The SDLP knew that Bairbre de Brún had taken a poisoned chalice. So too did those other vociferous critics - those parties that did not have the guts to take on that brief.

The motion talks about a "current crisis". There is a historical crisis in the National Health Service created by 18 years of Thatcher and Tory undermining.

Will the Member give way?

I will not.

They did not subscribe to the National Health Service. That was followed by six years of Labour mismanagement and refusal to recognise in the Barnett formula the special circumstances of the North of Ireland.

There is a crisis in the health service in the UK and in the Republic of Ireland. We have known about that crisis since the time of direct rule and Westminster decision-making that destroyed the service. While the Tories were putting the nails in the coffin of the National Health Service that resulted in this crisis, the twelve apostles - the MPs from the Six Counties sitting at Westminster - presided over the wake.

Will the Member give way?

I will not give way.

The crisis in the Health Service is what the Assembly has inherited, and it must be put right. There are no quick fixes. Tony Blair is in the same position as Bairbre de Brún. During his election campaign he talked about 10 days to save the National Health Service. He is now talking about 10 years. He knows, and this Assembly knows, that the Health Service can work and that it does work. However, to work it needs commitment and resources. It needs a commitment from Members to believe that, collectively, politicians can deliver a service that people can rely on.

We acknowledge the additional finance provided by Mark Durkan. However, it is £50 million short of what the Minister requires. Last year there was a £700 million underspend in health in England. Mark Durkan should bid for part of that. We do not need to rehearse the Derek Wanless report into the undermining of the Health Service. We have watched over the years as managers and chief executives have been replaced by trusts, boards, and innumerable quangos. The stethoscope was replaced by the briefcase, and patients suddenly became clients.

We do not need brain surgery to tell us the obvious. If you employ fewer nurses and doctors; if you invest less on equipment and technology; if you create a system of private and public fundholding, you will get what Northern Ireland now has - an inferior Health Service on a starvation diet. We know about the waiting lists, the winter pressures, the breast cancer survival rates, and the beds in corridors. These things did not happen because Bairbre de Brún became Minister of Health. They have been there for years. [Interruption].

Order. I will have order in this House.

We know that if you need a hip replacement, you will have to live in pain for years. The mother of the Minister of Education, Martin McGuinness, was exported to Scotland for her operation after spending years on a waiting list. That was long before Bairbre de Brún became Minister of Health.

Order.

During 30 years of conflict, additional pressures were put on our Health Service. However, far from being given additional resources to cope with the war, Health Service finances were siphoned off to pay for the British war machine, prisons, police, quangos, and endless bureaucrats.

Will the Member give way?

For the fourth time, I will not give way.

As if that was not bad enough, the move towards privatisation by the back door, which the Tories began and New Labour carried on, has starved the Health Service of money and prevented service delivery. We all know that privatisation of catering and cleaning services in hospitals was a disaster for workers, patients and medical staff.

The basic cause of the failure in the Health Service is inadequate funding. The Minister recognises that, and she recognises that a cultural change is needed. We must establish a patient-led service. The days of fat cat managers lining their pockets while doctors and nurses struggle to survive on a fraction of the salaries that are paid to some chief executives are gone forever - [Interruption].

Order.

Those days are gone because of what Bairbre de Brún is doing. The Minister has begun to address the problems of the fundamentally flawed, under- resourced and badly managed National Health Service in the Six Counties. She should be given every support and resource necessary. It is a test - not for her, but for the Executive and for us as elected representatives. It is our collective responsibility. We must do better. Go raibh maith agat.

This debate is not an opportunity to attack or blame the Minister, the Executive or anybody else. The problems in the Health Service are everybody's problems. We are all responsible if the service is not working.

The Health Service badly needs a major injection of positive, creative management. The service must be proactively managed, with greater vision, some stability and some hope. In 25 years as a GP, I have never known nursing, medical and other staff to be as despairing or depressed. They are not sure what tomorrow will bring and what they will face. The only certainty is that they are faced with muddle, confusion and a lack of access to the necessary secondary care and service.

The people who work in the Health Service can make a difference, but they need to feel that they are encouraged and supported. That goes beyond rhetoric. They need some vision and some sense that their commitment will be rewarded. They must be given the opportunity to show local leadership, and they must be given credit when that local service is delivered.

The merry-go-round management in the bureaucracy of the Health Service must end. Under the guise of consultation, there are continual meetings and reviews, but no real decisions are taken. That is especially frustrating at the middle and lower levels of the Health Service, where it can take years to reach a simple decision. Management at trust and board level has become little more than a grandiose exercise in passing the parcel. Things go round and round like the revolving door of a large supermarket.

Frustration is immense at the primary care end of the service. Hospital waiting lists are longer than ever. Although some people working in hospitals may not agree, many in the medical profession feel that efficiency in some aspects of the hospital service is less than optimum. I am not referring to the accident and emergency departments; I had every sympathy with Dr Liz Dowey in Belfast City Hospital when she screamed - almost in despair - for help and support a week ago.

I am concerned about the lack of a proper surgical service. About six weeks ago, GPs received a letter from the neurosurgery department of the Royal Victoria Hospital saying that while they would struggle on with head injuries and such, they could no longer operate on brain tumours. I understand that at that stage some people with serious life-threatening brain tumours were sent home without having had an operation. The same situation exists in cardiac and orthopaedic surgery.

Those are the regional services, where people have no choice but to wait. There is only one service for those specialities in Northern Ireland. In some of the simpler services things are different; there is a scattering of provision across various major hospitals. If a service is not available in one, it may be worthwhile applying to another. When the regional services become clogged up, however, everything clogs up.

There is a critical lack of nursing and technical support staff in many surgical sub-specialities. While there may be surgeons, anaesthetists and all the people required to undertake surgery, they do not have the nursing and support staff to look after patients in intensive care following surgery. That creates major bottlenecks and obstacles to good healthcare and good practice.

On the other hand, as other Members have said, in many cases there is a shortage of medical staff. I was told by a friend that in the Northern Health and Social Services Board area there is only one rheumatologist to deal with rheumatoid arthritis. That person runs from pillar to post to provide a skeleton service. There is a need to examine such shortfalls.

Primary care must be freed up and allowed to get on with what it does best. GPs and community nurses have built up years of useful experience in dealing with people, but the problem is that many of my GP colleagues spend up to 25% of their time lobbying hospitals and trying to beg, coax and cajole their way past the waiting lists for those who are critically ill. Much of that time is taken up by unnecessary consultations with people who plead to have their appointments brought forward because they are "going down the hill" and want something done for them before they die.

Perhaps 85% to 90% of National Health Service care occurs in primary care. The essence of the solution to much of our problem could be dealt with there. I commend the Minister and the Department of Health, Social Services and Public Safety. The recently announced initiative on winter care, the effort to unlock some of the potential in primary care, is very welcome. It could be better funded, but it is a start and a step in the right direction.

In the limited time available, I want to mention psychiatric care.

The Member's time is up.

Psychiatric care has been forgotten in the plethora of activity. If you will indulge me, Madam Deputy Speaker, I want very briefly to appeal -

I am afraid that the Member gets only seven minutes. I must ask him to sit down.

I want to appeal for the elimination of some of the bureaucracy. I hope that we can get rid of some of the boards and amalgamate some of the trusts.

Order. The Member's time is up.

I will attempt to speak in - I hope - a good, sound south Antrim dialect. I hope that Members will not need earmuffs either to block it out or to work it out.

Not Ulster Scots?

I speak Ulster Scots all the time. Earlier this week I addressed a group of senior citizens, and last night I addressed a group of my constituents who were touring the Building. I advised both groups to try not to be sick this winter. Those are not the words of someone who is trying to catch a headline or be alarmist. I believe that I gave them sound advice.

My constituency office in South Antrim receives calls on a variety of topics, but recently health issues have outnumbered all others. Daily, distressed constituents call for assistance. In the last few weeks alone, issues have included waiting lists for psychiatric treatment and the problem of no emergency beds for psychiatric care. Patients wait for days to have broken bones set. Elderly patients are left in bed at home unwashed and uncertain about when their care workers will call. People are concerned about the inconsistency and unreliability of health services. Patients are being released prematurely from hospital following surgery with no arrangements made for their convalescence. Elderly and disabled patients are discharged from hospital with no satisfactory support at home. Families with severely disabled relatives are left to struggle alone, and there are reports - and I emphasise the term "reports" because I have no first-hand proof - of patients lying in hospital wards where hygiene standards are not as they should be.

At a recent meeting with representatives of the Northern Health and Social Services Board, colleagues from my constituency and I were alerted to the serious problems that lie ahead. We heard of the sheer frustration, despondency and poor morale that is seeping through the entire staff structure at administrative and professional level. That can have only a detrimental effect on the good work that they strive to do and is expected from them. We were told of many schemes that they would like to introduce to benefit patients, but cannot because of a lack of funds. The Minister should note that extra money coming into the system now will support only the status quo. It will not support new proposals for better care - it is needed to balance the books.

We hear day and daily about the lack of accountability and, therefore, responsibility that permeates the system. The Department gives money to the boards; the boards give money to the trusts; and along the way, as my Colleague Robert Coulter and others have said, the audit trail just leads to a bottomless pit. The audit trail has been described by some as leading to a big, black hole. Those are not my words; it is what I am told by members of the Committee for Health, Social Services and Public Safety and others. When other Committees carry out an audit, recipients of money can be identified - but not so with the Health Service.

The underfunding of the Administration during the years of direct rule means that if we are to achieve the standards enjoyed elsewhere in Europe, we must play catch-up in nearly every aspect of life. The funding of the Health Service has always been a cause for concern, but I fear that this crisis means that the Health Service can be described as having broken down.

I fear that it is the elderly, those most in need, who are being treated most abysmally. Those people in the early years of their life did not enjoy some of the modern services and appliances that we who were born in the post-war years have come to take for granted. Many of those people worked hard to save for their old age, and society has let them down and continues to do so. They deserve better.

As might have been suggested by Mr John Kelly, I am not playing games - but I do not want anyone to play games with my health. I support the motion.

We have heard many adequate and eloquent descriptions of the current crisis in the Health Service. About eight weeks ago, I had a bout of puritanical frustration. I discovered a 17-stone weight of documents in my office that had been produced on the Health Service since 1998. There were several reports, including the Hindel and Pantell Reports, quality impact assessments, first, second and third editions of consultation documents, healthy-eating documents, and healthy-living documents. All that I could think of was the state of health of a patient who had just left a doctor's surgery and her hope to get a simple operation.

What I moved out of my office represented the devastation of hectares of trees; a waiting list that was growing by the furlong, and millions of pounds that were wasted because the information had to be written, printed, produced and circulated. I appeal to the Department of Health, Social Services and Public Safety to stop producing expectations that cannot be delivered. This also applies to the recent Burns Report. We have had health charters, including the Patients' Charter, and various aspirations as to the delivery of services we could expect have been stated. However, they have been like many political manifestos - not surviving even past election day.

We have suffered from gross underfunding for over 30 years. Last night we read about the state of our transport system. People who live in the west of the Province could tell you about the desperate state of our road infrastructure. The Health Service has also experienced 30 years of underfunding. We quickly forget that we suffered 30 years of devastation caused by the Provisional IRA.

To help amplify the point, will the Member join me in condemning the actions of Sinn Féin Youth, which is sponsored by the political party of the Minister of Health, Social Services and Public Safety, whose actions were -[Interruption].

Order. The Member will resume his seat. This is not in line with the debate.

On a point of order, Madam Deputy Speaker. How can a comment on health expenditure, and the reason for that expenditure, not be relevant to the debate?

I have ruled that the Member's comment was not in keeping with the context of the motion.

On a point of order, Madam Deputy Speaker. It was clear from my intervention, which the Member for West Tyrone allowed, that I understood him to be making a point about the expenditure incurred by the Health Service due to the war of terrorism waged by paramilitaries. This war placed a significant burden on the health budget, and I was simply bringing the House up to date on the matter.

Order. I will consult Hansard and respond to the Member.

We have suffered 30 years of underfunding. Although we have committed 40% of our Budget to health, there is not an opportunity in the short term to make up for the 30 years of havoc and wrecking caused by the Provisional IRA.

We must honestly examine how that 40% can be constructively utilised to deliver the best possible service. Members have eloquently described the budget trails and the administration of community care. However, Mr Robert McCartney was the only Member to put a constructive proposition to the Assembly. On the radio this morning, I heard GPs, consultants and employees in every aspect of primary care talk about this crisis and demand immediate action. In a crisis, we should pull out the stops and introduce emergency management of our 40% of the Budget to ensure that it is delivered in the most effective way.

The designer suits can no longer put a gloss on such evident failure. We must get down to the job of managing that 40% of the Budget in order to deliver, as far as possible, on the Minister's mission statement. The matter is much too serious for any political gimmick. I do not like the idea of one party jockeying against another. My constituents deserve the best healthcare possible, and other Members will wish the same care for their constituents. We have not examined how we will manage the crisis, nor have we heard a response to our questions. The Minister's task is to work out how we can manage the crisis; that responsibility falls not only to the Minister, but to every other Member.

Go raibh maith agat, a Cheann Comhairle. Tá mé buíoch de Carmel Hanna as an rún tábhachtach seo a chur síos ar chlár.

Tig an díospóireacht seo i ndiaidh ár ndíospóireachtaí ar an Bhuiséad an tseachtain seo caite, agus mar sin taispeánann sí a dháiríre atá an Tionól faoi na géarfhadhbanna atá os comhair ár seirbhísí sláinte; seirbhísí atá an-tábhachtach go deo ag an phobal uilig.

D'éist mé go cúramach agus le suim mhór leis na pointí a luadh. Aontaím le cuid mhaith de na tuairimí a nochtadh agus is maith liom go n-aithnítear go leathan go bhfuil brúnna suntasacha ar ár seirbhísí sláinte agus sóisialta. San am a chuaigh thart ba séasúrtha iad cuid mhaith de na brúnna a tugadh chun solais le linn na díospóireachta; ba bhrúnna iad nár tháinig ach le linn bhuaic-amanna éilimh i míonna an gheimhridh. Anois, áfach, ó tá éileamh ag méadú de shíor agus ó tá seirbhísí ag feidhmiú ar a lánacmhainn, ach sa bheag, bíonn na brúnna seo ann ó cheann go ceann na bliana.

I am grateful to Ms Hanna for tabling this important motion. Following our debate on the Budget, today's debate underlines the seriousness with which the Assembly views the real problems facing the Health Service. I welcome Members' interest in the services, which are crucially important to the community.

I also welcome the widespread recognition of the significant pressures on our health and social services. In the past, many of these pressures were seasonal; they arose only during peaks of demand in winter months. Now, as Mr Watson pointed out, this is a year-round phenomenon, as demands grow and services work almost to capacity.

More is being demanded of our health and social services. The number of patients being treated has risen by no less than 10% in the past five years, and the number of community care packages has risen by 27% in the same period. During the past year alone, medical activity in the Eastern Board area has increased by nearly 10%. We must add this considerable rise in numbers of people waiting for treatment to the stark rise in the numbers being treated in order to appreciate fully the scale of the increase in demand.

In the face of this rise in demand, hospital staff and community providers are tireless and dedicated in their work. We owe much to the commitment and dedication of the staff who provide the necessary skilled care and treatment, often in less than ideal circumstances. Despite the efforts of staff, it is simply impossible for any service routinely to absorb increases of that magnitude without pain. The recent additions to the Budget are welcome, but they do not allow us to match the extra funding that the NHS in England is getting at present. Matching that funding would require many millions of pounds. The NHS sets many of our costs drivers - our levels of pay and the cost of drugs are decided there. We cope here; we suffer costs that are beyond our control without the comparable funding required to meet them.

Bob Coulter, Carmel Hanna and Paul Berry raised the matter of the regional strategy. Planned, concerted work is being done to develop a soundly based strategy, and I have been carefully constructing the building blocks for the strategy by concentrating, first and foremost, on the key areas that must underpin any new direction.

These include prevention and health promotion; primary care development; the review of community care; the reorganisation of acute hospital services; establishing clear standards of quality and professional regulation; workforce planning; and securing a sound financial base. In doing this I have been conscious of the importance of interaction with the public, with the staff of the health and personnel social services and with service users. I have ensured that they have a say in developing my approach and, as I bring all the building blocks together in an overall regional strategy, I shall ensure that this important element of public consultation continues.

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I welcome the wider debate here and elsewhere about the level of funding needed for health and social care. These services and our willingness to support those who are sick and vulnerable define our society. This is a challenge that the Assembly and society in general cannot walk away from - it is a collective responsibility in which we must all play our part and in which we must all work together. Mark Durkan's announcement last week is evidence that the Executive and the Assembly are ready to rise to this challenge. Our services have paid a price for years of underfunding, and I welcome the fact that many Members recognised that in their contributions. That past underfunding weakened our services and brought them to the brink. This historic neglect must be rectified; only now are we beginning to do that.

The additional resources give a positive signal to the Health Service. Clearly, they are not sufficient to turn the situation around, but they will allow us to help services that need urgent investment to maintain their effectiveness and to continue to meet growing demand. They will allow for some carefully targeted service development. In my time as Minister I have also sought to build the effectiveness of our services and to focus on key problems. Much has already been achieved, even under severe financial constraints. We have increased critical care provision significantly. By March 2002 we shall have 33 more intensive-care and high-dependency beds than I inherited as Minister.

There are now 100 more training places for nurses and extra residential childcare places. We have three permanent MRI scanners in place, and we have secured funding for three more. The number of people waiting for MRI scans has been reduced. While targeted improvements, such as those I have itemised, are being put in place, we are working to sharpen the effectiveness and the efficiency of the service. For example, the service now has a new performance management system to improve planning and accountability. Winter planning has been improved, and by March 2003 efficiency savings of £12 million will have been reinvested in services.

I recognise Members' concerns about winter planning, given the pressures on services. Boards and trusts have planned more comprehensively than ever before for winter and its associated pressures, and as in last winter, more primary care services and more community care support will be available. We are completing a targeted programme of flu immunisation, and we are building on the success of the 2000-02 campaign; more beds will be available at peak times and for emergency admissions, and there will be more specialist beds in critical care areas. Later this month I shall meet the chairpersons of the health and social services boards for a final review of arrangements for winter; arrangements for working together in integrated planning that have been going on all year at official level.

This is prudent, orchestrated planning to relieve the expected pressures of winter. The funding that was made available in the Budget and in-year additions will help us to make some extra provision for those anticipated pressures. However, services that are running almost at peak capacity for most of the year do not have the spare capacity to react instantly to sudden surges in activity. We must build that capacity and recruit and put in place the additional staff and facilities to cope with higher levels of demand. I have already taken measures to increase specialist nursing and medical staff; these measures may take time to yield benefits, but they are an important investment for the future.

In the interim, work continues on tackling nursing needs during the winter. The best and most effective way of guaranteeing that peak pressures can be met effectively is by ensuring that a properly resourced service is in place. That is the best - indeed the only - lasting solution to winter pressures.

The Department has embarked on a major initiative to improve workforce planning mechanisms, and the work should be completed during the next year. The document 'Best Practice, Best Care', which recently completed consultation, dealt with setting, monitoring and enforcing standards. Decisions on the way forward will be taken soon. Consultation is necessary, and the documents that some Members have referred to are essential for progress.

I shall return to the matter of financial accountability. We keep a close track of money, and it does have a real effect on the quality and volume of care and treatment.

The Department's role has changed from regulating an internal market, particularly under the British Conservative Government, to one of direct management under the re-established local Executive. Therefore we have implemented significant changes in how we manage our resources. We have much tighter control over the allocation of resources. For 2001-02 that can be traced from the Programme for Government through the public service agreement into the priorities for action, which set out the key priorities for the service. Boards are required to use that new approach in their service investment plans to describe how they intend to deploy their additional resources; similarly, trusts, in their service delivery plans, must set out how they will deliver my agenda. Regular progress meetings with the boards enable us to keep track of how money is spent and of the outcomes of that spending.

We shall take the same rigorous approach to financial management in 2002-03.

The Comptroller and Auditor General does have audit authority over the Department of Health, Social Services and Public Safety, just as with any other Department. While he does not have direct audit process powers over the health and social services trusts, those are subject to the scrutiny of the Health Service auditors.

I accept and absolutely agree with Members that a long-term approach to the issue of waiting lists is needed. In fact, our approach, as I set out in our framework for action last year, is based on a consistent long-term approach. I made some funding recurrent that had been non-recurrent in the past in order to have that consistent approach. We need long-term action, supported by the necessary resources and service capacity, to provide levels of service that will meet need. In the South and in England, where we have seen action, it has been not only on waiting lists but also on building the capacity of the service. In dealing with capacity generally, the only cure is more resources.

To aid efficiency, a significant programme of work is under way to improve the flow of patients through the system. That includes reducing the number of people who fail to keep their appointments and putting in place alternatives to hospital admission, such as physiotherapists in the community treating patients with back pain. It also includes ensuring that theatres are operating at maximum capacity and validating waiting lists to ensure that they are accurate.

The service has taken a number of initiatives, and I have outlined that several times during debates in the House. Despite the problems, the Health Service has continued to treat similar numbers of patients as in previous years and has made efficiency gains by, for example, treating more patients as day cases.

A number of measures have been taken to help alleviate the current difficulties with regard to fractures. These include the provision of additional theatre lists at the Royal Victoria Hospital, the Ulster Hospital and Musgrave Park Hospital, and the use of spare capacity at the Duke of Connaught unit on the Musgrave Park Hospital site. The Department continues to monitor the service to ensure that emerging difficulties are effectively addressed.

Joe Hendron asked about the cardiac surgery review. Implementation of some recommendations relating to changes in clinical practice is already in hand. Some of the extra resources allocated for next year will support additional cardiac surgery procedures. Implementation of some of the other recommendations will depend on the outcome of the consultation process and the availability of resources in 2002-03 and beyond.

However, my Department has already allocated additional funding for specialist nurse training posts in cardiac intensive care to support the existing staff and allow additional nurses to receive specialised training. Of the 13 additional nurses going through specialised training in the cardiac surgical intensive care unit, 12 have remained in post. A further four specialist nurses are currently going through. A consultant anaesthetist is now also present in the unit during working hours. A significant number of the protocols recommended by the two reviews have also been adopted.

Dr Hendron also asked about the ending of GP fundholding and a "seamless transition." At the beginning of the year, when we had a debate about ending GP fundholding, it was pointed out that the money currently being used to run the GP fundholding scheme and the commissioning pilots will be redeployed to meet the cost of the new arrangements. That is on top of additional resources that we made available to boards to allow them greater flexibility to enhance the quality and quantity of primary care services.

While every effort will be made to ensure that there is a smooth transition to new arrangements, it is clear that the money currently used to run the GP fundholding scheme will be redeployed. It will be available, once GP fundholding has ended, to meet the cost of the new arrangements. We are now making firm plans to end the GP fundholding scheme from 1 April 2002. That will allow us to move forward from there. As Members will know, work is already under way to set up the local health and social care groups.

I share Prof McWilliams's expectation that the needs and effectiveness study will illustrate the extent of the pressures on the service. The study will also show that the service performs effectively in the present circumstances.

Bob Coulter and other Members asked about structures and administration, and those aspects will need to be looked at in the context of the Executive's intention to review public administration, and of the recommendations and proposals made in the acute hospitals review. The Executive will decide if changes should go ahead. However, we should not fool ourselves that that will somehow solve the funding problems of the service, because it will not.

Carmel Hanna asked about the compatibility of information systems. The implementation of a project to introduce a unique identifier for patients across all areas of Health and Personal Social Services is due to begin early in 2002, as funding for that has now been secured. That will ensure that ICT systems throughout Health and Personal Social Services and in GP practices include the new identifier as part of their patient records. That is a first and essential step towards the reliable sharing of electronic patient data and the exploitation of modern ICT services to communicate that information. The recent Executive programme funds announcement also included funding for further bids that we have made to allow us to further improve ICT facilities in the service.

On 11 October, I announced a new pay and grading system, in response to concerns, which I have long expressed, about the award of substantial pay rises to senior executives. That practice was derived from the old internal market, which gave trusts the freedom to develop their own pay schemes and to make their own pay awards. All new appointments will be made on the basis of the new scheme. Existing staff will have the legal right to retain their current contracts, but the Department will work with the service and employees to encourage staff to move on to the new contract and to ensure that the service is working with employees on the question of how to move forward.

Joe Hendron and Alasdair McDonnell raised a question about neurosurgery and the letter to GPs from the neurosurgery department at the Royal Victoria Hospital. The trust has told me that emergency head injuries continue to receive immediate attention. To help to overcome some of the difficulties that exist, the trust has increased the number of theatre sessions and has employed a staff grade doctor. That has enabled it to provide three extra neurosurgery sessions. It hopes that nurses will soon be ready to take up posts in this specialised area, enabling the neurosurgical unit to return to its complement of 40 beds early next month.

I recognise the difficulty in recruiting care workers, particularly to posts that involve unsociable hours. I appreciate that money is an issue, and that there are other questions. I am aware of the need for funding for the residential nursing home sector, and that will be among the matters that I will examine in the weeks to come, when I decide my detailed allocations for the forthcoming financial year.

Tommy Gallagher said that it was cheaper to keep people at home, rather than in hospital, and I recognise that. The funding allocated for 1,000 additional packages, and the additional £8 million provided this year, will help trusts to address this issue. The 1,000 extra community care packages to be provided next year have been made in recognition of those difficulties. The draft Budget, as Mr Gallagher knows, did not allow for development. We now have the ability to make some developments in certain areas. In the interim, the cost of a hospital bed is comprised mainly of staff costs. Those are fixed costs, which cannot be freed up readily for redistribution to the community.

Where we can put extra money into the community to free that up, we will do so. Money, of course, is not the only consideration. Statutory and independent sectors compete with large supermarkets, call centres and others in a decreasing pool of available staff. That has also created some difficulties.

On the acute hospitals review group report, the numerous comments made during the consultation period are now being analysed. Following consideration of the outcome of the public consultation process, and discussion with Executive Colleagues, proposals on the way forward can be put out for consultation. I assure Tommy Gallagher that I hope to be in a position to announce decisions in the course of 2002.

Roy Beggs raised the question of the variation in the funding of community trusts. Community trust spending varies because of age, need and rurality. Those factors vary from trust to trust. The figures available may well include services to populations beyond the immediate catchment area of the trusts concerned. Some trusts have a regional function, and Muckamore Abbey Hospital, for example, falls into that category in relation to the North and West Belfast Health and Social Services Trust.

I share the desire of Members to put in place high quality and responsive services that are available to support those who need them, when they need them.

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