services an Public Sauftie, for its Meinister disnae seem able for it. This maitter mebbe isnae o onie interest til the Meinister, sin it's nocht adae wi speikin the Erse or wi Erse cultur; at the hinner-end it's relate ti this kintra an hauldin its fowk - comprehendin thae fowk versant in Erse - haill an fere.

Once again I must speak up for the Department of Health, Social Services and Public Safety, as its Minister seems incapable of doing so. This subject may be of no interest to the Minister as it is nothing to do with speaking Irish or the Irish culture - it is, after all, relating only to this country and keeping its people, including those who speak Irish fluently, alive and well.

I want to highlight some issues in relation to care in the community. Some £13 million was set aside for care in the community services, and even that amount is unlikely to result in a break-even situation, because the Government are giving money to the Health Service and to that particular area. The last time we spoke on this matter, in relation solely to the Ulster Community and Hospitals Health and Social Services Trust, at least £20 million was needed to address care in the community. The sum of £13 million across the Province is a very paltry sum in comparison - and it is spread across 19 trusts and 4 health boards. It is just over 4% of the sum awarded to England and Wales.

The amount of money needed to cover the community care bill is staggering. The Strangford area has seen less money and time spent on its elderly and disabled people than has been the case in many other places. It is incredible that, in the twenty-first century, people are still living in cold houses and will have to continue to do so for the immediate future, because the hospitals still cannot afford to provide adequate cover or support to ensure a comfortable life for all.

The lack of adequate funding has stretched resources for the whole of the National Health Service. Elderly or disabled patients are not being allowed home until adequate care facilities are available. There are currently no available community care places, which means that beds are being taken up by patients who could be cared for at home. That has the knock-on effect of increasing the time that people spend on waiting lists and increasing the numbers on those lists. In the Ulster Community and Hospitals Health and Social Services Trust area, 50 patients in beds could be released if there were enough money to provide community care. That means that reasonably well people who just need aftercare are blocking 50 beds.

The same scenario is being repeated in many areas of the Province.

Funding has been sporadic and inadequate. It is hard for staff to see a speedy solution to the problem. Last year, the Ulster Community and Hospitals Health and Social Services Trust received funding for nine additional complex care packages. However, so far this year 60 additional complex care cases needed help, and they cannot be looked after. There is a great shortfall. Thirteen million pounds will help a little, but not enough.

We can petition the Government for funding, but they are too slow to react. The subsequent snowballing is a problem in our own areas. It does not help that the Government do not see the National Health Service as an entire problem. All areas in the trusts are affected, although members of the public get angry only about the problems that affect them at any given time.

The call for more money is not a request or an item on a wish list; it is a demand and a need. We do not want to see money being put into the bottomless pit of the Health Service. We want the money to go directly to the people who need it most. My Colleague Paul Berry talked about the pressures on doctors and the help that they need. They are short of funding.

The underfunding and mismanagement of the Health Service has occurred under the present Minister. It is not due to Margaret Thatcher, as Mr McCarthy said. What has happened in the three years that the Minister has been in control? Her insistence on spending money on the Irish language and culture prevents some of those most in need from getting help. The Minister has given the go-ahead for pay rises for chief executives. How far behind the times is she? Has she not been listening to the nurses and doctors telling her that chief executives' pay has been eating into hospital budgets?

Administration soaks up money and takes funding away from those who need it most. Some chief executives earn 10 times more than nurses do, and they can double their salaries with bonuses, something which other Members have referred to. Would it not be more sensible to invest the money in nurses, doctors and equipment rather than in chief executives who sit in offices and direct others?

The funding is not sufficient to cover the problems with community care in one trust, let alone all the trusts in the Province. The country deserves more than the paltry £13 million that has been set aside for the care of the elderly and the disabled. The money will alleviate the problems for community carers, but not for many other people. Even then, it will only do so for a short time. It would be better if the Minister examined the efficiency of the trusts, the need for staffing and equipment and particularly the need for adequate funding.

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Ms Hanna's motion is worthy of support, and I can go along with it. I want to mention an incident that occurred just over two years ago, when Northern Ireland suffered a serious flu epidemic. The nurses were also suffering, and the beleaguered staff were working on emergency rotas. Some nurses were working 12-to-14-hour shifts. The elderly and the young were not the only people affected, and the nurses were so run-down that they were in danger of being the next target for the debilitating bug. In their wisdom, the executives of the trust thought that it would be a brilliant idea to employ agency staff. They were mindful that they had to restrict themselves to their budget, but they paid the agency nurses almost twice the hourly rate of the regular nursing staff. Members can imagine the nurses' reaction when they found out. Unfortunately, they could not go on strike, because of their oath to care for the sick. The chief executives did not reimburse the nurses who struggled through the staffing crisis, nor did they show appreciation verbally. It must be soul-destroying to work for a boss who thinks only about his bonus while his staff are in the firing line.

We have the same problem today. We are talking about community care, while the chief executive still gets his money. It is crucial that money is spent where it is most needed. It is unfair and unreal to suggest that the money that goes into the Health Service should end up in administration and stuck in the system. Give it to the people who need it. The Minister has failed miserably to do that in her three years in power. If she were in power for 33 years, she still would not address the issues to ensure that those who need care receive it.

Go raibh maith agat, a LeasCheann Comhairle. The motion concerns the crisis in the Health Service, and it urges the Minister to take urgent action to tackle that crisis. No one would disagree with the sentiments of the motion, least of all the Minister. During her short term in office she has endeavoured to deal with the crisis that has existed for at least 10 years and which was 18 years in the making.

However, the motion is not really about concern for the health of the people. It is about attacking Bairbre de Brún. It is party politicking of the worst kind. It is political point scoring on the back of the sick and the dying. Assembly Members should exercise our responsibility collectively and examine how we, as politicians, can address the issue of the Health Service.

Will the Member give way?

I will not.

Order. The Member is entitled to refuse to give way.

The SDLP and the DUP resort to cheap attacks on the Minister for media consumption. Duncan Shipley-Dalton must be making a bid for the seat that he lost. When the SDLP had the choice of ministerial briefs, it chose to back off from health. The SDLP - [Interruption].

Order.

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