6.

asked the Minister of Education what resources he will make available to address the backlog in the school building programme.

(AQO 572/01)

The public expenditure plans for 2002-03 provide £106 million for new school buildings, ongoing capital works in schools and other areas of capital expenditure.

Go raibh maith agat, a Cheann Comhairle. Gabhaim buíochas leis an Aire as a fhreagar, ach tá ceist eile agam air. The Minister will be aware of some of the health and safety issues that arise, both in schools that, from necessity, use temporary buildings - some of which are past their sell-by date - and in older buildings that require structural improvement. Those health and safety issues put additional pressures on head teachers and teaching staff. Therefore, will the Minister give priority to addressing those issues in the future school building programme?

I agree that the unacceptably large number of temporary buildings at schools creates great difficulties for schools, teachers and principals. The Department is determined to reduce that number year by year. However, much of the temporary accommodation is a legacy of many decades of neglect and underfunding. It is not a problem with an overnight solution. It will not be resolved in the school capital building programme that I will announce in March, but the Department is determined to tackle the problem, and to provide the proper buildings and resources for principals, schools and pupils.

Lang may yer lum reek wi ither fowk's coal. Can the Minister clarify how much progress has been made on the PFI projects announced in the 2001 capital building programme? Does he agree that it is rather disingenuous to announce a spending programme of £70 million in 2001, when it is likely that building in any of the PFI projects will not take place for three or four years?

Last March, I announced details of an investment package to address the backlog of building work in the schools estate. It included 17 projects to be implemented under the conventional school building programme, which represented an investment of £62 million, and eight secondary school projects, with a total capital value of £70 million, to be implemented under public-private partnerships (PPPs). A further £16·2 million for four school projects was made available under the Executive programme funds.

Those involved with PPPs know that it is a fledging initiative in this part of the country. The Department has gained valuable experience, and the officials who deal with the negotiations in conjunction with our education partners are very experienced. However, the negotiations are lengthy, and that creates difficulties such as the expectation, which Dr Adamson mentioned, that all that can be accomplished speedily. However, as our negotiating techniques improve, it will be possible to reduce the timescale, and the Department is constantly endeavouring to do that.

The Minister wished the House a happy new year. I hope that he recognises that for many, still nursing the hurt of the terrorist campaign that he and his friends directed, 2002 will be far from happy.

With regard to the backlog of capital spending that is required in schools, will the Minister assure the House that the blatant imbalance that we have witnessed since he took over as Minister will not continue in this financial year and will not continue if and when additional resources are made available to deal with the appalling backlog? Schools that cater for the mainly Protestant community have faced an imbalance of three to one with capital spending. Money is required in all sectors of education, but the Minister seems unable to recognise that.

The Member should grow up. He should recognise that much has happened in the past 10 years. We have a peace process and the Good Friday Agreement. We would move forward more decisively if every political - [Interruption].

Order.

We would move forward more decisively if every political party and every Member of the Assembly put their shoulders to the wheel with the rest of us to try to bring about the new society that the agreement promised.

I absolutely reject the accusations of imbalance - that is an old chestnut. The allegation is untrue and unjustified. We heard that nonsense last year. The schools capital programme is determined solely on the basis of educational need, wherever it exists, whether the money is for controlled schools, voluntary schools, or any other schools.

The make-up of last year's conventional school building programme was as follows: six Catholic maintained school projects, costing £25·7 million; 10 controlled school projects, costing £24·1 million; and one grant maintained integrated school project, costing £12·5 million. I hear that Sammy Wilson used to be a teacher - well, my God, it appears that the man cannot even count.

I hear that the Minister used to be a terrorist.

Order.

7.

asked the Minister of Education to outline the result of his discussions with both sides of the teachers' negotiating council regarding pay and conditions of service.

(AQO 554/01)

My meetings with both sides of the negotiating council on 13 December were very positive. The teachers' side explained its claim for an independent inquiry into teachers' pay and conditions of service. The management side described its offer of a joint review to be carried out in the scope of the existing negotiating machinery. I said that I would have to give careful consideration to the respective views before reaching a discussion, based on what is best for the teaching profession as a whole. I shall make that decision shortly.

I thank the Minister for his answer, but why has it taken so long to reach a decision on the matter? Why has the situation been allowed to reach the stage of teachers' unions balloting their members about possible industrial action?

As I said, my meetings with both sides occurred on 13 December last year. Given the Christmas and new year holidays, the time span has not been unduly lengthy. However, I concede that the matter was in the public domain prior to that. The decision will be taken shortly.

Will the Minister begin an inquiry into teachers' pay, conditions of employment and, more importantly, the bureaucratic burden placed on them that makes actual teaching more difficult?

During the Christmas period, I gave serious consideration to all those matters. The outcome of the inquiry could have an effect on my Department's resource requirements and may have implications for other Departments. Therefore, I wish to consult Executive Colleagues before establishing such an inquiry.

8.

asked the Minister of Education to outline his initial conclusions regarding the Burns report and the practicalities of implementing its recommendations.

(AQO 571/01)

I will not make any conclusions on the Burns report until I have considered carefully all comments received during the consultation period. Academic selection is at the heart of the issue, and I hope that there will be a mature and constructive debate on that central matter. Our aim must be to create a modern education system that will secure fairness and raise standards for all of our children. We can achieve that if we work together.

Does the Minister accept that if the Burns report's proposals are implemented fully, it will be impossible for grammar schools to retain their academic ethos and excellence. Therefore, they will cease to exist in their current form.

I am encouraged by the way in which the Burns report has been welcomed and by the interest that it has generated. There is evidence of consensus on several issues, such as the guiding principles, ending the test, the value of the pupil profile and the value of collaboration among schools, including grammar schools. There are also concerns about the practicalities of other issues, including the admissions criteria, details of the pupil profile and the operation of the collegiates. Those issues, and the central issue of selection using academic ability, are vital to the future of our education system, and it is important that the debate continues.

That said, there is no doubt that grammar schools have made a massive contribution towards academic achievement through the years. However, there is a debate about academic selection: less than one third of the cohort who sit the 11-plus go on to grammar school education, and two thirds are consigned to a system that is perceived as being unfair and full of inequalities.

The proposals are very important. The consultation process is ongoing. I expect that there will be wide- ranging responses to the proposals and I will be interested to read those contributions. We shall follow the debate with keen interest to pick up on the various issues raised, not least the one just raised by Mr Kennedy.

This represents a massive challenge for the education sector, the House, the political process and society. Many people, including young people in the Shankill Road and Falls Road areas, and other socially deprived parts of the Six Counties, are depending on their elected representatives getting it right.

I wish Members a happy new year. I hope that the commander is prepared to go to the rioters in north Belfast and persuade them, and his fellow members in Sinn Féin, to stop the rioting for the new year.

Order. I ask the Member stick to the substance of his supplementary question.

Is the Minister committed to delivering the Burns proposal on free transport for school children? If so, can he explain to the House how he reconciles that commitment with the cost allocations? Does he agree that the moneys identified for him by the Burns report fall well short of achieving any expectation raised for free transport? Will he admit to the House that he failed to cost that proposal and that those moneys will simply not deliver free transport as promised?

I advise everybody interested in the debate to make their contributions to the consultation process. Mr Paisley raised several issues concerning school transport. One must remember that the Burns proposals are "the Burns proposals". I am keen to see what contributions are made during the course of the consultation period so that, in conjunction with my Department and the Executive, we can move forward and deal decisively with those important issues.

Question 9, standing in the name of Mr Dallat has been withdrawn. I do not see Ms Armitage in her place, so Question 10 falls.

11.

asked the Minister of Education, pursuant to his Department's letter of 13 November 2001 to education and library board chief executives on the subject of changes to LMS schemes 2002/03, to detail a common funding formula towards which boards should aspire.

(AQO 546/01)

A consultation document seeking views on the Department's proposals for a common funding formula was issued to schools and other interested parties on 5 April 2001. The consultation period was extended to 21 September, and there has been a good response across schools of various types. On 4 October I announced that implementation of the common formula will be postponed until April 2003. The decision to postpone allows more time to consider the responses to the consultation in detail, to prepare the legislation and to complete the necessary groundwork and practical arrangements for the implementation of the formula. Work can continue in parallel on several of these issues, and I hope that following further consultation with our education partners, I will be in a position to announce final decisions on the formula in late spring or early summer of this year.

If I may diverge for a moment, I want to associate myself with Mr Gibson's remarks about the attacks on the buses in Strabane.

The Minister is well aware that a letter went out to chief executives on 13 November 2001 suggesting that they should be working towards the common formula. Are we being told that the period of consultation is worthless?

I have outlined the processes put in place to deal with these matters. I am satisfied that things are moving according to plan, and I hope that we can take final decisions about this in late spring or early summer.

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Health, Social Services and Public Safety

1.

asked the Minister of Health, Social Services and Public Safety what discussions she held with district councils prior to the appointment of council representatives to health and social services (HSS) councils; and to make a statement.

(AQO 549/01)

A Cheann Comhairle. Ní raibh aon chomhráite agam le comhairlí ceantair. Tá ceart reachtúil ag gach ceann de na 26 chomhairle ar shuíochán amháin ar chomhairle SSS a chlúdaíonn a limistéar geografach, agus tá suíocháin bhreise ag na cinn mhóra de réir a ndaonra.

I ndiaidh na dtoghchán rialtais áitiúil, iarradh ar na comhairlí ceantair uilig ainmniúcháin a chur isteach ar bhallraíocht chomhairle sláinte agus seirbhísí sóisialta. Tá 39 gcomhairleoir ceantair ceaptha agam ó shin.

Déantar gach ceapachán do chomhairlí SSS de réir nósanna imeachta ceapacháin phoiblí mo Roinne; déantar iad a rialú agus a mhonatóireacht ag an Choimisinéir Ceapachán Poiblí.

I did not hold any discussions with district councils. Each of the 26 councils has a statutory right to one seat on the health and social services council that covers its geographical area, with the larger ones having additional seats on the basis of population. Following the local government elections, all district councils were invited to submit nominations for health and social services council membership. I have since appointed 39 district councillors. All appointments to the HSS councils are made in accordance with my Department's public appointment procedures, which are regulated and monitored by the Commissioner for Public Appointments.

I thank the Minister for her reply and the appointments made to the health and social services councils, which are purely advisory bodies. Will the Minister consider the extension of democracy to where it counts - the health and social services boards, from which local government representation was withdrawn by the Health and Personal Social Services (Northern Ireland) Order 1991? In her review of the situation, will she take on board the need for having elected representatives on the decision-making boards for health and social services, and thus restore that element of democracy that has been missing for 10 years?

If Mr McGrady had wished to ask a question about boards, it would have been a good idea to do so before, rather than wait until today to ask a supplementary on a question that is clearly about the health and social services councils.

The Member will know that the health and social services boards, trusts and all other elements of public administration will be looked at as part of the review of public administration that the Executive intend to undertake. On several occasions I have explained to the House how we will proceed with the element referred to in the acute hospitals review on the structures of health and social services. Therefore, how we regard the health and social services structures will be considered in the context of the Executive's stated position on the review of all public administration here.

Go raibh maith agat, a Cheann Comhairle. Is the Minister satisfied that enough people at grass-roots community level are coming forward for public appointments?

The idea of public appointments is clearly that people should be appointed on merit. It is important to understand that the question of merit in this context is not limited to business or professional expertise. Appointment opportunities are open to people with non-traditional career paths, experience of voluntary or community work or direct experience of the problems faced by service users. I am keen to have such people on the various public bodies.

In pursuance of my wish to attract more candidates with experience at grass-roots community level, and to encourage more applications from women, disabled people, ethnic minorities and people from outside the Greater Belfast area, my Department has raised public awareness through major press advertisements, by targeting local advertising in community magazines and professional publications, and through the delivery of presentations to various community and interest groups and information stands at major conferences. I want to encourage a wider section of the community to apply for appointments.

In order to achieve that, my Department holds interviews locally or reimburses travel expenses so that people who are unemployed or on a low income are not unnecessarily disadvantaged. All possible outreach measures are being used, and I can only take the opportunity once again to appeal to those from a wider spectrum to put themselves forward in order to carry out that essential work in our public bodies.

2.

asked the Minister of Health, Social Services and Public Safety, taking into consideration that the elderly are the only section of the community who are compelled to pay for nursing services, to explain how this anomaly relates to section 75 of the equality agenda.

(AQO 550/01)

Tá ceanglas reachtúil ann faoi láthair de bhua alt 15 agus alt 36 den Ordú Sláinte agus Seirbhísí Sóisialta agus Pearsanta (Tuaisceart Éireann) 1972, i gcás ina gcuirtear cónaitheach i dteach altranais agus ina mbainistíonn bord sláinte agus seirbhísí sóisialta cúram go ndéanfaí é nó í a mheasúnú faoi na Rialacháin Sláinte agus Seirbhísí Sóisialta agus Pearsanta (Measúnú Acmhainní) (Tuaisceart Éireann) 1993 maidir lena gcumas íoc as an chúram sin. Bainfidh an reachtaíocht nua atá mé a thabhairt faoi bhráid an Tionóil - An Bille Sláinte agus Seirbhísí Sóisialta agus Pearsanta (Uimh. 1) - costas chúram altranais i dteach altranais as an mheasúnú sin.

At present there is a statutory requirement by virtue of articles 15 and 36 of the Health and Personal Social Services (Northern Ireland) Order 1972, but where a resident is placed in a nursing home managed by a health and social services board, he or she should be assessed by the Health and Personal Social Services (Assessment of Resources) Regulations (Northern Ireland) 1993 as to ability to pay for that care.

The Health and Personal Social Services (No 1) Bill will remove the cost of nursing care in nursing homes from that assessment. I agree that charging elderly and other vulnerable people for nursing services in nursing homes does not fit easily with the fact that nursing care in all other hospital and community settings is free at the point of delivery.

The elderly are the main users of nursing home care, and they are, therefore, most likely to be affected by the regulations governing financial support for community care. I intend to introduce free nursing care in nursing homes from October 2002. The provision of £4·5 million in the revised Budget for 2002-03 will pay for that change, subject to the successful passage of the necessary legislation.

I thank the Minister for her reply - or should I say the two replies - and she has answered my supplementary question with her assurance that she will bring in free nursing care for the elderly. Thank you.

Few Members are honest enough to acknowledge when a supplementary has already been answered. They usually take a second bite at the cherry - sometimes on a completely different issue, it has to be said.

I too welcome the Minister's announcement. How many people will benefit from free nursing care?

At present, approximately 2,000 people pay for all of their care in registered nursing homes. A further 6,000 are supported by the health and social services boards, and 1,200 receive the special higher rates of income support to pay for their care. Initially, the 2,000 who pay for all of their nursing home care will benefit from the proposed changes in nursing care funding arrangements by up to £5,000 per year.

3.

asked the Minister of Health, Social Services and Public Safety to outline any plans to reduce the waiting list for operations for hip replacements.

(AQO 569/01)

Is eol domh go bhfuil liosta feithimh suntasach ann do mháinliacht athchur corróige faoi láthair. Bhí méadú ginearálta ar ráchairt ar sheirbhísí ortaipéideacha; mar thoradh air sin agus mar thoradh ar an easpa máinlianna ortaipéideacha, tháinig borradh ar liostaí feithimh.

Rinneadh bearta le plé leis an ardú éilimh sin, lena n-áirítear ardú 50% ar líon na máinlianna ortaipéideacha atáthar a oiliúint agus obráidí a cheannach in Albain.

I am aware that there is a significant waiting list for hip replacement surgery. A general increase in demand for orthopaedic services and the shortage of orthopaedic surgeons have resulted in longer waiting lists. Measures have been taken to deal with the increased demand, including an increase by 50% in the number of orthopaedic surgeons in training, and the purchase of operations in Scotland.

I thank the Minister, but I did not understand the first part of her answer. Will the Minister undertake to place on record in the Assembly Library a list of waiting list times for all categories of operations? The last time that a request for lists was made, those provided were incomplete. Does the Minister agree that not only is there a shortage of money, but there is insufficient staff to care for patients? How will the Minister encourage people to join this important profession?

If Mr Armstrong outlines the information on waiting lists that he seeks, I will forward it to him. If he has difficulties with any information that he received in the past, he should tell me. My officials will study Hansard tomorrow to note the information that the Member wants us to forward, and we will ensure that that is provided.

Initiatives designed to reduce waiting lists here include reducing the number of people who fail to keep their appointments. Last year, for example, over 13% of those with outpatient appointments for trauma and orthopaedics failed to keep them. The effect of this is that others are being denied the treatment that they need. The service is also creating alternatives to hospital admission. For example, a pilot initiative in south and east Belfast is aimed at treating people in the community and reducing the need for surgery. It involves ensuring that theatres are operating at maximum capacity and validating lists to ensure that they are accurate.

Mr Armstrong is correct that an increase in resources is one aspect of the staffing problem. As a result of the absence of resources to train staff in the past, there is a lack of orthopaedic surgeons and anaesthetists here and across the NHS. Simultaneously, hospitals are looking for specialists, who are in scarce supply. We are doing all that we can to attract specialists here, and we will make a sustained investment in our services covering future staffing and physical capacity.

The Minister will acknowledge that there is a crisis in orthopaedic surgery. The Minister mentioned the need to use operating theatres to their maximum capacity. Aside from those waiting for hip replacement, patients in Craigavon Area Hospital with fractures of the neck of the femur must sometimes wait for a week to be admitted to the Royal Victoria Hospital.

There are two excellent operating theatres in what is known as the security wing of Musgrave Park Hospital, and I understand - although I am not totally sure - that the Ministry of Defence has given permission to use them. Are those theatres being used, and, if not, are there any plans to use them?

Immediate measures taken to alleviate the difficulties include the provision of additional theatre sessions at Musgrave Park Hospital and the utilisation of the Duke of Connaught unit on the Musgrave Park Hospital site. One major difficulty we had recently was the virus affecting the Royal Victoria Hospital fractures department and its knock-on effects. The Musgrave Park Hospital site has had to help out with fracture surgery, and that will have a knock-on effect on the activity of elective orthopaedic surgery. However, to minimise that knock-on effect, additional sessions are being arranged at the hospital.

I was interested that the Minister said that there is a lack of resources. Does she not agree that the money would be better spent if there were some sort of restructuring? If we did not have the 19 chief executives in the trusts that run the Health Service, their wages would pay for 400 hip replacements a year. Getting rid of their 19 personal assistants would pay for another 150 hip replacements. The Minister said that she had obtained resources. From which Department were those resources taken to be put into orthopaedic surgery?

I bid for resources - I do not bid against any other Department. However, I notice that sometimes when Members ask for extra resources they want the resources to remain in all other Departments and to come to mine at the same time. Unfortunately, the Executive cannot facilitate that. I cannot, therefore, say from which Department resources were taken, because I have not taken resources from anyone. I have bid for resources to carry out vital work in health and social services, and I sincerely hope that all Members who have asked for those services to be improved will also applaud the allocation of funding to see those improvements carried out. We will need much more of those resources in the future.

Almost every time that I have come before the Assembly I have outlined that there is a process which the Executive have decided on to review public administration. Within that, we will be looking at the structures of the health and social services. In the short term some of that restructuring might cost more, and in the longer term some of it might produce savings. I have no doubt that savings can be achieved through restructuring in some areas.

Restructuring, however, will not generate enough money to make up for the £190 million that was taken out of health and social services by the Conservative Government in the 1980s and 1990s. That reduction in funding has resulted in a massive lack of capacity in the service today, affecting staff and staff training, beds, equipment and services in the community that could prevent people from having to go into hospital. No amount of restructuring can make up for that. People should not hold on to some idea that there is another way around the present lack of capacity other than putting capacity back in. That is the way forward.

We will do what we can. We will examine the structures, and I have outlined on numerous occasions how that work is advancing in conjunction with the Executive. In addition, and in the context of severe financial constraints, my Department has undertaken several measures to increase efficiency. It is to be hoped that that will make savings in the coming year which can be ploughed back into the service. We know that we need to help ourselves. However, the basic problem remains that in the 1980s and 1990s an amount of money, equating to £190 million at today's prices, was taken out of the Health Service baseline. In spite of that, in the past five years we have treated 10% more patients and produced 27% more community care packages. We have treated more people, increased the number of intensive care unit beds and produced more childcare places.

I draw the attention of the House to the fact that we have made it through only three questions so far. I hope that in the time remaining we can make it through a few more.

4.

asked the Minister of Health, Social Services and Public Safety if her targets are being met in promoting awareness of nutrition and health, especially among the less well off.

(AQO 589/01)

Léirigh suirbhéanna a choimisiúnaigh an Ghníomhaireacht um Chur Chun Cinn Sláinte gur tháinig feabhas suntasach ar an tuiscint atá ag daoine ar na teachtaireachtaí tábhachtacha ar chothú agus sláinte. Tá an cothú ar cheann de na réimsí tosaíochta a sainíodh i gclár sláinte poiblí an Choiste Feidhmiúcháin 'Infheistíocht do Shláinte', a fhoilseofar san Earrach. Mar chuid den chlár sin déanfaidh mo Roinn athbhreithniú ar an straitéis bia agus cothaithe faoi Aibreán 2003.

Surveys commissioned by the Health Promotion Agency have demonstrated a significant increase in awareness and understanding of key messages on nutrition and health. Nutrition is one of the priority areas identified in the Executive's public health programme, 'Investing For Health', which will be published in the spring. As part of this programme, my Department will review the food and nutrition strategy by April 2003.

The inclusion of specific targets for promoting awareness will be considered in the development of the new strategy. We continue to work to promote the messages among the less well off. The Health Promotion Agency has developed a community-based nutrition education programme, 'Cook It', targeted at low-income families. It has also worked with the Department of Education to produce new nutritional standards for school meals - standards which were issued for consultation last month.

Does the Minister accept that information about these targets is so hard to find in her Department that many members of the public know nothing about them? In view of the recent report on poor health, which indicated that the gap between the health of the rich and that of the poor is widening, will she undertake to make the information more widely available in her Department, throughout the trusts and from the Health Promotion Agency?

Mr Gallagher will be happy to know that surveys undertaken by the Health Promotion Agency show that people have an increased knowledge of the information available to them about nutrition and the problems that are of concern to him. Respondents in the 1994 survey did not show the same awareness as those in the most recent survey.

I am happy to say that several actions have been taken to promote healthy eating in early life, both by my own Department and by the Department of Education. Nutritional guidelines have been issued to support the work of the early years teams with under-5s in childcare. Schools offer an ideal venue for educating children about nutrition. Many schools have acknowledged this and have developed and implemented initiatives such as breakfast clubs, healthy snacking schemes, lunchtime schemes and healthy eating days organised in association with school meals staff. My Colleague, Martin McGuinness, talked about the nutritional standards for school meals, which were issued by the Department of Education for consultation on 12 December 2001. A considerable amount of work has been done to raise awareness.

In addition, the ministerial group on public health, which is consdering inequalities in health, will look at this.

What effect will recent increases in meals-on-wheels charges have on the Minister's nutrition and health targets? This is the second increase in the past 12 months.

Those who commission meal services, whether in the hospital setting or through meals-on-wheels, will take account of the need to produce nutritional food at all times.

Go raibh maith agat, a Cheann Comhairle. What is the Minister doing to promote nutrition on an all-Ireland basis? I take this opportunity to congratulate her, her Department and the Health Promotion Agency on the graphic new anti-smoking advertisement.

The Food Safety Promotion Board, the all-Ireland body set up as part of the Good Friday Agreement, has established a working group comprising interested parties north and south to discuss the development of a food and nutrition forum. The group first met on 10 December 2001 and will meet again on 5 February 2002. Terms of reference are being developed for the forum, which will provide a more focused and effective dissemination of information on nutrition to the public on an all-Ireland basis. We hope to build on our successes in other areas, such as promoting awareness of the benefits of folic acid.

5.

asked the Minister of Health, Social Services and Public Safety if she plans to have an evaluation study to examine the deployment and effectiveness of all the additional finance invested in the Health Service in the past year.

(AQO 547/01)

Déantar na cuspóirí ar a gcaitear an t-airgead breise a mhonatóireacht go dlúth in aghaidh spriocanna cuí. Mar shampla, cuireadh na hacmhainní uilig atá leagtha amach le seirbhísí breise a chur ar fáil i gcomparáid le hardú costais na seirbhísí faoi láthair ar leataobh laistigh de chreatlach an Chláir do Rialtas trínár gcomhaontú seirbhíse poiblí agus tríd na Tosaíochtaí le haghaidh Gníomhaíochta níos sonraí atá dírithe ar an SSSP go forleathan.

The purposes for which additional money is spent is a matter that is closely monitored against appropriate targets. For example, all resources designed to provide additional services, as opposed to the rising costs of existing services, have been earmarked in the Programme for Government framework through our public service agreement and the more detailed priorities for action, which have been directed at the wider health and personal social services. The outputs generated by those investments are monitored quarterly and are the subject of regular discussion with the area boards. Consideration of the effectiveness with which the Department's money is spent is an integral part of our existing procedures. I am, therefore, satisfied that no separate evaluation study is necessary.

The Minister will agree that one of the most worrying aspects associated with additional finance allocated to the Health Service over the past year is that it is a one-off payment that is unrepeatable. In the light of that, what steps has the Minister taken to significantly alter the balance of expenditure between direct clinical spending and administration costs?

I thank Mr Savage for his supplementary question. First, I absolutely agree with his point that although additional resources are welcome, the problem with money that is received in-year through the various monitoring rounds is that it is one-off money. It will not be in our baseline the following year, and so the service cannot make longer-term plans on the strength of it.

The nature of health and social services work is that it ought to provide a continuous service, maintaining standards and accessibility of service throughout the year. We cannot enter prudently into longer-term commitments that would require a multi-annual baseline increase with in-year money. In the absence of greater certitude about future funding levels, long-term planning is difficult, if not impossible.

The boards and trusts know that balance is necessary between administration and clinical services, and we have a situation where no more than 2% is being spent on administration costs in one board area and no more than 4·5% in others. Even within those administration cost figures, activities such as taking out files to hand to front-line staff account for some of those costs. Those activities would have to be carried out by front-line staff if support staff were not in post.

I too welcome the Minister's response, but considering that we still hear hardship stories on a daily basis, is she satisfied that the current monitoring system is sufficient to ensure that the money is being focused where it is most needed?

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