There are only a couple of Members left to speak. Please use the time as well as possible, and do not repeat what has already been said.

Go raibh maith agat, a LeasCheann Comhairle. I do not plan to speak for an hour.

I acknowledge the tremendous difficulties in the Health Service. I also acknowledge the Minister's best efforts to get to grips with, and to plan beyond, the difficulties that she has inherited. I want to add my voice to the call for greater funding for the Health Service - in recognition of, and in response to, historic underfunding. Members agree that it must become the number one priority for the Assembly and the Executive. We must put differences aside in the interest of providing a proper Health Service for everyone's benefit.

To depart from normal practice, I commend Mr Paisley Jnr for his initiative in visiting Craigavon Area Hospital. However, how much more powerful would that initiative have been if he had persuaded his Colleagues, Minister Robinson and Minister Dodds, to sit around the Executive table and add weight to the argument for more funding for the Health Service. That would be more meaningful and would deliver more in the long term.

It is rich to hear a lecture from the Democratic Unionist Party on the Health Service when that party ducked choosing the Department of Health, Social Services and Public Safety when it could have taken it. Sinn Féin had the courage to go for it - in the person of Bairbre de Brún.

The Barnett formula must be reviewed, with the objective of introducing a system that will address years of chronic underfunding. I speak from the perspective of Fermanagh and Tyrone. The Minister has met delegations from many hospitals and campaign groups that expressed people's concerns and fears about the Hayes review - not least from the two counties that I mentioned. I ask the Minister to ensure the maintenance, where possible, of existing services at both the Tyrone County Hospital and the Erne Hospital, and the expansion of services where necessary. People in Fermanagh and Tyrone fear a running down and destabilising of existing services in such a way that one might easily slip over to the other. I ask for a bridge to the future to be built with regard to both those hospitals. I also ask the Minister to listen to the consultants and various campaigners whom she met recently.

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You were very frugal with the amount of time that you used, Mr McElduff. I appreciate that.

It is probably significant that we have debated the Health Service today and yesterday. It is something of a shame that both motions could not have been combined, as they are very much interrelated.

The public no longer want to see the blame game being played - they want to see some action. I want to hear proposals from both the Minister and the Member winding up the debate to solve the problems. I have listened to much of the debate, and it has been disproportionately heavy on blame. Previous Governments have been blamed; not just the Conservatives, but also the current Labour Government, who seem to be investing as little as their predecessors. The Minister has been blamed, as have other Ministers and the Executive as a whole. Proposals must come out of the Assembly, otherwise motions such as this will continue to be debated.

I was worried to hear that medical negligence cases cost £27 million. That figure may go up, not down, if we do not start to tackle the crisis. I have received many letters, as other Members have, from consultants. We have previously mentioned, as has the Chairperson of the Committee for Health, Social Services and Public Safety, cases where patients have been passed through accident and emergency departments straight on to wards, where they are assessed for trauma. That happens because hospitals do not have the specialised or nursing staff in accident and emergency departments to do that. That is extremely dangerous and will increase the number of negligence cases in the future. If we are to save money, instead of currently pouring money in to prevent more of those problems arising, plans must be put in place.

I was concerned to hear the Minister state yesterday that five sixths of all spending will go on existing services. That leaves one sixth for very little else. We must turn those figures around. I do not want to repeat what I said yesterday about the need to reorientate the culture of how health services are delivered. We must think about delivering intensive and acute care to communities.

We have highly qualified and educated health and social services staff who are ready and waiting to do that. Most staff want to work within their communities. We must start to deliver intensive therapies and care in the communities. Other countries have proved that it can be done, as have some trusts here. I want to ask the Minister why, having looked at what services the trusts are providing, there is such variation in their plans. Some trusts are simply sending patients to be institutionalised and dealt with in hospitals, while others are beginning to introduce innovative plans to prevent bed blocking from starting in the first place. Equally, other trusts are trying to discharge patients more quickly. There is a notion that patients are moved out of hospitals quicker and sicker, but it has been proved that that is occurring less in Northern Ireland than elsewhere and that Northern Ireland is more able to cope with it.

We ought to look at plans of that kind. Yes, infections are increasing, and at the latest update 156 beds were out of use, but we should be able to predict other things. Infections are unpredictable, but most of what we are dealing with in the Health Service is predictable. It is time to reorient it and put those plans in place. Let us not wait for reorganisation; let us put that plan and those proposals in place now.

This morning we debated our December monitoring round, and I am very concerned. There is no such thing as a "Department of the Centre", yet it appears in the monitoring return. I asked that question over and over again. If it means the Executive, then that should be clearly stated. If the Executive say that they are holding back £40 million for a rainy day, why was only £8 million of that given to the Health Service? Of that, £3·4 million went on medical equipment.

At the moment we are hearing about staff shortages. Annie Courtney said that not only is staff morale being sapped, but that now staff are being attacked for their inability to get on with their jobs. Real safety precautions must be put in place to stop that. In addressing the recruitment and retention of staff, we must build up their morale.

Unfortunately, staffing has now become so dependent on agency staff that the permanent nursing staff are demoralised. Agency staff should not constantly be relied upon to make up the shortfall. I understand that the permanent nursing staff have been reduced by 43% since 1998. Something must be done about that. I understand that medical staff have not been cut in the same way, but clearly that must be addressed.

I am often concerned in discussions about hospitals, but if there has to be a bit of firefighting, we must also look at how we can prevent problems arising around mental illness, physical disability and learning disability. Sue Ramsey quite rightly said that money is constantly being taken from those services to deal with the problems in the hospitals. Those problems are genuine.

Concerning cancer, if the Health Service strike is discussed today, it is only fair that we should know what will happen with regard to all those patients with cancer who look for information about the new cancer unit on the Belfast City Hospital site. Also, I have just heard that once again the neonatal unit at the Royal Victoria Hospital has been closed to outside admissions. With 5,000 births in that hospital and 500 in the Downpatrick Maternity Hospital, we knew that a plan for a new centralised maternity hospital was needed.

The issues of cost effectiveness and cost efficiencies really must be taken seriously. A huge number of highly paid consultants sit around most of the time doing very little. Again, that service could perhaps be reoriented towards a midwife-led unit.

Those very difficult decisions clearly will have to be taken. To close the regional neonatal unit for the intensive care of babies to outside admissions is a very dangerous thing to do, and it clearly causes concern. I suggest that the Executive examine the reorientation of some of the moneys that were surrendered. Out of £40 million surrendered, only £8 million came out, and £3·4 million of that went on equipment. That left a very small sum of money - only £4·6 million - for the issues of staffing shortages and pressures. Those messages should not go out to disillusion people. There is £40 million, and the Executive must take it seriously. It is not only a matter of resources. It is also an issue of management, co-ordination and planning.

To pick up on a point raised by Ms McWilliams, I must first express disappointment about cancer services. As late as yesterday, in a written question, I asked the Department for a date on which the cancer unit would be operational. The Department is still not in a position to provide that date. We need both certainty and swift action to ensure that people are cared for.

Today's debate is vital; it is difficult to find an issue that is more important to the people of Northern Ireland. Without indulging too much in the blame game, having been present for most of the debate, I am somewhat disappointed that so few Members have attended.

Suppose that a family doctor diagnoses that his or her patient needs an operation. That person is asked which day of the following week would suit for the operation. A telephone call is made to the hospital, and the arrangements are made for the operation to be performed the following week. That scenario seems extremely unrealistic; in fact, it would appear surreal to many people in Northern Ireland. However, it is commonplace in many parts of western Europe.

In the long term, it is not simply a question of funding. Although I support the calls for greater pressure to be put on the Exchequer to bring Northern Ireland into line with the rest of the United Kingdom, we must realise that, as a whole, the United Kingdom has, for many years, lagged behind the general standards in western Europe. The level of gross domestic product that has been spent on health issues is well below the European average. Therefore, it is not simply a question of bringing Northern Ireland up to United Kingdom levels.

There has either been a deliberate misunderstanding or an attempt by some Members to suggest that the motion is not about funding. No one has suggested that additional funding is not required for the Health Service. However, time and time again, Members have correctly said that it is not simply a question of funding. It may not be, but funding is crucial to the allocation of resources.

The Department and the Minister must accept their fair share of the blame. It is not simply a question of the Minister's inadequacies; the crisis has also come about as a result of the apparently unaltered managerial ethos in the Department of Health, Social Services and Public Safety. At worst, change is regarded as something to be delayed and, at best, as something to be avoided altogether. One wonders whether that Department treats original thought with the same contempt that a minister would treat the concept of original sin. It seems that there is a resistance to change in the Department.

Although we are all agreed that we want to realise clichés such as pulling together and not treating health as a political issue, much of the blame must rest with the Minister and the Department. We need a Minister who will provide action, rather than consultations alone; we need a Minister who will deliver to the coalface of medicine, rather than produce yet another review.

Several issues must be tackled. If, as was indicated, the preponderance of health boards and trusts needs to be streamlined urgently, one would hope that the Department would adopt a proactive approach and devise its own proposals. However, if it is either unwilling or unable to do so, the Executive must fast-track the review of public administration. I appreciate that a review of public administration is ongoing, but priority must be given to the health issues to ensure that results are delivered as soon as possible.

As was indicated by the Chairperson of the Health Committee and others, including Mr McCarthy, the issues of primary care and care in the community must be tackled. They are the key to the hospital crisis. Doctors tell us that too many people are unnecessarily admitted to hospital and that people remain in hospitals for too long because there are no beds available in the community. That has a knock-on effect on the waiting lists for acute hospitals and provision. I am not convinced that the proposals will benefit primary care.

That is at the heart of the matter.

We also need rapid progress on acute hospitals. The Hayes Report states that too many hospitals deal only with acute services, so expertise is spread too thinly. Most doctors accept that that is the case. A better system would concentrate the number of acute hospitals and provide a secondary tier of services at community level. In my town of Bangor, a very good community hospital provides that level of service, thus enabling real medical resources to be put into acute hospitals.

Something must also be done urgently about the disillusionment of healthcare staff. Like others, I pay tribute to them. Unfortunately, to use a phrase that was first used in the first world war, "lions are led by donkeys" in the Health Service. Staff at the lower levels provide excellent care, but they are not given the help that they need from the top. A British Medical Association (BMA) General Practitioners' Committee recently conducted a survey of GPs' opinions by sending a questionnaire to every family doctor in the UK. The findings, which were released a few weeks ago, highlight the dissatisfaction with the Health Service and the need to resolve urgently the shortage of GPs. One of the results of the survey shows that four out of every 10 young GPs want to reduce their working hours over the next five years, and most GPs in their twenties intend to retire early. That is a major problem; resources have been put into training people, but too many drop out because of poor morale. That issue must be tackled.

We must make better use of technology. For example, more use of IT would enable medical staff to see, at the touch of a button, what medication a patient was on, what illnesses he or she suffered from and the results of previous investigations. That would save more lives, which is the ultimate test of any Health Service provision.

Ways of screening must be improved to ensure that people who do not need to see a doctor do not use up time. More help could then be given to those who need it. That would also ensure greater mobility and would allow surgeons to spend more time in theatre performing procedures.

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I ask the Member to draw his remarks to a close.

The crisis has not been caused simply by a lack of funding; inadequate management has played its part. We need action, not words; we need delivery, not another review or consultation.

Go raibh maith agat, a LeasCheann Comhairle. Few Members from the west have taken part in the debate; I wish to rectify that. Much of the debate has centred on management and on the roles of the Minister and the Committee. This is a long-running debate; it is a regurgitated debate. We are rehashing the same debate time and time again, a debate prompted more by politics than by health.

As I mentioned in yesterday's debate on community care, there is a history of destruction of the Health Service by the Tory Government, which dates from the 1980s and 1990s. They made cuts of 3% a year, which left us to cope with years of underfunding in community, primary, acute, and accident and emergency care in all Six Counties. The responsibility for health also lies beyond the Department of Health, Social Services and Public Safety: all Departments must make the matter a priority or it will not receive the attention that is needed. Healthcare is very significant, and health problems are probably the worst problems that anyone must face. Health should therefore have priority over other departmental issues. The Department of Education and the Department of Agriculture and Rural Development have a role to play, and, in my part of the country, the state of country roads also affects health.

Health issues have a major impact on family income. There is a high unemployment rate in Fermanagh. Many people are forced to take low-paid jobs, and we have a growing elderly population. All those factors increase the pressure on local hospitals.

Food and diet also have an impact on health. We live in a fast food society, in which children eat a good deal of junk food, and such products are widely advertised. Drinks vending machines are available in schools, which encourages children to have a high-sugar diet. Those factors will have a massive impact on hospitals' future costs. The effect of pesticides on food is a problem for the Department of Agriculture and Rural Development. I mentioned that yesterday to the Minister of Agriculture and Rural Development, who said that there was nothing wrong with organic or locally produced food. However, I was referring to food that we import, and which is grown using substances that we banned years ago.

Drugs, alcohol abuse and smoking also affect health. Every day, young people watch people smoking on the most popular television shows. Such programmes advertise smoking as if it were going out of fashion - of course, we hope that it will. Government Departments, Ministers and others should lobby to stop such advertisements for smoking, so that young people do not succumb to peer pressure and begin to smoke, as smoking can have a major impact on young people's future health.

The foot-and-mouth disease crisis and the loss of income in areas such as Armagh and Newry have had an effect by way of stress, depression, suicide rates, help to families and counselling. I raised that issue in yesterday's debate on community care. Those factors affect health services, because, if patients do not receive early treatment, they may have to go to hospital, which results in very high costs.

Carmel Hanna was quoted earlier as saying that it is no longer possible to blame everything on London. However, London must be blamed for the amount of money that we are allowed to spend here every year. Members, and particularly those in the DUP, seem to be playing politics. This is a handy football for the DUP, which it will use to the best of its ability. Health does not seem to come into it - it is mostly about politics.

Areas such as Fermanagh have fared badly with the recently published document on the Noble index. Departments and Ministers should re-examine that document to see whether it has been rural-proofed and TSN-proofed. We are told that it has been TSN-proofed, but I do not believe that that is the case - it does not stand up to local scrutiny. Perhaps the entire document should be reviewed. If Departments use that document as a baseline - and it would seem that that they do - rural areas will lose out badly.

Responsibility for access to healthcare and acute care services falls under the remit of Peter Robinson and the Department for Regional Development. Roads are very much a part of any debate on the Hayes Review and the reconfiguration of hospitals. In fact, access to services is more important than the hospitals themselves, and that issue must be dealt with. From the recent plans published for roads, it seems that most of the funding will be sucked into the Belfast metropolitan area, while other areas will receive no funding.

Barry McElduff mentioned the Hayes Report, which is vital to the future of hospital configurations in the Six Counties. We must include the border areas in those configurations too. A large geographical area running from Monaghan to Sligo, and including Tyrone, Fermanagh and Cavan, could be left with no acute healthcare services if both sides do not work together to ensure the provision of vital health services.

We need to get value for money from the Hayes review, and it must be implemented. Tyrone and Fermanagh need acute services and primary care - both areas must be looked after, and we need decisions as soon as possible.

I am disturbed that the Committee and the Department are at such extreme odds - or so it seems from this debate. That is not a healthy situation. It is not good for the health of the people, and is not a great way of going forward. They have to find a consensus. Is there enough money? Are we doing the right things? Are we getting it right, and are we going forward in the next number of years to put things right? Go raibh maith agat.

There being no further requests to speak - Mr Shannon.

Thank you for giving me the opportunity to speak.

This subject concerns us all, irrespective of party or opinion. Each of us is concerned that the Health Service is unable to deliver at present. Many of us have addressed this issue before. Most of us have spoken on it, and we will probably do so again. Yesterday we debated the provision of community care, which is a big issue. I agree with Members who say that there is a clear relationship between both. There is a domino effect - they both work in tandem. Will this debate end without any action being taken, or will steps be taken to address the issue?

Anyone who reads the provincial or local papers before or after Christmas will be aware of specific cases where people have not received the service that they should have done. The Health Service is failing to deliver for them. The demands on the Health Service continue to increase, and the system is crumbling at the edges. Indeed, my Colleague Mr Paisley Jnr said that the Health Service is showing signs of meltdown. That is what we believe to be the seriousness of the situation.

We all have constituents coming each and every day to our advice centres, phoning our homes and speaking to us on the streets. They tell us their horror stories of delays, long waits for operations, and a Health Service that cannot cope.

Accusations have been made in this debate that the DUP is being partial. I have a Roman Catholic constituent who has had cancer. She is fortunate that the cancer is in remission, but as a consequence she has bowel trouble. Her GP said that it would be terrible if the cancer came back and referred her to the hospital. She got a card to say that she would be seen in seven months. That is not an isolated case - it goes on and on. As Members of Parliament, and Members of this House, we have a responsibility to those people to highlight their cases.

When one of my Colleagues, Mr Campbell, banned sheep grazing in the Mournes because of cryptosporidium, Members called for his resignation. Now, when these problems are happening in the Health Service, criticism of both the Minister and the Department should be legitimate. We have been told that the Committee and the Department are at loggerheads, so something must be drastically wrong.

I thank the leader of my party for his intervention. We all could recount similar cases of people who, irrespective of their affiliation or political opinion, have come to us for help. That is our job as elected representatives.

I pay tribute to the doctors, nurses, and the ancillary staff. They are the unsung heroes who try to do their best in very difficult circumstances.

I want to highlight waiting lists, as they are a good indicator of what is happening. The waiting lists for orthopaedic speciality - not operations, just appointments - are interesting: 1,271 people have been waiting between one and 11 months, while 13,053 people have been waiting between 12 and 24 months or more.

The waiting list for surgery is horrendous. Almost 15,000 people are waiting for general surgery; 1,500 have been waiting for more than 24 months; 629 people are waiting for neurosurgery, 266 for 11 months and 353 for more than 24 months. It goes on and on. Two thousand five hundred people are waiting for plastic surgery, and 549 are waiting for cardiac operations. Almost 50,000 people in the Province are waiting for operations. That is a health system failing to deliver; that is a Department in chaos and disarray.

Things might have been bad a couple of years ago, but they have got worse. In 1999, 14,020 people were waiting for orthopaedic outpatient appointments; today that figure has almost doubled. That should illustrate the situation for those who are in any doubt that we are in crisis.

The Health Service is not doing enough for victims of sexual abuse. I met the chief executive of the Ulster Hospital Community Trust, and I asked him to make extra provision. The money is not there. The Nexus Institute does tremendous work in providing counselling. However, when I asked for extra provision for counselling in my constituency, I was told that the institute would love to do that, because people needed assistance, but that there was no money. There is extra demand on the Health Service, and the service is needed, but it is not being delivered. People need help, but the Department has failed to deliver.

Administration must be revamped. There are 27 trusts and four boards, yet there is talk of introducing another level of administration into the Health Service. We must make changes, and there must be streamlining at that level to make the service more efficient.

With regard to funding for the Health Service, it is time that we took the matter to the highest level, to Westminster. It is time for funding to be made available through the Department and through the Office of the First Minister and the Deputy First Minister. The time is right for a radical approach, with no holds barred. If that does not happen, I am afraid that we shall return to discuss the future of the Health Service while our constituents wait and suffer. I wonder how many of those on the waiting list for urgent operations will be here in a few months or less if they do not get the urgent and positive action that is needed. I support the motion.

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Go raibh maith agat, a LeasCheann Comhairle. Chuir go leor Comhaltaí a n-imní in iúl inniu faoi chúrsaí inár seirbhís otharlainne, agus tá mé féin ar aon aigne leo faoina thábhachtaí atá sé dul go bun na faidhbe seo go héifeachtach.

Tugaim do m'aire go n-aithníonn Comhaltaí brú suntasach a bheith ar ár n-otharlanna agus go háirithe ar an fhoireann atá ag obair iontu. Is mór mo mheas ar obair ár bhfoirne; mhaolaigh a scileanna, a n-oilteacht agus a ndíograis ar iarmhairtí na mbrúnna a bhí ar othair ar na mallaibh.

Ón uair a ceapadh i m'Aire mé, tharraing mé aird ar na brúnna troma atá ar ár n-otharlanna agus ar ár seirbhísí cúraim phobail; d'áitigh mé nár cuireadh acmhainní ar fáil do na seirbhísí seo le riar ar na héilimh a dhéantar orthu. Is é fírinne lom an scéil nach bhfuil na hacmhainní acu ná an fhoireann le riar go sásúil ar na héilimh a dhéantar orthu; éilimh atá ag méadú de shíor.

Dhearbhaigh mé ariamh nach mbeidh ár seirbhísí in innimh plé leis na brúnna a luaigh Comhaltaí inniu gan infheistíocht athfhillteach shuntasach thar roinnt blianta.

Le seachtainí agus le míonna beaga anuas, chuir mé béim chomh maith ar an iomad dea-rud atá ag dul ar aghaidh ar fud ár seirbhísí, ainneoin a bhfuil de dheacrachtaí ann le hacmhainniú. Tá dul chun cinn á dhéanamh againn i gcónaí le caighdeán agus éifeacht seirbhísí a fheabhsú; agus níl deireadh ar na torthaí ar an phleanáil a rinne muid lenár gcórais a shruthlíniú agus lenár gcomhoibriú a fheabhsú, go háirithe san uair is treise brú.

Many Members have expressed concern about the situation in our hospital services today. I share their anxiety, and I am equally determined to ensure that the underlying issues are effectively addressed. I note the widespread recognition by Members of the significant pressures on our hospitals, and particularly on the staff who work in them. I have the highest admiration for the work of our staff, whose skill, expertise and commitment have played a vital part in minimising the effects of recent pressures on hospital patients.

Ever since my appointment, I have drawn attention to the heavy pressures on our hospitals and community care services and argued strongly that these services have not been resourced in the past to meet the demands made on them. I welcome the fact that that has been reiterated today by virtually every Member who spoke in the debate. Our community and hospital services simply do not have the capacity or the staffing to handle the continually growing demands that are being made of them.

Despite the removal from the baseline of £190 million in today's terms since the 1980s and 1990s, the service has treated 10% more patients, and there has been a 27% increase in community care packages. The service has also seen an increase in emergency admissions of almost 10% in the last year. I have maintained that without significant recurring investment over several years, our services will not be able to deal with the pressures that Members have drawn attention to so graphically today.

Over recent weeks and months I have also highlighted the fact that, despite all the problems relating to resourcing, there is still much that is positive happening across our services. We continue to make real progress in improving the quality and effectiveness of services, and our planning to streamline our systems and improve collaboration continues to pay dividends, particularly at times of intense pressure. Colleagues elsewhere have commented favourably on the degree of integration in our services.

With regard to the work and the immediate action that has been taken to address the situation that I faced when taking office, since that day our hospitals have 33 more intensive-care and high-dependency beds, 100 more nurses are entering training every year and more people are receiving community care than ever before. There will be a further 1,000 extra community care packages in the coming year alone, on top of the additional 230 extra this year, and 100 new ambulances are on our roads.

I have also directed additional resources into important areas of hospital services, such as cancer treatment and cardiac surgery. That is only an initial step in the right direction. Local cancer units are now up and running in all our major hospitals, with over 50% of all day-patient chemotherapy now provided outside the main centre in Belfast. We are also making significant progress on the construction of the new cancer centre.

On foot of the recent review of cardiac surgery, I am putting in place measures to get more operations carried out and to deal with unacceptably long waits for treatment. We have carried out convincing work to improve all of those services. I am determined to press for further improvements in the quality of both those vital service areas.

We are also addressing capacity issues through staffing, recruitment, training and the professional development of staff by means of comprehensive health and social services workforce planning. That will have a direct and positive impact on the staffing of hospitals. Those are just some of the building blocks being used to put meat on the bones of our clear vision for high-quality services as resources become available to put the vision into practice. There has also been detailed planning over the short, medium and longer terms. We have the investing for health strategy, the review of acute hospital services, 'Building the Way Forward in Primary Care', the review of community care and the implementation of the Northern Ireland Ambulance Service review. Those measures will enable us to take the necessary steps to meet the needs of the service user, while reflecting the potential impact of longer-term drivers for change, such as the age profile of the population and new or emerging medical technologies.

I have already reported to the Assembly on how I am developing that work. I assure Members that my Department and I are committed to working closely and effectively with the Committee. I value and welcome the Committee's input and support and I will do so in respect of the work that lies ahead. We must work together to make this vision for the future a reality.

Other immediate actions have taken place. I have already mentioned extra nurses, extra ambulances, extra care in the community and extra intensive care and high-dependency beds. On top of that, the Northern Ireland Social Care Council has been established, to develop the work that social workers want done and to improve standards for social workers. There are extra residential childcare places, there is closer integration of the service, and I have put in place financial management arrangements. There have been several forms of immediate action, and yet the self-same Members still stand up during debates and say that a decision must be made. When I make a decision, I am described as "imposing change".

I am working very closely to set up local health and social care groups. Much work has already been undertaken, guidance has been issued, and further guidance will be provided shortly. The Department has been discussing the matter with the British Medical Association and other colleagues. We are setting up these groups to ensure that local people and local health professionals can work together in a multidisciplinary fashion to make local decisions about local services. In addition, this year there has been significant investment in primary care, with an additional £2 million of investment to support the infrastructure of general practice and £2·3 million secured from Executive programme funds to modernise the use of information and communication technology (ICT), as one Member mentioned. The aim of our work is to modernise the use of ICT in general practice over the next three years.

A further £1·5 million for primary care development was devolved to boards, and additional money has been made available to boards this year to meet the cost of setting up the new groups from 1 April 2002. The money currently used to run the GP fundholding scheme, which is tied up in that, and to run the commissioning pilots will be redeployed to finance the new arrangements. That will also allow up to £2·5 million to be diverted from management costs to front- line primary care services. We cannot do that until GP fundholding ends next year. It was unfortunate that we were not able to end that last year. That is on top of the additional resources that I already mentioned.

I join Members in expressing my absolute disgust at the attacks on health and social services staff. The recent attacks in Altnagelvin Hospital have already been mentioned. The Western Health and Social Services Board and Altnagelvin Hospital are discussing specific measures to enhance security at the hospital. I share Members' concerns about this outrageous attack on vital services, and I know that the trust and the board will give priority to looking at improvements. I will give immediate attention to any proposals that come to me and, while I am attending this debate, my permanent secretary is visiting Altnagelvin Hospital.

With regard to primary care patients, a great deal of action has been taken to provide new GP out-of-hours arrangements to keep people out of hospitals. We also ran a recent advertising campaign to encourage people to get the right treatment, particularly during winter. The Member who raised the point will know of the pilot schemes in Ards Community Hospital and Bangor Community Hospital, which treat many people who would otherwise have gone to the accident and emergency department at the Ulster Hospital. Primary care is central to the way in which our social and health services will work together in the years ahead.

I recognise that the development of the cancer centre is a priority. Work is ongoing at the day-patients' and outpatients' wing of the planned cancer facility. That will be completed at the end of 2002 and will be open early next year. The Department of Finance and Personnel has approved a detailed business case for the construction of the new centre, which has been revised to take account of best practice and the latest technology. With the support of the Committee for Health, Social Services and Public Safety, I shall raise that crucial development with Executive Colleagues, with a view to having it included in the next tranche of Executive programme funds. The Committee has discussed the matter with me in the past.

I take the opportunity to outline some of the immediate actions and benefits that have resulted from the framework for action on waiting lists, on which many people have worked so assiduously. The MRI waiting list initiatives that are taking place across all boards, which include the use of mobile scanners, have successfully reduced waiting numbers. In cardiac surgery initiatives, the Northern Health and Social Services Board has secured capacity with Health Care International (HCI) Private Hospital and Ross Hall Hospital in Glasgow for 51 patients. If all those patients undergo surgery before the end of this financial year, the board's excess waiting list for cardiac operations will be cleared.

The Southern Health and Social Services Board is using a mobile cath lab at Craigavon Area Hospital to treat 20 patients per month. The Western Health and Social Services Board is using the North West Independent Hospital at Ballykelly for orthopaedic and plastic surgery, and the Northern Board has plans to do that also. Some 210 orthopaedic outpatients have been seen in the Southern Board as a result of a waiting list initiative. The Western Board has held additional ophthalmology clinics at Roe Valley Hospital, which had reduced inpatient waiting numbers from 360 to 30 at 19 December 2001, and the average waiting time from two years to six months.

In general surgery, the Mater Hospital and the Downe Hospital will take 50 and 200 patients respectively from other providers by March 2002. We are working continually on the validation of waiting lists and on specific pilot projects on restructuring theatre use and on rheumatology. Down Lisburn Health and Social Services Trust has an acute and community nurse pilot scheme for rheumatology, and it is also making use of an acute and community nurse for chronic pain. Those are just some of the initiatives that are being introduced to address current problems.

I have been monitoring the situation at Craigavon Area Hospital and other hospitals for some time, and I am very aware that staff in Craigavon are working under extreme pressure. I spoke to staff when I visited that hospital, and I have spoken frequently to the chairperson and the chief executive. Departmental officials are also in continual contact with the hospital. The Southern Health and Social Services Board and Craigavon Area Hospital have been working closely together to deal with the increasing pressures on the hospital.

I assure Ian Paisley Jnr that I look doctors, nurses and ancillary workers in the eye daily. I am delighted to hear that he recognises the effects of underfunding on our services, and I hope that he will work with me to fight for better resources to support those hard-pressed staff.

Although much can be done to make effective use of the facilities at the South Tyrone Hospital, it is not currently possible to provide the type of overnight care described. As Members will know, the Royal College of Physicians withdrew training recognition from the hospital in July 2000. That decision, on top of several measures that had been taken in previous years, led to the temporary removal of some services from that site.

The long-term decisions on the future of the hospital will be taken in the context of the acute hospitals review. There are, however, many outpatient clinics and day surgeries, including new clinics for cardiac outpatients, and brain trauma, at South Tyrone Hospital. There is also a doctor-led minor injuries unit, a comprehensive radiology service, inpatient medical geriatric wards, a day hospital for the elderly and a significant professions- allied-to-medicine service. As South Tyrone Hospital cannot provide overnight care of the type described, it could not have been used to help those recovering from major trauma surgery when pressure was being placed on Craigavon Area Hospital. However, the Southern Board and Craigavon Area Hospital Group Trust are working together to determine how more effective use can be made of South Tyrone Hospital. The question that was raised on extending the doctor-led minor injuries provision is currently under investigation as part of those discussions.

Members often talk of the need to approach the Chancellor of the Exchequer to get a fair share of public money. I do not wish - and it would not be right - to stray into the remit of the Finance and Personnel Minister, Dr Seán Farren. However, I fully agree that the Barnett formula is inadequate and defective, and I note that it will be a matter for the Executive to decide how to approach the matter in the future. If five sixths of additional money is spent on the rising costs of existing services, and the rising costs are being driven by developments in England on pay review body recommendations, drug costs, clinical and other professional standards, and we are not receiving the same uplifts as England, the inevitable effect will be an impact on our standards and levels of service here. In spite of getting additional money this year on top of Barnett, the Department of Health, Social Services and Public Safety is faring less well than the provision in England, where all the significant drivers of pay costs originate.

This year our budget is 5·6% higher than the amount spent last year, including one-off non-recurrent moneys that I secured from monitoring rounds. In England the equivalent increase is 9·4%. Those involved there receive a greater amount of recurrent funding which aids them in their longer-term planning. As has been said, there is a distinct difficulty in having to rely on additional in-year moneys, which are welcome, but they are non-recurrent. Therefore they are not suitable for use in addressing recurring difficulties. They are also not useful in employing additional staff or in addressing long-term planning. We need not only significant extra resources, but much more certainty about the level of funding in the future. Therefore, with regard to the December monitoring addition, it is one-off money, and it would not be prudent to use it for recurrent expenditure. The best and only effective way to put back the capacity that we need is to ensure that we have a properly resourced service. I will try my hardest to secure that in the spending review.

Similarly, I have put in place financial management arrangements that ensure that I can track the money. I published my priorities for action in the Programme for Government, which sets out the key priorities for the service. Boards now have to set out their service investment plans and how they intend to deploy their additional resources. Similarly, trusts, in their service delivery plans, have to set out how they will deliver the agenda. The resources that were needed to deliver the priorities listed in the priorities for action have all been ring-fenced this year, and no discretion is allowed for their deployment elsewhere.

Regular progress meetings with boards enable us to keep track of where the money is going and, should boards wish to redeploy some of the ring-fenced funds, they must first get our approval.

I have put in place a complete system to ensure that health and personal social services remain financially stable, including a requirement to pursue robust recovery plans where expenditure exceeds income by more than 0·5% and the requirement to produce contingency plans when in-year deficits are forecast.

However, one of the most significant points has been the moves to remove the internal market, which contributed to the financial problems by imposing significant income risks on the system and having competitive, rather than collaborative, working arrangements. We have now introduced much more collaborative working arrangements between boards and trusts.

Of course, ensuring that care services are adequately funded before new developments are considered is another important point. However, the overall point is that if we can ensure adequate funding for services to begin with, then we can make best use of those services, and of the dynamism, dedication and commitment of our staff.

Reference was made to the additional funds that I have received this year, and questions were asked about what had happened in relation to that. People will know that of that money - allowing for pay and price inflation, as one Member said - there was £41 million available to improve services. That is less than 2% of a £2·25 billion budget. However, within that I have used those resources to achieve, among other things, an increase in the number of high-dependency beds; investment in improving cancer services; the extension of the Sure Start programme for disadvantaged children; an increase in the number of residential childcare places; an increase in the number of community care packages; and the beginning of modernisation of the Ambulance Service's accident and emergency fleet. Those are vital issues that had to be addressed.

Like many Members, I have talked about the problem of resources, and much of the pressure that pervades our hospital services has its roots in a lack of investment over many years. As I have said, no less than £190 million - in today's terms - was taken out of health and social services in the 1980s and 1990s. The legacy of that approach has left a massive lack of capacity in staff, in beds, in equipment and in the community. The outcome is that too many people are in hospital who do not need or want to be there. The immediate action and the long-term planning that we are engaged in are intended to provide a service in which that will not be the outcome for our people. There is no way around the present lack of capacity other than by returning capacity to the service. To do that, we need a stable funding platform to support the development and maintenance of all our services.

A properly resourced service is an absolute priority. I welcome the extra funding that has been made available for this year and next. It will help to sustain existing services and facilitate some modest improvements. However, it will be a long haul to remedy the funding failures of the past. In the meantime, the service is working hard with what it has.

In preparing for winter, for example, a great deal of detailed planning went into making sure that services were boosted for the inevitable winter peaks in demand. There are extra hospital beds and nursing home beds available in this winter period, as well as extra community care services. GP and community pharmacist services have been augmented, and there was another successful flu vaccination programme this year. That is evidence of the commitment and dedication of the staff and also of a year's detailed planning to see what was needed to ensure that winter pressures would be met by a service that had planned for it.

During the recent virus outbreak that resulted in the temporary closure of some beds on top of the winter pressures, staff worked tirelessly to minimise the disruption to patients. Different trusts worked together collaboratively, as we saw with Musgrave Park Hospital and others when the flu virus affected the fracture service in the Royal Victoria Hospital.

Staff deserve our thanks and credit for their efforts over these weeks in containing and controlling the outbreak and in ensuring that no one who needed emergency care was denied it. It is crucial that we give them the support and the resources they need and that we look to the longer-term future of our hospitals. The acute hospitals review will prepare the ground for major and long-overdue modernisation of our hospital services. The resulting discussion at Executive level, the consultation, the equality impact assessment and the final decisions - all to be taken in the course of this year - will set the hospitals' agenda for some years to come.

I want to build hospital services as part of an overall, fully integrated service that will meet need not only today, but into the future also. That work will require commitment, determination and resourcing. The work that I have begun will bear fruit, and I am determined to see it through. I look forward to Members' support in building the services that people have every right to expect.

It has been a delight to sit through the debate and listen to many Members' concerns in relation to Northern Ireland's Health Service.

I rubbish the claim that the DUP is being political by tabling such a motion. I stress that we have constituents coming to us from both sides of the community who are raising deep concerns about the healthcare treatment that they or their relatives have been receiving in hospitals across Northern Ireland. It is important for public representatives such as us to highlight those concerns in the Assembly. Health is an important issue, and no matter what colour, creed or religion a person is, if he fears his health is affected or that he has recurring cancer and he is told that he must wait for seven months before seeing a consultant, such as was the case with Dr Paisley's constituent, such issues should be brought to the Floor of the House. We cannot say "Oh sorry, we cannot raise that because we might be accused of being political." We need to steer away from that and focus on our constituents' concerns.

Members of the Committee for Health, Social Services and Public Safety tell me that health is one of their constituents' biggest concerns. Why is that the case? It is because of the state of our Health Service, and it is up to us to highlight that situation.

The majority of Members' speeches today have been helpful and productive. Dr Hendron mentioned GP fundholding. That issue was raised by GPs last year at the Committee for Health, Social Services and Public Safety. We have lost a golden opportunity to provide a first-class measure in primary care, and we must seize the opportunity we now have to put that right. I trust that the Department will take Dr Hendron's and other Members' views and concerns about primary care and the ending of GP fundholding on board.

Rev Robert Coulter stated that Members must not attempt to score points. I agree with that. We have to work for the constituents of Northern Ireland, no matter where they are from. Many people have deep concerns about their health. Rev Robert Coulter discussed the problem of waiting for operations as did my Colleague Mr Shannon, who stated that a patient must first go onto a consultant's waiting list and then wait for the operation to be scheduled. That waiting time can average out at over a year. That is totally unacceptable. Rev Robert Coulter stated that we must examine the entire Health Service system in Northern Ireland.

It is clear from the debate that although money is important, we must take a close look at the management of the Health Service. I want the Department to tell the Assembly, through the Health Committee, what it intends to do about its management structure and the boards and trusts. I have not yet heard the Department make any proactive suggestions.

Mrs Courtney said that proper management from top to bottom of the structure and on the hospital wards would improve the Health Service. The perception is that there is too much bureaucracy. However, it is up to us to keep highlighting that until the perception is no longer true. Although we need professional management, it must be properly structured.

Rev Robert Coulter said that we must examine doctors' and consultants' contracts. He raised concerns about nurses' training, the morale of medical staff and the stress that they are under. The Health Committee has visited many hospitals and talked to nurses on the wards. They told us of patients waiting on trolleys for beds, but they also told us about the pressure that they are under. Nurses and health professionals must deal with complaints and the anxiety of patients' relatives all the time, which causes them stress and anxiety. The Department must consider that and deal with it in order to help the nurses' situation. It requires immediate decisions.

My Colleague Mr Watson commended the hospital staff across Northern Ireland, as Members have often done. In the last debate on the Health Service in Northern Ireland, I said that the service was running on the goodwill of the nurses, doctors and hospital staff. These problems must not be put on the back-burner. As a Member of the Assembly and of the Health Committee, I say that if we must continue to raise the issue of the Health Service, we shall do so. We should raise it at every opportunity, because it is our duty to the people whom we represent and to the nurses and hospital staff.

The problems of Craigavon Area Hospital have made headlines for several weeks. The problems are still there, and we must examine them. Mr Morrow gave us his views on the problems in his constituency, as well as those of Upper Bann and Newry and Armagh. Craigavon Area Hospital and the hospitals in those areas are under pressure because of the closure of the South Tyrone and Banbridge Hospitals. Those closures were bound to have a detrimental effect on the Health Service and on Craigavon Area Hospital. Craigavon was put under pressure by having to cover the services of other constituencies. Mr Morrow called for the reopening of South Tyrone Hospital to provide more services. We must relieve the pressure on Craigavon Area Hospital before it reaches meltdown.

We go from one crisis to another. All our people have the fundamental right to good healthcare. He said that there is a perception in the community that no one cares. Surely this debate shows that someone cares. The debates initiated by Ms Hanna and Mr Gallagher showed that someone cares. It is important that those issues are taken on board. The Assembly has to show the community that it cares.

Time and time again we hear that the Tories created the current problems in the Health Service, yet in today's headlines we find a problem that was not created by the Tories. During the last three years £27 million has been paid out in medical negligence cases. That is a matter of deep concern. How can the Assembly tell the people of Northern Ireland that it is doing everything it can for the Health Service, when they only have to look at the headline in today's 'Belfast Telegraph' to find that £27 million, which could have been spent on many of the issues that were discussed in the debate today, has been going down the gully? The Health Committee needs to know - at its meeting tomorrow - how that £27 million was wasted and what plans are being put in place to ensure that that never happens again. Whether the sum is £27 million or £100 that should not happen. Something needs to be done about it.

Mr Gallagher went on to say that funding and management are big issues. The high salaries paid to executives also give cause for great concern. He felt that general planning is needed. He referred to the South Tyrone Hospital. Management and funding were the two big issues raised today.

Mr McFarland raised a point that I thought was important. He asked where the £2·5 billion was being spent. He stated rightly that the Committee had tried to examine the health accounts and that it had not been possible at that time. How is that money spent through the system? The Committee needs further briefing on that situation. He also stated that there is a problem with poor relations between the Department and the Committee. Committee members trust that those relations will be mended in the weeks ahead. He also said that there was an arrogant attitude towards the Committee. That must be rectified.

Mr Paisley Jnr talked about the problems that are renewed daily. He mentioned his visit to Craigavon Area Hospital. He said that everyone there is under severe pressure - patients, relatives, nurses and doctors - and that something needs to be done. He said that he thought the Health Service was in meltdown. There is a lack of beds and a lack of resources, and management at the top has failed. That is the perception in the community. It is up to the Department to take all those matters on board and to deal with them effectively now. In future when officials from the Department are being cross- examined and questioned they must have proper answers.

Ms McWilliams made some important points. She wanted to know what proposals were being brought forward. She said that time and time again this subject has been debated in the Chamber and asked what was being done about it. Debates such as this are important. There are Department of Health officials here taking notes of Members' proposals. It is a way of doing something about the Health Service.

Ms McWilliams also condemned the attacks on health staff across Northern Ireland. The House condemns the attacks on the staff at Altnagelvin Hospital. Those are matters of grave concern. Further attacks on medical staff in hospitals will have an impact on resources. Staff are, quite rightly, calling for measures to deal with the problem. However, the provision of security to allay the anxieties of staff and relatives visiting the hospitals will require more money.

There have been many matters raised in the debate today. In conclusion, more needs to be done regarding the perception of management and about how funding is spent. Also, the Assembly needs to know more about the waste of £27 million through medical negligence. We need answers and action - not reviews, consultation and discussion -to address this crisis.

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