Go raibh maith agat, a LeasCheann Comhairle. It is interesting that Assembly Member Iris Robinson chided the Minister for politicising her role. No issue is more politicised, inside or outside the Assembly, than health, and the only reason for that is the Minister's political position. That is the only reason, and most of the politicisation has been by the Democratic Unionist Party.

Last Friday, an agricultural item on the BBC programme 'Newsline' compared our health with that of animals. I objected strenuously to the programme at the time, but I have yet to receive a satisfactory reply from the BBC. Health has been politicised because of the party to which the Minister belongs.

Every party had the opportunity to take the health portfolio when it was offered on the first day on which the Assembly sat. Each party in turn passed the chalice to Sinn Féin, who accepted it. I contend that Sinn Féin, and the Minister, have behaved in a very responsible, progressive and energetic manner in relation to health. She has attempted, despite the backdrop of a lack of financial resources, to address the problems. Unfortunately, the political sniping continues. A similar motion was debated two weeks ago. If that is not recycling and politicisation, I do not know what is.

Dr Maguire met members of the Committee for Health, Social Services and Public Safety, and last week its members fulfilled their promise to him when they visited Downe Hospital. It was noticeable that no members of the DUP attended the Committee's meeting with Dr Maguire and the executive of Downe Hospital - so much for their care for Downe Hospital and the extreme circumstances in which it finds itself.

It has been said before that health is an emotive issue - an issue that people play politics with. However, I am not going to play politics with it, nor is my party. We have a genuine concern, given our background as a socialist party, for the welfare of people in our society. We are not here to play the politics of the DUP.

People's health is the central responsibility of the Government. If we have a Government here, they should deal with the critical issues of our time. It is interesting that Assembly Member Iris Robinson said that it is not just a question of funding, yet she wants the First Minister and the Deputy First Minister to meet with the British Chancellor of the Exchequer to ask for more.

It is also interesting that, although my Colleague Sue Ramsey and I proposed, in November, that the Committee for Health, Social Services and Public Safety should meet with the First Minister and the Deputy First Minister, we did not receive a reply until last week - so much for the concern for the financial problems in the Health Service. So great is the Executive's concern that they did not respond, as a collective, to our request for a meeting with them until last week. We are sick and tired of the political sniping over the health of our community - political sniping that extends beyond the Assembly into some areas of the news media as well.

We are talking about the health of the people who live in our community. Health has no sectarian walls or divides because it affects all of us. If a person is sick, it does not matter whether he or she is a Prod or a Taig: everyone requires treatment for his or her illnesses. A fracture requires treatment; cancer requires treatment; and a heart condition requires treatment.

We must work together to form, as Joe Hendron mentioned, a cohesive and collaborative approach to the Health Service. It is wrong for people to sit on the sidelines, not participating in the Executive, still wanting the largesse of the Assembly and the largesse from the Good Friday Agreement, but ignoring their responsibilities to the Good Friday Agreement. Those people have little room to talk about the Department of Health, Social Services and Public Safety, or any other Department, given the disgraceful attitude of their party to the Executive and their neglect of the Executive and the Good Friday Agreement.

Will the Member give way?

When we stand up, you people refuse to give way, so I will not give way.

I ask the Member to address his points through the Chair.

On a point of order, Mr Deputy Speaker. Is the Member addressing the motion? I would like you to rule on that because he does not seem to be doing so. He seems to be on a political rant, and it is neither the time nor the place for that.

They do not like the message, so they want to shoot the messenger. I suppose that it is not the first time that they have shot messengers.

As Dr Hendron said, the Committee for Health, Social Services and Public Safety has attempted to address the issue of health, with whatever ability we have, in a non- partisan way. The Committee has visited most of the hospitals in the Six Counties. We have met staff from all areas of the medical profession - midwives, nurses, consultants, junior doctors, and members of the British Medical Association (BMA). The underlying problem, according to them, is the lack of funding in the Health Service. There is no escaping that fact - however much others may wish to cover it up with calls for inquiries about where money went in the past. The Health Service needs funding, not only for crisis management but also for a health strategy. The Health Service needs a strategy that goes beyond the present crisis into next year, and the year after, and so on.

Members have talked about the Chancellor of the Exchequer: Gordon Brown himself said that the Health Service in England, Scotland and Wales had suffered 50 years of neglect. Charlie McCreevy, the Minister for Finance in the Twenty-six Counties also said that there was a shortage of funding. I call on the Executive to make the health of our people their number one priority - [Interruption]. You sit down. You cannot stand up.

TOP

Mr Deputy Speaker, you have asked Members to limit their speeches to eight minutes. I could spend 108 minutes on the subject. It has all been said before, so I will be as brief and to the point as possible.

The Health Service is in crisis. It has been in crisis for a long time - since before Bairbre de Brún came on the scene. Many people are suffering unnecessarily, which is disgraceful and totally unacceptable. The crisis in the Health Service exists across the whole range of health provision. There is a lack of hospital beds; a lack of services for patients who suffer from a vast range of complaints; a lack of outpatient facilities; problems with regular and emergency treatment; and a shortfall in the provision of good quality care in the community. Vital drugs, which could improve the quality of life, are withheld, and the latest digital hearing aids, which could make such a difference to people with hearing disabilities, are still not provided free, despite the fact that Minister de Brún has asked for funding for that provision.

The crisis in the Health Service was fully debated just before Christmas. The Assembly and the Executive have now agreed that health is the number one priority, which, in itself, is progress.

I accept that the Executive and the Assembly have agreed that health is the number one priority. However, that was not reflected in the December monitoring round, when only £7·8 million was allocated to health.

I accept what Ms Ramsey says, and I hope that the Minister of Finance and Personnel will take that on board.

Before Christmas, we fully discussed the lack of provision in the Health Service. The pressure to greatly improve services must continue. Members must continue to put pressure on. I appeal to all Members to forget about who is to blame. Now is the time for us all to band together, as Rev Robert Coulter has already said. We must work together to get the best possible services from the resources that we have, to give everyone decent quality healthcare - maternity care, primary care, hospital care and community care. Free nursing and personal care must also be provided. In that way, everyone can be assured of a quality health service from the cradle to the grave.

I welcome the extra money that was allocated to health this morning. It is not nearly enough, but let us hope that it will be used wisely for the benefit of everyone.

I support the motion, and I pay tribute to staff in the Health Service for their continued professionalism and devotion to duty. Once again we are discussing the serious situation in our Health Service - a service which has been thrown into further crisis.

I do not share the views of some Members who think that the issue should be put on the back-burner. This is an important issue that must be kept to the fore at all times until it is finally resolved. The crisis will not go away until we make serious decisions and take effective action to ensure the long-term future of the service and develop mechanisms to cope with the situation.

In the last debate, I raised specific issues about Craigavon Area Hospital Group Trust that have since come home to roost. The cries for help were genuine. They came from staff who have been working under emotional blackmail in the Health Service for many years. The crisis at the Craigavon hospital peaked on Monday 7 January, when 31 patients were waiting for beds. The situation was highlighted extensively in the media, and while it concentrated on the accident and emergency services, all of the hospital services were under pressure.

The trolley waits have been reduced - yesterday they were down to 17, which is still unacceptable. It is a stark reminder of the lack of capacity in the hospital, which presents an unsafe environment for patients and staff. That must be addressed. All medical, nursing, administrative, portering and domestic staff have worked, and continue to work, extremely hard in difficult circumstances to ensure that a high quality of care is maintained for all patients.

There are currently 433 beds in Craigavon Area Hospital Group Trust. In 1993, there were around 600 beds across the trust, and about 200 in South Tyrone hospital. In the same year, the numbers of patients treated were as follows: 21,000 inpatients; 76,000 outpatients; 36,500 accident and emergency attendances; and 2,138 deliveries. In 2000-01, there was a 23% increase in the number of patients treated. The total numbers treated were as follows: 25,886 inpatients; 130,161 outpatients, representing a 71% increase; 70,815 accident and emergency attendances, representing a 94% increase; and 2,567 deliveries, representing a 20% increase.

The increase in workload and the corresponding reduction in beds reflects the ability of staff to provide a high level of care in a rapidly changing environment. The Craigavon Area Hospital Group Trust is discussing a 10-year strategic plan with the Southern Health and Social Services Board and the Department. I urge the Minister to make a long-term commitment to, and investment in, Craigavon hospital, which plays a vital role in the delivery of acute hospital care in the south of the Province.

Bed-capacity problems are evident across the Province, as the main hospitals do not have the beds, the staff or the resources to deal with the number of patients currently requiring treatment, which results in long and growing waiting lists. The main hospitals in Northern Ireland have the biggest demand for services. Sadly, only about 10% of the work in Craigavon hospital is elective or planned surgery. That figure is being reviewed weekly, with the trust carrying out as much urgent elective work as possible. However, some of the smaller hospitals have less demand for services and much shorter waiting lists. The pressure remains on the acute hospitals, and the problem has been well documented. The Minister must acknowledge that, with the limited capacity in hospitals, the necessary emergency work must go ahead as a priority, and other ways must be found to manage the planned work, and reduce the unacceptably long waiting lists. Many of my constituents would be more than happy to travel some distance to receive elective surgery at other hospitals that have the necessary capacity, rather than remain on the waiting list for Craigavon hospital.

A review of how elective work is managed across Northern Ireland is urgently needed so that the workload can be spread more evenly across all hospitals in the Province. Surely it is time for a closer working relationship to be forged between the management teams of various hospitals to ease the inequalities in access to the Health Service.

We all know that the Health Service has been blighted by bad publicity. There are difficulties in recruiting medical and nursing staff, and many experienced staff are leaving because of low morale and lack of job satisfaction. That impacts on those who remain, and makes it difficult to sustain even the present levels of care. That needs to be addressed urgently if safe care and quality of care are to be maintained and improved.

It was welcome to hear the Finance Minister announcing an additional £7·8 million today on top of the £8 million that has already been allocated. However, there is no use throwing money at the Health Service during the year, because that is not a solution to the problem. We need significant long-term investment, and it must be equitably distributed across the Province. The Health Service must be properly resourced; managers need to know the level of available resources so that services can be properly planned, run and maintained. The Hayes review of acute services points the way forward for acute hospital care in Northern Ireland. Serious consultation and decisions on the future configuration of hospitals must be a priority for the Assembly.

This problem affects all our people, irrespective of class or creed. It is far too serious an issue for political point-scoring. It is time that the Assembly stood together and got this problem resolved once and for all. This crisis is not acceptable, and the Health Service needs urgent, decisive action. I support the motion.

I too support the motion. The concern being expressed outside conveys the message to us all that all is not well in the Health Service. I suspect that during the Minister's deliberations she will again remind the House that, in some way, the problem is not of her making. The continual distancing of herself and her Department from the problem washes very lightly with the general public. Whether it is of her making or not, the bottom line is that it is her problem and her responsibility. It is difficult to understand why we seem to be going from one crisis to another. If this were happening in a modern company, something drastic would be done.

One of the most fundamental and basic rights of any individual is access to a good healthcare system. However, it appears that when it is the Health Service, there seems to be a degree of complacency, indifference and, at times, neglect, to say the very least - I am trying to be kind. Some might find those words a bit sharp, but I did not create the perception. The perception out there is that no one seems to really care. It is the Minister's responsibility to sit down with her officials and work out a resolution to the crisis in our healthcare system.

Every possible index of the state of the Health Service shows one thing; one word could sum it up - deterioration. From waiting lists to the hours worked by junior doctors, there is a continual deterioration. We, as Assembly Members and public representatives, demand to know why it is that way. The Minister continually tells us that the Tories did all this, and that it is of their making. My understanding is that the Tories are long gone, and some even say that they have been forgotten about. Others have made the bold statement that they will never be back. Who are we going to blame then? Has Labour not had a term of office? Has Bairbre de Brún not had a term of office? "No blame at all to me" she says - and, like Pilate, washes her hands.

During direct rule, the cry was always made, "If we had a local Administration, we would make things different. We would make them hum. We would have a Health Service that was second to none, and we would make every citizen proud of the fact that local people had their hands on the local issues." Is that happening today?

To be fair, would the Member not agree that the situation is different? Since the Minister took over, things have got worse.

Sadly, that is true. Things are steadily getting worse, and soon they will be out of control. Without the professionalism of the doctors, the nurses - and the ancillary staff, I hasten to add - there would be chaos. The Department's managers and the Minister must take note. They cannot continually stand up like Pilate and say "Not our responsibility. We are not the guilty people."

The Minister has approximately 40% of the block grant at her disposal. She may say that that is not enough, and that may be true in some cases. However, if the Minister had enough money tomorrow, would she have a blueprint and a plan to put before the Assembly, the doctors and, more importantly, the patients in Northern Ireland? Has she got that blueprint to demonstrate in unambiguous terms that she is in charge of the situation? She will have to do better than she has been doing, because she convinces nobody. Whether or not the situation is of her making, she must stand up and say "Look, this is my job. This is my responsibility. I am concerned."

The Minister's continued running away from the crisis in her Health Service will not wash any longer. It may be a nice, convenient fig leaf to hide behind to say that the problem is somebody else's. It is the Minister's problem. She may not want it, and Mr John Kelly argued that anybody else could have had the Health portfolio. Well, nobody else has it. His party has it. He then boldly said that his party are socialists, yet they leave patients lying in wards, on trolleys and in corridors.

If the Conservatives did that, I hasten to add, those socialists would be standing outside every hospital with their placards. However, they are not doing that, because the birds have come home to roost, and now that it is their responsibility they do not like it one little bit. They do not like criticism, but a Minister should not be so gutless as to be unable to take criticism. Let the Minister stand up and take the criticism, and never mind the yobbo behind her who seems to be more interested in going down for a political rant. Some of us are very sincere about this.

I recently visited Craigavon Area Hospital at the invitation of Dr Maguire, and I saw at first hand what was happening there. When the Minister and her officials decided to close South Tyrone Hospital, they were warned that Craigavon Area Hospital could not cope, because it was already at 90% capacity. What were we told? "You do not know what you are talking about. We can cope. We can sort it." Are they sorting it? Tragically, they are not. Patients are being left for hours on end simply because of the overload that has come as a result of the closure of South Tyrone Hospital.

I ask the Minister to retrace her steps, reopen South Tyrone Hospital, especially given the current crisis. Let her demonstrate that she does care and that she is concerned. Then she will start to convince people that she has the stomach for the job that she is in.

TOP

I welcome the opportunity to discuss the recent health crisis. The public, who have witnessed the dreadful scenes in our hospitals in recent weeks and years want to see and hear about solutions. That also goes for the patients whom we saw on trolleys, for their distressed families - some of whom we saw interviewed - and for the harassed doctors, nurses and other health workers involved. The public do not wish to see an acrimonious debate in the Chamber, or attempts by individuals or parties to push around the blame.

The public know that there is a solution. They know that what needs fixing comes down to two issues - funding and management. It is as simple as that. As I said yesterday, in the past decade we have lost out in comparison to Britain by around £30 million or £33 million a year, yet its Health Service is in a beleaguered state. We must bear that in mind and figure out where we stand.

The funding issue requires a three-pronged approach. First, as has been pointed out, this Assembly must press the Treasury to make up some of the funding shortfall. Secondly, our Executive must take on board our key service's priorities. At that level, additional money has been set aside for health and, already this year, approximately an extra £20 million has been directed towards our Health Service. It is encouraging to see that the Executive have some recognition of the problem.

Thirdly, the Committee for Health, Social Services and Public Safety - and I am sure that other members of that Committee agree with me - relies on the Minister to make the case for more funding. We support the Minister. When we receive correspondence from the Committee for Finance and Personnel, we make our case. When we receive officials from the Department of Health, Social Services and Public Safety, we make the case again.

The other issue concerns management. Everyone knows that executives in the Health Service are highly paid, and some are not doing a good job. We have seen that they are repeating past mistakes. In the light of the scenes that we witnessed in recent weeks, it is time that they were brought into line. That is an issue for the Minister and her Department, and it is one on which I wish to see action taken.

General planning in the Health Service could also be addressed in the short term. Last week, I visited the South Tyrone Hospital in Dungannon where I saw the empty wards. The accident and emergency department is open nine to five, five days a week. If that service alone were open from nine in the morning until 10 at night, seven days a week, less pressure would be placed on Craigavon Hospital. The public understand that; it is common sense. Our managers must be pulled into line about such issues.

We also need a decision on the Hayes Report so that we can get a plan in place and into people's heads.

Wide consultation has taken place. An independent and representative body was set up, which consulted in this country and beyond, and made recommendations. I hope that we will not be going into further consultation. The doctors and the hospitals realise that in the meantime, with the uncertainty that is generated, services are falling through the floor. They say that it cannot wait, and I agree.

We heard outside the Chamber that the First Minister and the Deputy First Minister, through their offices, refused to meet the Committee for Health, Social Services and Public Safety and that that has something to do with this problem. I do not agree with that view. There are lines of procedure: we have the Committee, the Minister, and the Office of the First Minister and the Deputy First Minister, and we should abide by those lines. Members of the Health Committee back the Minister of Health, Social Services and Public Safety in making her case, and the Committee expects the Minister to argue that case at Executive level.

I will not argue that the Committee should bypass the Minister and go directly to the First Minister or the Deputy First Minister when it suits it. Regardless of what Committee I am on - [Interruption].

Will the Member give way?

I will not give way. To bypass the Minister is to undermine her. I do not understand why I am hearing that argument from individuals who belong to the Minister's party, and I would like that matter clarified. Do they want to bypass their own Minister or do they not?

Will the Member give way?

I will not give way. I have outlined how we should approach the issues of funding and management clearly and consistently.

On a point of order, Mr Deputy Speaker. Did the Member support the call for the First Minister and Deputy First Minister to meet with the Health Committee?

I supported the Chairperson's exploration of that concept, and I am on record in the Committee as doing so.

We have an Assembly that people have long sought, and there are procedures and ways of doing business. Let us all get behind those who are in key positions. We all have a responsibility to the public to deliver a proper and efficient Health Service and one that serves them well.

TOP

We have heard a fair old tale of woe from around the Chamber. The Department must know by now that there is a crisis. The difficulty is that I cannot envisage action of any great detail to sort out the problems. Does the Department know where the choke points are? Where are the problems in the Health Service? On the one hand, £2·5 billion is going in at the top end, and on the other, patients on trolleys and overworked staff exist at the sharp end. That would indicate to any objective observer that something is wrong.

The Health Committee tried to find out where the problems are. It examined the Health Service accounts to try to identify where the money was going and to track it down through the system. That was not possible. It tried to follow the audit trail, but, sure enough, the moment it got there the Department changed the headings, so it was impossible to identify where the money coming in at the top had worked itself out at the bottom. That remains to be the case.

If this were a commercial business, the managing director and the board of directors would have been sacked long ago. In its lack of clear action to deal with the problem, the Department reminds me of the old Soviet politburo, which was unwilling to countenance any change to, or any interference in, its affairs. It will review, consult, consult again, but do nothing.

The Department has a very bad relationship with the Committee for Health, Social Services and Public Safety. It has been an unhelpful and reluctant colleague, unlike many other Departments' relationships with Assembly Committees. It has adopted an arrogant attitude towards the Assembly. Members will have noticed the concern expressed in a recent report by the Public Accounts Committee about a reply it received from the Department of Health. In its reply to a comment made by the Public Accounts Committee that highlighted a departmental wrongdoing, the Department stated that it did not accept the comments. That Committee is the most powerful one in the Assembly. My colleagues in the Committee for Health, Social Services and Public Safety will bear that out.

We need to re-examine the present situation. Let us look at primary care. The Committee Chairperson talked about the looming chaos, and why, last year, we gave the Minister and the Department a year's grace to sort itself out and to ease in a better, simpler GP fundholding system. There has not been a dicky bird. There has been no movement, and what was brought before us last year has reappeared. I am concerned about the Department's attitude.

We have heard about patients waiting on trolleys in hospitals. The Hayes Report stated that 80% of patients in accident and emergency departments should not be there; they would be better dealt with in a primary care situation. Those who live near hospitals use them like a medical centre. We have known that for a long time. What action has been taken to clear the primary care patients out of hospitals, where they are gumming up the works, to allow the hospitals to function properly? There has been no mention of it at all. We heard yesterday about the amazing state of affairs in community care, which is gumming up hospitals from the other end.

Staff on the ground will say privately that the problem is as much a management one as it is a financial one. Health Service staff know where the problems lie, but they are not allowed to initiate change. They fear for their jobs and the system above them that will not countenance change. They are not empowered to implement changes that they know would improve the hospitals.

The Department of Health and the hospital managers need to remind themselves of the purpose of the Health Service. It is not an employment agency, nor is it a system that sits still. It is there for the benefit of patients. However, the patients will say that they do not believe that the present system works for their benefit. That cannot be right. We need leadership from the Department and the Minister and better management in the hospitals.

I urge the Minister to lead a drive to slim down bureaucracy in the boards and trusts. She must encourage managers to empower their staff to improve the effectiveness and efficiency of our hospitals. Then, perhaps, if the Department can identify where the money that the Assembly directs into the Health Service is going, we shall be confident that the Department of Health is effective and is hitting the target. I support the motion.

Go raibh maith agat, Mr Deputy Speaker.

I find it a little difficult to hear you, Ms Ramsey. Will you speak towards the Chair?

John Kelly started the debate as a consultant, but I am only a junior doctor. I will not take a hard run at him.

The most recent Assembly motion, as amended, on the Health Service urged the Minister of Health, Social Services and Public Safety

That debate took place on 11 December 2001; it was the last debate before the Christmas recess. My Colleague John Kelly and I tabled an amendment to that motion calling on the Executive to provide additional money. We are both aware that there are pressures not only on the acute sector but throughout the Health Service - from community care to mental health, from services for the elderly to those for young people. We discussed the situation during the debate on 11 December 2001 and in a debate on care in the community on 21 January 2002. On 11 December 2001 all parties agreed to call on the Executive to provide additional money to target pressures in the service as a whole.

It is regrettable that Tommy Gallagher has just left the Chamber, because he sought clarification on a point. The Committee for Health, Social Services and Public Safety wrote to the Office of the First Minister and the Deputy First Minister on 16 November 2001 because it was aware that we would face a crisis in the service - in dealing with winter pressures, et cetera. We requested a meeting to discuss the years of underfunding of the service. Mr Gallagher states that he agrees with the decision by the Office of the First Minister and the Deputy First Minister not to meet with the Committee because he would see that as sidestepping, or bypassing, the Minister. However, the Minister wrote to the Committee to welcome its approach, because Committee members were going to support her bids. The Committee was visiting hospitals, and it witnessed the problems there. Its intention was to support the Minister's bids to the Executive.

I hope that Mr Gallagher reads my clarification in the Official Report. In my view the SDLP has now pulled back because the Office of the First Minister and the Deputy First Minister does not want to meet with the Committee. Who is playing politics now?

The Chairperson of the Committee wrote to the other Ministers about the problems faced by the Health Service. One of the proposers of today's motion, Rev Dr Ian Paisley, is the Chairperson of the Committee for Agriculture and Rural Development. Following on from Dr Hendron's letter, would Rev Dr Ian Paisley and his Committee allow some of its Department's budget to go towards alleviating some of the serious problems in the Health Service? It would be silly not to welcome the additional money that has been given to the health sector. However, it is non-recurrent funding.

The Minister of Finance and Personnel today stated that the health sector faces real problems. Some Members said that health is one of the most talked about topics in the Assembly. However, the Department received a less than 10% increase in its budget in the December monitoring round. I must stress that that money is non-recurrent. One cannot talk about a three-, five-, or 10-year plan when the money received is only year-on- year and is non-recurrent.

The Minister of Finance and Personnel also said that many people will ask why the Executive are not doing more to target funding in the Health Service. I want to ask that question. We are aware that there is a serious underfunding of the service. Health is a priority in the Programme for Government, but where is that priority when the Executive are talking about money?

As a member of the Committee for Health, Social Services and Public Safety, I am aware of the problems faced by people working in the front line. I send my thanks to them, because they sometimes work in serious conditions. Last week we visited the Downe Hospital, where there are such problems. Staff there do a brilliant job, and we must congratulate them.

I have spoken to several people in the community sector who are concerned that money will be transferred from their funds to support acute services. The acute sector gets the big headlines. The community sector states that that has happened before, that we need to get away from it and that we must take a holistic approach to health rather than taking money away from one part of the service to give to another.

I make no bones about talking about the years of underfunding. Members have stated several times that this is not a funding issue, yet they proceed to attack the Minister. However, they rightly highlight the problems faced in their constituencies: occupational therapy issues; people not getting community-care packages; and people not being able to get access to wheelchairs. Members need to be aware that the funding of trusts is an issue.

Several Members mentioned waiting lists, an issue that I raised during the debate on 11 December 2001. The Committee for Health, Social Services and Public Safety looked into non-attendance for hospital appointments, because a percentage of patients do not attend appointments. Waiting lists are growing, so we must ensure that people who have appointments keep them - otherwise they are just extending the lists.

What have the Executive done since the motion on the Health Service crisis was passed on 11 December 2001?

Some Members said that we cannot go on blaming the Tories, who have been out of power for the past five years. When they were in power, the Tories stole £190 million a year from the Health Service - a service that they were against from the start. New Labour are not doing any better, because it is giving us the crumbs from the table while investing in the Health Service in England.

Ms Ramsey, thank you for making yourself much more audible to my old ears.

While there are many uncertainties in the Chamber, there are some certainties; one is the way in which some Members react when they are chided. John Kelly is a case in point, given his reaction to crucial health issues raised by my Colleague Mrs Iris Robinson and by Dr Hendron, Mr McFarland and Rev Robert Coulter. One certainty is that when the bait is put into the water, John Kelly always bites. However, he made some interesting points, which are worth repeating and studying when we get the Official Report. He said that the Minister's political position is the problem - those are his words, not mine. Now that there is a realisation of the problem, perhaps they should do something about it. He is the only person in today's debate who has said that he did not want it to take place because it is a recycled one. All that the Member has to do -

On a point of order, Mr Deputy Speaker. I said that the problem with the Minister was the DUP's problem; not the Minister's problem.

Hansard will show who is being accurate, Mr Deputy Speaker.

We have a serious subject here, and it would be nice if both parties would just get on with that.

TOP

Mr Deputy Speaker, you have touched on another certainty about what will and will not happen in the Chamber. Nonetheless, the statement was made that the issue is being recycled. It is clear that if one goes into the wards in Northern Ireland, as many have done, and speaks to patients, relatives, medical, nursing and auxiliary staff, one will find that the problem is not being recycled; it is being renewed every day. It is being repeated in hospitals up, down and across Northern Ireland.

This blindness, this Pontius Pilate-like washing of the hands of blame is completely unacceptable. For a short period during the debate it appeared that the Minister had, for the want of another word, the moral support of the President of IRA/Sinn Féin standing behind her, but as the debate went on, he abandoned the ship, which appears to be sinking.

Two weeks ago, I had the privilege of shadowing Dr Peter Maguire of the BMA in the Craigavon Area Hospital for ten and a half hours of his 22-hour shift. The invitation to accompany Dr Maguire was extended to the Minister, and I had to accept it, although the Minister should have been there to see the problems at first hand. It appears that the Minister could not look the medical, nursing and auxiliary staff, and the patients and visitors to the hospital, in the eye and tell them that her policies were working. I saw a Health Service not in crisis, but, in the words of Dr Maguire, in "meltdown". People have been running away from that reality, and a holier-than-thou attitude of blaming everyone else is no good. The Health Service is staying together only because the tireless efforts by its staff are holding it together by the seams. Sooner or later that could give way.

Mrs Iris Robinson stated that the Minister should have visited Craigavon Area Hospital, because she should be aware of the situation there. I will remind the House of some of the things she would have seen, had she accepted the invitation. She would have witnessed stressed medical staff, overworked nursing staff, no beds available for patients and patients eligible for care in the community blocking beds. The Minister would have seen people giving their all to the Health Service and being given very little in return. She would have seen agency nurses willing to work as full-time members of staff but not being allowed to do so. In the intensive care ward I witnessed the sad reality of the lack of resources when one person was taken from an intensive care bed, put into a medical chair and told that he would have to be treated from there because the intensive care bed was required for a more urgent case. The patient was given a brass bell and told to ring it when he needed nursing attention.

The Health Service has been brought to that Victorian state, and the Department is blind to that reality. I saw patients with nowhere to go, their dignity violated by a lack of privacy. I saw a public toilet being used as a ward toilet by patients assigned to trolleys in the corridors. I saw staff having to work their socks off in overcrowded conditions, where the movement of patients became an obstacle course along corridors. One emergency theatre had been turned into a makeshift ward. Perhaps the Minister could not look them in the eye and tell them that her policy was working, because it was not working then.

I am sick of hearing the old excuse - let us blame the Tories. That does not wash anymore. The responsibility is here, and we must ask where the allocated money is going. Each time money has been made available Members of the House have voted more and more resources to the Health Service - up to 40% of the block grant. Is the money not traceable once it goes to the Health Service, or is its impact not delivering the desired result? It is not a question of finance at that point, as some Members seem to think - it is a question of management. Management does not start at the bottom; it starts at the top, with the Minister, where it has failed.

Carmel Hanna, who has now become a Minister herself, said in the 'Belfast Telegraph' that it is no longer possible to blame London for the problems, and I think that that is absolutely right, but you do not have to take a politician's word for it. Take the word of the 'Health Service Journal'.

It said that more money is needed. However, it is not the money that counts; it is the bureaucracy. In fact, it said that the management of the service is escalating the crisis. The 'Belfast Telegraph' article said that there was no point in blaming London for the crisis, because it is a crisis of local management.

On 28 December a 'News Letter' article said that doctors and GPs were calling on the Minister to either do her job or quit. Those people are not members of the DUP, the UUP or the SDLP; they are health professionals. When those people make such remarks, it is time for the Department to buck itself up or else be put out. Until people realise that, the problem will go beyond meltdown.

When the Assembly votes money to health - before Christmas it voted an extra £8 million for waiting lists - it does not appear to have any effect. Many Members have suggested prescription and improvements. However, people must realise that the Minister has failed. The Office of the First Minster and the Deputy First Minister must recognise that when it is invited to examine a crisis, whether it be foot-and-mouth disease or the problems at Holy Cross Primary School, it has a responsibility to let the people who are up to the job take over and sort the problem out.

The Health Service faces a crisis of confidence. Every day we hear hardship stories of patients waiting for much-needed surgery. Despite the extra funding since devolution, the situation has deteriorated. For example, the number of patients waiting 18 months or more for elective treatment has jumped by about 700% in four years. Since March 1996, the number of people waiting for outpatient appointments has risen from 59,000 to over 128,000. The total number of people waiting for a hospital bed has risen by almost 10% in the last year. Trusts' deficits more than doubled between 1998-99 and 1999-2000. All that happened despite extra resources.

A 7·2% increase in the budget was announced in October 2000; £17 million was allocated in November 2000; £14·5 million was allocated in January 2001; and £18 million was allocated in February 2001. The budget for 2002-03 will be 37% greater than it was when the Minister took office. That is an increase of £687 million.

The North already spends a higher budget per capita, and a higher percentage of its Budget on acute healthcare than England or the Republic of Ireland. This is proof of the Executive's and the Assembly's commitment to the Health Service. However, the Health Service is about management as well as money. Arguments about the lack of resources should not detract from the need to manage the health budget professionally and to deploy resources efficiently. No matter how much we spend on health, we have a responsibility to ensure good management and accountability for how resources are used. Those lying on trolleys because there are no beds need to know that the money is being spent - if not on a bed for them - on something necessary.

It is over seven months since the Department was allocated £18 million to address trusts' deficits. However, it was not unconditional. The Minister must address the origins and consequences of the deficits. We need answers now. There is concern that some trusts were allowed to run up large deficits, while trusts that managed their budgets well suffered as a consequence. That has nothing to do with the amount of money available to the Department.

In autumn 2000, the framework for action on waiting lists, which was supposed to reduce the waiting list to 48,000, was published, but there is still no report. We need answers to our questions.

Throughout all healthcare facilities there is great disillusionment among staff, including surgeons and medical, nursing, ancillary and ambulance staff. Those people are at the forefront of care. The more hardship headlines they see in the 'Belfast Telegraph' - such as "Elderly woman's 22-hour wait on a trolley" - the more concerned they become, because they must explain to the management why patients were waiting on trolleys.

I agree that funding is critical. However, as the Hayes Report states, while problems can be the result of underfunding, they can also be the result of not using resources efficiently and effectively. It is difficult to argue for additional resources for hospital and community health services, against other national and regional priorities, if it cannot be demonstrated that existing resources are being used to best effect by generally accepted levels of comparison. We need decisions on primary care, on acute care and, above all, on the administration structures in the Health Service. Staff are dealing with day-to-day crises, so they cannot, therefore, give the required time to strategic planning. The Department must take the lead if the situation is to be turned around.

Reference has been made today to the violence at Altnagelvin Hospital during the early hours of Sunday morning. A similar incident occurred three months ago. Security was brought in at that time. Obviously it was not completely effective. How and why that violence occurred is part of the problem. We must ask ourselves why it happened. I believe that it is part of the wider deterioration of community structures. But whatever the reason is, the Assembly needs to take action. We need extra resources for the security that is necessary, if there is not to be a complete breakdown of staff morale. It has got to the stage where the Royal College of Nursing, which is not a militant organisation, is calling for strike action. There is a meeting in Altnagelvin Hospital this evening to discuss the possibility. The call for strike action is the ultimate weapon against the lack of staff security. The matter is critical, and I ask the Minister to make extra funding for the security that Altnagelvin requires a priority.

The Department of Health, Social Services and Public Safety has been allocated an extra £7·8 million in today's December monitoring round. That is in addition to the £8 million that was announced on 3 December 2001. I recognise that there are many demands, such as junior doctors' contracts and consultants' payments, and that there are other pressure such as laboratories, pharmacies and domiciliary care. However, a safe working environment is critical to delivering care. For that reason I ask the Minister to address that problem as a matter of urgency.

Next year's health spending will be some £224 million pounds more than the current year's. However, we must ensure that that money is used to the greatest possible effect - we want staff in accident and emergency departments to feel secure in their work and patients requiring treatment to come into a safe environment. This morning the Minister of Finance and Personnel stated that his Department is to carry out a needs and effectiveness evaluation. That evaluation is necessary to enable us to understand what we are achieving with what we are spending. The Assembly must restore confidence in the Health Service. In becoming a member of the Health Committee, I hope that I can work constructively for the betterment of the Health Service.

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