Order. If Members wish to have a conversation, they should use the Lobbies.

I share Members' concerns that waiting lists for hospital treatment are so high. I share their concerns that so many vulnerable people are waiting in the community for the care that they need to maintain their independence and often their dignity. I share their concerns about patients in need of emergency hospital admission, waiting for hours on trolleys. I am determined that the shortcomings in care will be addressed and improvements forged.

Work towards building the new health and social services has begun. I have ambitious plans for developing our ambulance services and for improving cardiology, and cardiac surgery. I have set out a framework for tackling waiting lists. I have set in motion a review of community care services. I have published proposals for improving the quality of care, and for getting our standards and governance right. Considerable work to improve children's services is under way.

All of that has been done alongside the vital work of addressing the day-to-day problems, and within the context of severe financial restraint. Building that new Health Service will take time and resources. I inherited a Health Service that had been starved of the investment that it needed to keep pace with services elsewhere. Last week's Budget announcement was an early, important step in the right direction. The extra funding from it will translate directly into more care packages, more operations, more key staff and more targeted growth in vital areas. However, it is no more than a first step.

One could say that any Minister who inherits a situation in which the population experiences some of the worst health status in western Europe, allied to one of the lowest budgets for health in western Europe, will have a major challenge facing them. Building up our services so that they are able to meet demand is going to require a sustained commitment over a number of years. It is that long-term commitment to underpin the action that we in the Health Service are taking that is needed if things are going to be better in the future. I look forward to working collectively with all of my Executive Colleagues and with all Members of the Assembly - as well as with staff throughout the Health Service - to make the improvements that we need, with the resources that we need.

Go raibh maith agat, a Cheann Comhairle. I thank Carmel Hanna for proposing the motion. However, I want to outline why John Kelly and I tabled the amendment, which, we believe, complements Carmel Hanna's motion. There is a crisis in the Health Service, from children's services right through to community care and mental health. That has rightly been highlighted during the course of the debate. I also want to commend the Minister of Health, Social Services and Public Safety for being here for the duration of the debate.

Some Members have mentioned the years of underfunding. In England, and in the Twenty-six Counties, both Governments have recognised that billions of pounds will be needed to stabilise their respective Health Services before they can attempt to develop services for the future.

The problem is compounded by the fact that successive British Governments robbed the Health Service of close to £190 million every year. During the years of underfunding there was no debate or long-term plan, and the internal market was created. I welcome this open and honest debate.

However, we need to realise that the Executive and the Committees have to take responsibility for ensuring that there is openness and accountability in the Assembly. Some people have criticised reviews in the Department of Health, Social Services and Public Safety. Are they saying that the community should not have its say, now that we have this openness and accountability? Do they want to go back to direct rule, or are they afraid of accountability?

Some people touched on the boards and trusts. Sinn Féin has said for a long time that boards and trusts must go. However, reality needs to come into play here. The end of boards and trusts will not generate millions and millions of pounds, although it will generate a small amount of money - I do not think that people are thinking that out. The reason that we want the end of the boards and trusts is that they facilitated the internal market. We have to realise -

That is a fantasy.

- that the additional money that was announced in the Budget should be welcomed, because it is a positive step. It shows that the Executive as a whole are listening not only to the Minister, but to the Department, to the Committees and to Assembly Members.

While I welcome the money, it still falls £50 million short of the Minister's original bid. Her words to the Committee for Health, Social Services and Public Safety at that time were to keep the services as they were and not to target any additional pressures on them.

I want to touch on a number of comments that were made by previous Members who spoke. Carmel Hanna, who supported the motion, said that a blank cheque is not the way forward. In no way would I suggest that, and I support Ms Hanna's thinking behind it. However, there is a need to target and tackle the years of serious underfunding of the Health Service. She and other Members, pointed to the increase in waiting lists, which is alarming, but the Committee took this on board and asked for research to be carried out on the cancellation of outpatient clinics. Nine percent of these clinics were cancelled, and the main reason was that no holiday arrangements had been made for consultants, so that needs to be tackled as well, and we can target waiting lists if there is planning in the acute sector.

It has been said that we should not call for more resources without knowing where the money will go. As a Member of the Committee for Health, Social Services and Public Safety I know where the money should go. As every Member who has spoken has said, that money should go to the new cancer unit, to mental health, to children's services and to community care. There is a need there for additional money. Arguing that there has been mismanagement of money undermines the argument for additional money. The Chairperson of the Committee for Health, Social Services and Public Safety says that there is a crisis in the fracture unit. I agree with him - we visited the Royal last week - and that brings me to the need for collective responsibility.

Will the Member acknowledge that while some Members from the Ulster Unionist party mutter under their breath, a number of their Members in the Westminster Parliament held the balance of power and never once lifted a finger or raised a voice about the way the Health Service and other services here were being destroyed by that same Westminster Government?

I agree totally.

We have heard much from the Member and her party Colleagues about underfunding and mismanagement. To that I align what has been significantly ignored: the cost to the Health Service of 30 years of paramilitary violence. To come up to date, will the Member join with me and condemn the actions of the youth wing of her party who inflicted an extra burden on the Health Service this week in south Armagh?

I gave way for the Member to make a comment, not a speech. I commend the Member for getting that point in. It takes me back to my point about collective responsibility. Dr Hendron mentioned - [Interruption]. You should not throw stones, Danny, you never know what you might hit.

Members should conduct business through the Chair, not that I wish the stones to come in this direction.

I hope that Dr Hendron will agree with me about collective responsibility. It is reflected in the fact that the increase in the waiting time for some fracture services happened because some roads and footpaths were not gritted last year. Most problems that the Health Service faces are not under its control, including, for example, cryptosporidium, fuel poverty and the fact that 20% of children live in poverty. I am not trying to diminish the problems in the health sector, but we need a proper debate.

The Committee for Health, Social Services and Public Safety asked a few weeks ago for a meeting with the Office of the First Minister and the Deputy First Minister and also the Minister of Finance and Personnel to discuss the underfunding of the Health Service. We have received no answer. That makes me wonder whether they take the matter seriously. Do they take their commitments in the Programme for Government seriously, or are they just paying lip service to them?

I agree with what Mr Beggs said. He and I sit on the Public Accounts Committee. However, Mr Beggs should calm Mr Dalton down. If he takes a heart attack, it will add to the waiting lists in our hospitals. I also agree with the Minister that the Assembly and the Executive are ready to rise to the challenge. The problem of years of underfunding must be tackled, but the additional money should, in a mature debate, be welcomed. The funding is not sufficient, but I am pleased at the increase in funding for cardiac surgery and children and family services.

Many Members said that finance was not the main issue, before going on to call for more resources for their own area. That is the reason for our amendment; there is a crisis in the Health Service, and we must tackle it. I urge all Members to support the amendment.

I thank all Members for their valuable contributions. I particularly thank the Minister for listening and responding to our concerns. I welcome the Minister's comments on the ongoing action.

Mr John Kelly spoke about lighting a candle, rather than cursing the darkness. I hope that Members were more constructive than that. He also talked about the lack of resources; we must know exactly what resources are required. Dr Hendron gave some stark, frightening details of the number of people waiting for cardiac surgery and said that a number of people had died waiting for surgery. He talked about accident and emergency waits, neurology and primary care.

Rev Robert Coulter discussed the structures, the number of trusts and the financial wastage of over-administration. He also expressed his concern about pay awards and mentioned the need for a clear strategy and better management. Mr Berry spoke graphically about crisis, disaster and despair that the situation was getting worse. He said that we needed more debate and expressed concern about the hours that junior doctors work and the related safety implications.

Ms Gildernew referred to the link with poverty and the rural issues - [Interruption].

Order. I have told Members from time to time that, if they wish to converse, they should do so in the Lobbies.

Ms McWilliams talked about the need for more resources and the problems with delayed discharges. Mr McCartney returned to the theme of collective responsibility. He also discussed the idea of establishing an emergency committee to deal with the situation. Mr Gallagher talked about the need for common sense and the requirement for more decisions and resources. He also said that we needed a clear plan.

Mr Beggs asked what the Department of Health, Social Services and Public Safety does. He talked about the need for more speech therapists and nurses, and the problems caused by the delayed discharge of patients. He highlighted the frustration that that causes. Mr Shannon spoke about community care, the chief executive's pay rises and agency nurses. He said that we must hold on to and value our health care staff.

Mrs Nelis made an unfortunate attack on the SDLP, and accused us of being party political. I am sorry that she feels that way. I feel strongly about health issues, and three of my party Colleagues are health professionals who have spent years working for the Health Service. I assure the House that we feel passionate about the issues about which we speak, and we are genuinely concerned about the patients. I resent that attack.

Dr McDonnell spoke about the need for good management and efficiency. His contribution was very constructive; he mentioned the shortfalls in funding for rheumatology and neurology and highlighted the importance of primary care and psychiatric care. Usually, psychiatric care is left until the end of a debate, with the result that we do not get around to discussing it. We could have a whole debate on that topic alone.

We have all tried to address the issue collectively, albeit from differing angles. A general theme of the debate was the need to develop a clear strategy and to make more decisions. We acknowledge that there has been a history of underfunding. However, we must ask where our expenditure is being directed at present. No one doubts that the money is allocated to the hospitals and patients. However, there is a concern that we do not have a clear long-term strategy. If we constantly inject funding in an emergency, we are only sticking a plaster on the problem, rather than getting to the core of it.

In January, £14·5 million was allocated, and in February a further £18 million was allocated. Of that, £8 million was allocated for the work plan on the waiting lists. I would genuinely like to know what happened to that report, because the waiting lists are getting longer.

Northern Ireland does not have an official GDP, and our allocation from the Treasury is made according to the Barnett formula. However, within three years, the UK's expenditure on health will be 7·6% of the GDP, by comparison with an anticipated EU average expenditure of between 8% and 9%. In general, a higher proportion of the UK's GDP must be spent on healthcare. The Labour Government have committed themselves to meeting that aspiration. However, money is not the only problem. There is no direct correlation between the amount of money that some countries spend on health and their outcomes.

The UK's public health expenditure is about the same as Italy's; it is greater than Spain's, and it is only 1% behind that of France. We can learn a good deal from other countries. As I said, Northern Ireland spends more than 40% of the block grant on health and social services. For 2002-03, we have allocated £2·527 billion. That is a substantial sum. The Minister of Finance and Personnel noted, rightly, that the Health Minster was successful in well over half of her bids for the discretionary initiatives that she wanted to undertake. In other words, resources are a problem, but they are not the only problem.

We need to get off the merry-go-round of reviews and consultations. We must make some tough decisions, and we need a clear strategy. The patients are crying out for it. I look forward to working with the Minister and the Health Committee and to playing my role in contributing to a better future for the Health Service.

Question, That the amendment be made, put and agreed to.

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