Northern Ireland's three MEPs have established a strong record of collective and constructive work, which has greatly advantaged our community. Since devolution, the Executive have sought to continue a collective and positive approach. I am pleased to report that there are continuing positive outcomes in our relationships with the European institutions.

I acknowledge that some Members have not reached the same conclusions as the Administration on European integration. Therefore it is all the more significant that a Committee that contains a diversity of views on those matters has produced such a helpful and constructive report.

Some quarters have been quick to criticise the work of the devolved institutions. The detailed, constructive, positive approach of the Committee of the Centre and the work that it has produced are a clear illustration of our collective commitment to work on behalf of the electorate.

On behalf of my Colleagues in the Office of the First Minister and the Deputy First Minister, I fully welcome the report and assure the House that the closest possible consideration will be given to the analysis and recommendations in it. The report contains a useful analysis of our situation. It carefully examines the value of our approach, and it makes considered recommendations to protect our interests, to project the distinctive voice of Northern Ireland and to avail of the opportunities that our membership of the European Union gives us.

I have considered the report carefully, and three major themes emerge from it. First, we should develop and implement a collective and workable vision of Northern Ireland as a region of the European Union. Secondly, we should draw on the learning derived from our work in the European Union, that which we can derive from our colleagues in other parts of the European Union and from our own citizens' work in the European Union. Thirdly, we should establish effective, open and transparent working methods that make the best use of the public resources invested in that area.

I should like to speak about the development and implementation of a collective vision. I note that the Committee reviewed in considerable detail the approaches in other parts of the United Kingdom, in the Republic of Ireland and in regions of other member states. As I read the Committee's evidence, I was struck by how the successful regions in Europe identified clearly the regional role in the European Union of member states. It reflects my experience of working in European matters for over 20 years. Successful regions have considered the reality of the regional role, examined the potential of that role and defined a clear and practical vision that meets the strengths and addresses the weaknesses of their region. The less successful regions have done that less well. The less well they have done it, the less successful they have been.

Northern Ireland has made considerable progress in developing that approach in some areas. Our political representatives in the European Parliament, the Committee of the Regions and in the Economic and Social Committee have a strong track record of working together cohesively, identifying available opportunities and co-operating to secure progress on them. Through that work we have received considerable financial benefit from our colleagues in the other member states through the mainstream structural funds programmes and, significantly, through the special support that has been given to Northern Ireland through the programme for peace and reconciliation, Peace II and the major contributions made by the European Union to the International Fund for Ireland.

All Members have seen the substantial benefits of that support in their constituencies, and they welcome the assistance that has been provided. However, the challenge now is to build on the progress that has been made with the assistance of the European Union. Devolution has brought new and important roles for Ministers, Committees and Members.

In the report, the Committee identifies the necessity to work towards establishing better ways of integrating the work of Ministers, Committees and Members, as well as agencies and bodies outside the Assembly, in a collective regional approach. There is considerable value in such integration. Officials in the Department will undertake further work to address the issues that the report has highlighted and to secure the kind of open working methods that are required. As the report illustrates, it is also essential to ensure that the work of all sectors has access to the development and implementation of the collective vision that the Assembly hopes to demonstrate.

As I made clear in my evidence to the Committee of the Centre and in discussions with the Chairperson and Deputy Chairperson and members of the Committee, the Office of the First Minister and the Deputy First Minister is strongly committed to a collective approach. Many issues that the Assembly faces in relation to the European Union and European matters highlight clearly the need to work collectively - to establish frameworks and approaches that enable all sectors to share their perspectives in order to reach a better understanding of how issues affect each other. A common misconception is that regional Administrations such as that of Northern Ireland must be organised in Brussels in order to do business in Europe. It is more important to be organised in Northern Ireland in order to develop the capacity here to do business in the European Union.

As the Assembly works together to develop the approaches of the new institutions, the Office of the First Minister and the Deputy First Minister will seek to put in place improved mechanisms for providing better information and enabling other sectors to play their part and to deliver on their responsibilities in this collective work. At the opening of the Office of the Northern Ireland Executive in Brussels, the First Minister and the Deputy First Minister made it clear that the Administration see that office as a resource for all sectors and interests in Northern Ireland. The report notes that the name of the office is perhaps, therefore, somewhat misleading. That point will be considered by the Office of the First Minister and the Deputy First Minister.

When I spoke at the function in Brussels, which was held on the day of the opening of the office, I made it clear that it was simply a building block in the construction of a much bigger edifice - the regional representation in Brussels of all sectors, and providing facilities and opportunities for involvement by a much wider range of regional interests in Northern Ireland. Much reference was made to that in the debate on the Northern Ireland Centre in Europe. That was the initial aim of the centre - hence the name.

The Northern Ireland Centre in Europe is refocusing and renaming its organisation. The Administration are working out a new relationship with the Northern Ireland Centre in Europe. Perhaps the Assembly could address that. The Office of the First Minister and the Deputy First Minister will ensure that the head of the Brussels office will develop the office and its work in building regional representation, not just as an office for the Executive. An office for the Executive is needed. However, Northern Ireland needs much greater regional representation in Brussels.

We will also be examining ways and means by which all the organisations that I mentioned - the social partners, the various agriculture representative bodies, the further and higher education sector, local government and, indeed, the Northern Ireland Centre in Europe itself - can become involved in building the collective and co-operative approach that was endorsed and recommended by the First Minister and the Deputy First Minister. The report provides further evidence, if further evidence were required, that that is the only sensible approach to those issues.

In the period before devolution, as I told the Committee, officials worked in a difficult environment; policy lines were set in London and, often, there was little clear distinctive development of those lines to take account of our regional interests. However, the establishment of the devolved institutions removes that difficult dimension. As the report illustrates, there is now a clear political will to undertake an open and informed approach to developing a distinctive regional posture for Northern Ireland within the European framework. That will characterise the work of the Office of the First Minister and the Deputy First Minister, and we will ensure that it characterises the approach of the office in Brussels.

That takes me to the second theme, which is drawing on the learning available to us from our experience of the European Union to date and, indeed, the experience of other regions in the European Union. The theme also involves developing and drawing on the learning that different sectors of our society have derived from their work in Europe.

Over a decade ago, an initiative was undertaken to establish a centre where all sectors could consider how to address the issues arising from membership of the European Union. That initiative arose from work done by the main constitutional political parties of that time and led to the establishment of the Northern Ireland Centre in Europe. That organisation established a positive track record working with all parties and all sectors of our society. It greatly assisted and clarified the understanding of the challenges and the opportunities to be addressed. For many years, it was one of the few organisations in this society that had the full involvement and support of all the main constitutional political parties.

It secured support from all councils and from a wide range of interests in the private sector. For a time, the centre also secured the support of central Government. No one regrets more than I do -

Will the Minister give way?

Is it traditional for a Minister to give way? If so, I have no problem with it.

It is up to the Minister.

You may have been about to comment on this, but I just wanted clarification of the grand words about the Northern Ireland Centre in Europe. If the centre was so valuable and so good, what happened to it? Why is it half of itself?

I was just coming to that. No one regrets what happened more than I do. No one worked harder to prevent it from happening than I did.

I could say an awful lot here. I could redd my chest. To do so would give me a great deal of satisfaction, but I do not believe that recrimination, name-calling, finger-pointing and laying blame and accusations will get us anywhere. What happened, happened. I fully agree with those who say that it was tragically unfair, but that does not measure the full importance of it. It was more than tragically unfair - it was a mistake of serious dimensions that has cost us dearly.

We are where we are, and we must build from that position. When I gave evidence to the Committee, I said that, because of the opportunities that now exist, we were currently engaged in rebuilding our relationship as an Administration, and the relationship of central Government here on the regional level, with the Northern Ireland Centre in Europe. That work is nearing completion, and I hope to be able to report fully and positively on the outcome of that to the Assembly in the very near future.

I acknowledge that many Members of the Assembly feel as strongly as I do about this. Many of them benefited in no small way from the clear, professional, independent analysis provided by the Northern Ireland Centre in Europe. Those who may wish to reflect on the issue should also reflect on the fact that I was among those members of my party who, along with leading members of the Ulster Unionist Party, the DUP, the Alliance Party and others, created that institution. Therefore, I do not want the value that I attach to it to be questioned in any way.

I welcome the Committee's recommendation, which accords completely with the view taken by the First Minister, the Deputy First Minister, Mr Leslie and myself, that we now have the task of building on, and strengthening, the approach pioneered by the Northern Ireland Centre in Europe. I assure the Assembly that my ministerial Colleagues are at one in relation to that. We are putting in place mechanisms that will secure and widen the value of the independent analysis provided by a stronger, refocused and - as I said earlier - perhaps renamed organisation, and we shall ensure that value is applied across a range of issues.

Therefore, in considering the Committee's report, the detail of the written submissions makes it clear that there is a wide level of support in this society for the work of the new democratic institutions established in this House. I welcome the significant degree of support expressed in those submissions, but that lays heavy responsibilities on those of us who are involved and who were elected to take those responsibilities. Among those responsibilities is one to find ways of drawing on the learning from the different sectors, especially from those who took the time and the trouble to make submissions to the Committee. Those organisations have clearly indicated that they are interested in more than simply lobbying for their own narrow concerns. They are willing participants in the collective work of developing a regional posture and strategy for Northern Ireland.

I also noted the Committee's approach in taking evidence from a range of expert analysts and practitioners from other regions of the European Union. Those inputs have provided valuable insights as to how we can further develop our own approach. I have considered and discussed those submissions with officials, and we are keen that the Committee's approach should be further developed. Measure 4.1 of the Peace II programme, 'The Outward and Forward Looking Region', which is implemented through the Office of the First Minister and the Deputy First Minister, offers us an opportunity to build on that process and to learn from our relationship with other regions of Europe by examining how they have done business. Measure 4.1 has been put in place to support further strategic examinations of how we relate to the European Union and beyond, to reflect on how we undertake our work here, and to seek ways in which we can learn together, thereby establishing better and more effective means of policy development and implementation.

In addition to the work that will be undertaken through that measure, we have asked officials to prepare proposals to build on the available learning. Those proposals will address a wide range of issues identified. For example, the potential benefits of secondment were frequently mentioned during the course of the debate. Other examples range from the question of ongoing research and analysis, more open work practices and better reporting systems to widening opportunities for considered inputs into policy development. Through that collective approach, the Administration will seek to integrate in a practical manner several observations and recommendations made by the Committee in its report.

Any initiatives must, of course, be in the context of effective, open and transparent working methods that make maximum use of the public resources invested. Many challenges and many opportunities arise from EU membership, and we must invest in early-warning systems if those are to be identified at a sufficiently early stage for them to be effective. Several Members made that point.

Where resources are scarce, we must ensure that we get the best return on our investment. The time is now right to examine the value of the approach that has been taken since devolution. That examination will provide evidence that will help us to ensure that we are using the most effective and efficient methods possible, and to make any necessary adjustments in cases in which we find any shortcomings.

I welcome that the Committee intends to continue to monitor the analysis and recommendations of the report. I shall ensure that the Committee is provided with the full response to that.

The report is a valuable analysis of the current situation. It provides a context in which we can clearly see the progress that has been made and the goals that are still to be attained. I thank the Chairperson of the Committee, Mr Poots, and his Colleagues for their detailed and constructive work. I also thank all who contributed to the report's preparation. I assure the House that the Ministers in the Office of the First Minister and the Deputy First Minister will reflect on its analysis and recommendations, and seek to use them in the same positive and constructive spirit in which they were prepared.

I thank the Members who participated in the debate for the largely positive and constructive contributions that they made. It is indicative of a growing interest in European Union affairs, and overall there has been a general welcome for the report and its recommendations.

Jane Morrice referred to the need to involve young people. The Committee would also like to see the greater involvement of young people in EU affairs. Indeed, one of the main themes in the report is the need to involve all people, including the young, in European issues. The recommendation that deals with secondment to non-governmental organisations covers the point that she made.

Sean Neeson referred to the Committee of the Regions. The Committee of the Centre addresses that issue in paragraphs 134 and 135 on pages 30 and 31 of the report. It compared the mechanism for nomination used by the Office of the First Minister and the Deputy First Minister in Northern Ireland to that used by the Scottish Executive. In Scotland, provision was made for the involvement of the Scottish Parliament to endorse the Scottish nomination. The Committee understands that no similar provision exists in the relevant Northern Ireland papers. Despite the fact that the appointments were made in November, I only received notice of the appointees to the Committee of the Regions from the First Minister and the Deputy First Minister last week. I leave Members to draw their own conclusions from that.

The fact that no provision was made for it does not mean that there should not have been any consultation with the Assembly. The Committee was eventually informed of the appointments following several requests for that information. Therefore, the Committee recommends that the Office of the First Minister and the Deputy First Minister follows the model used by the Scottish Executive and ensures that, although the Assembly is not involved in endorsing the nominations, it at least receives proper and timely notification of them.

Mr Beggs and Dr Birnie referred to the creation of an EU affairs committee. I assure them that Committee members made that recommendation only after considerable thought, and they know that there will be difficulties, such as those that other Committees have experienced in achieving quorums. The Committee knows that the creation of such a committee must be looked at in the wider context. However, it feels that a marker must be set to show that the Committee thinks that EU affairs are important enough to warrant an independent committee.

Junior Minister Haughey also commented on the potential role of the EU affairs committee. Its role would be similar to those of the committees in the other devolved Administrations that deal with EU affairs. The Committee of the Centre did not envisage that such a committee would take up the remit of current Committees. The Committee of the Centre has had initial discussions about the EU affairs committee, but more work must be done. It is assumed that the committee would be strategic, and focus on cross-cutting issues rather than delve into departmental issues.

I largely welcome the junior Ministers' comments.

Mr Haughey commented on the cost implications of the report. Although some recommendations will cost money, the majority have no or minimal cost implications. However, I must point out the cost of some European Directives. For example, it will cost some £400 million in capital alone to deliver the current waste management strategy that is being advertised heavily on TV. That is not to mention the recurrent year-on-year costs of delivering it. The amount of money that it would cost to implement this report's recommendations in full would be peanuts compared to the cost of implementing some European Directives. In addition, savings could be made if we could, at an early stage, make changes to the small number of issues that affect Northern Ireland.

I regret the comments made by the junior Minister, Mr Leslie, about the activities of the MEPs. It ill behoves a Minister to use his position to attack Members of the European Parliament. Perhaps I can put that down to his inexperience.

I agree that the junior Minister Mr Leslie did not dress himself in any honour by making those comments. I hope that that is not an indication that the junior Ministers are going to continue to burn bridges with the MEPs. They should be building bridges to allow the MEPs' expertise and experience to play a part because that will lead to a better understanding of, and a better commitment to, European affairs. We can all make cheap jibes. If the MEP that he was praising is doing such a wonderful job, why did he not use the professional staff in his Brussels office to make a written submission to the report. However, let us not make such silly points.

I shall not take that point any further. I do not believe that the junior Minister was speaking on behalf of OFMDFM on that occasion.

I welcome the increase in the capacity of the European Policy Co-ordination Unit. Nevertheless, the Committee recommends that it should remain free-standing, and I know that Ministers will consider that in more detail.

With regard to NICE, I take Mr Haughey's comments at face value and accept what he says. I shall be watching developments on that closely to see what progress can be made.

By and large, I am very encouraged by the response of Members and Ministers. Adopting this report will ensure better days for Northern Ireland in its dealings with European Union affairs and in what it derives from Europe. At some stage, it may be useful to conduct some research into how much it is costing Northern Ireland to implement European Union Directives. We often hear of the benefits of Europe and of how much we are drawing down in structural funds, peace fund money et cetera. However, it would be interesting to do a comparative study to establish how much we are having to spend to adhere to, and implement, European Union Directives.

I thank the Assembly for the time that it gave to this report and I look forward to its being adopted by the Assembly.

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

Main Question, as amended, put and agreed to.

Downpatrick Maternity Hospital

TOP

Mr ONeill:

Initially I tabled this debate for November 2001 when the crisis in maternity services had reached a new peak. There had been, and there still remains, urgent concern about the future of maternity services in Downpatrick and, indeed, the hospital itself. I was anxious that strict new guidelines that barred specific women from giving birth in their local hospital would reduce the rates of delivery in the hospital by between 10% and 20%, thus making the hospital appear less credible. I want to re-emphasise that issue. The Minister subsequently gave a commitment that the full range of services would be available until the outcome of the review was known. While we patiently wait for reviews, and sometimes reviews of reviews, there is a great danger of the existing services becoming even further eroded. If that were to continue, by the time reviews have finally been published, the case for maternity services in particular will have been reduced.

Sceptics might say that that could be seen by some people in the Department of Health, Social Services and Public Safety as a convenient way to handle the decision without having to take responsibility for that decision. Down Lisburn Trust is running into an underfunding gap, estimated at £9·1 million, but some would say that it may well run to £12 million. That lack of investment in professional services must be responsible for the reduction in the numbers of higher-risk pregnancies being taken into the Downe Hospital. Down District Council is calling for that shortfall to be made up and for the situation to be restored. The local health trust has met the Department's requirements for funding controls, and it has been punished because other health trusts had not met their required levels. Funding has had to be redistributed, and the impact is now being felt.

In November 2001, we were informed that anaesthetists were refusing to provide facilities for mothers who were overweight, who were expecting multiple births, who had previously undergone a Caesarean section, or who were under any threat of early labour. Notably, the decision to adopt new stringent criteria was taken without consultation with the people whom it would affect. The threat to the maternity services in the Downe Hospital is a direct threat to the rights of the community. It is not a little backwater hospital. In 2001, Downpatrick Maternity Hospital was recognised by the Imperial College of Science, Technology and Medicine as the third safest unit in Northern Ireland. That small rural unit has a history of high standards, good service and continuity of care, which is highly valued by the local community. The professionals on the ground - the obstetricians and midwives - have attacked the criteria as being unduly restrictive, and there are statistics that prove that they effectively screened out 50 mothers-to-be, who were transferred to Belfast hospitals. The numbers being admitted to the hospital are being eroded continually, thus undermining the case that the Minister will have to report on shortly and the recommendations that she will have to make for the continuity of the service.

Some questions spring to my mind. Have those circumstances been properly taken into consideration? What are the consequences for the future of Downpatrick Maternity Hospital? Have all other hospitals in similar situations been subjected to the same criteria? Is the Minister of Health, Social Services and Public Safety satisfied that our anaesthetists' response to the needs of our maternity and other acute services in Downe Hospital has been the proper one?

When I look back over the years during which we have tried to fight for the retention of acute services in Downe Hospital, it occurs to me that we, especially in Down district, have been subjected to a bureaucratic form of snakes and ladders. During the past few years, we have had documents, reports, consultations and strategies commenting on various ways by which services should be offered by Downe Hospital and Downpatrick Maternity Hospital. Each subsequent throw of the dice seems to have further eroded the services and further strengthened centralist thinking.

We reached the top of a ladder in 1994 when Baroness Denton recognised the need for a new Downe Hospital, which would incorporate maternity services. We then hit a snake's head with the changes made by Ministers Worthington and McFall and slid all the way down. Now, as far as maternity services are concerned, it looks as if we have encountered another snake. As a public representative, I am concerned that centralist professionals, few in number, are using their key professional positions to further their centralist political aims. I am concerned that their work may result in a lack of will to keep the maternity services open.

Then, of course, there is the broader issue. Will we always manage our services subject to diktats from royal colleges? Now that we have a devolved Administration, should we not make policy decisions that meet our particular needs? This is the first time that people of our generation have had the opportunity to structure our services to meet our particular needs, and it is our responsibility to ensure that we base such a structure on real, existing and future needs, and not on the need to sacrifice maternity services in order to maintain other services for the area.

By threatening the training accreditation, royal colleges further risked the future of the hospital. Down district has recognised that Downe Hospital and Downpatrick Maternity Hospital must be linked to appropriate Belfast hospitals for third-level care and specialist diagnosis. If activated at this stage, that link would ensure continued accreditation for those working in Downpatrick Maternity Hospital through the rotation of staff. Rotational training between the hospitals will ensure that all our professionals will meet royal colleges criteria and is a way around the difficulty that they identified. It will ensure that essential services are kept open in the district while plans for the new Downe Hospital are implemented. The case for the retention of maternity services remains strong in Down.

There are no immediate plans to upgrade the two main roads between south Down and Belfast that pass through Downpatrick and Ballynahinch. There are demands for bypasses around both towns because they are bottlenecked at significant times during the working day. Housing development has increased heavily in south Down, and the growing population in the area will be most evident in the forthcoming census results. Many people travel to and from Belfast to work, thus congesting the already inadequate road system. It is clear that access to Belfast hospitals, which currently stands at one hour, will not get any easier - in fact, it will get worse.

The joint review team said that there is no doubt that the standard of services in the community would deteriorate if maternity services were removed. In line with their human rights, the women of Down district, an area served by Downpatrick Maternity Hospital, should have the choice of having their babies delivered locally.

It is accepted by the joint review team that many women will have neither the desire nor the means to travel to Belfast to give birth; a rise in home births and related concerns is therefore anticipated. It also estimates that in the past five years, four or five babies in the area would not have survived the journey from their homes to Belfast. To accept the closure of Downpatrick Maternity Hospital, would be to accept that it is all right to see four or five infants die each year. How can we possibly accept that?

In the Down area, it is widely accepted that the maternity hospital provides a necessary service for our local community, and the entire community will suffer as a result of any diminution of that service. I would like to see the threat to its existence totally removed.

As a somewhat younger Member of the House, when I was elected here in 1982, the first obvious crisis that arose in the constituency of South Down was yet another threat to the future of the Downe Hospital. I remember the then Health and Social Services Committee visiting the hospital. We were informed that the hospital's entire future, including Downpatrick Maternity Hospital, was under imminent threat. Some 20 years later, we are debating exactly the same problem.

What is going on in Downe Hospital reminds me of plates spinning in a circus. No sooner is one plate spinning than another is about to collapse to the floor; no sooner has one important aspect of the Downe Hospital come under threat and been saved as a result of public outcry than one finds another crucial element of the hospital under threat.

If all the newspaper cuttings, reports and documents that were printed on Downe Hospital in the past 25 years were laid out, they would cover many football pitches. It is only as a result of the tenacity of the local council - I pay tribute to Councillor ONeill and many others for their stance on the issue - and the community that we are even here this evening debating anything concerning Downpatrick Maternity Hospital. If it were not for that tenacity, there would not currently be a hospital to debate.

I have grave doubts about royal college assertions that everything must be bound by numbers. Those numbers take no account whatsoever of an expectant mother who goes into labour on a wet Saturday night in an area such as Killough, Ardglass or Strangford. She is currently faced with a relatively straightforward journey into Downpatrick. Without that maternity unit, she faces the nightmare of travelling into Belfast.

Not all babies will decide to come at convenient times. There will be those who will decide to arrive during the rush hour. Councillor ONeill and I have both been involved in calls for bypasses for both Downpatrick and Ballynahinch. As Mr ONeill said, it is difficult enough to get through those towns at the best of occasions. However, the situation in which a lady who is about to give birth is trying to get through those towns in an ambulance is absolutely horrendous.

I simply do not see the issue as a numbers one. We have been set this high threshold target by the royal colleges, and I fully accept that Downpatrick Maternity Hospital does not meet the target. There are less than than 500 births there a year. However, one must look at some of the reasons behind that. So much doubt has been cast over the future of the maternity unit in Downpatrick that many women have decided to go elsewhere to have their babies. A guarantee of the future security of Downpatrick Maternity Hospital would increase confidence, and more people would choose to have their deliveries in Downpatrick Maternity Hospital.

There is no doubt that the maternity unit will die the death of a thousand cuts. At times, I do not know where to turn. We thought that the problem had been solved, but then a great difficulty arose with the cover for anaesthetists. At one stage, there was a real threat that the unit would close due to the lack of anaesthetic cover. Then, as the result of a huge outcry, we managed - mostly due to the Down community health committee - to obtain adequate anaesthetic cover. No sooner had that been solved than we found that the future of the maternity unit was again in doubt. That ignores the fact that in the Ards and Down area plan 7,000 new homes are allocated in the area covered by the maternity unit. Most will be starter homes for young couples. There could be a significant increase in the number of births in Downpatrick. However, we could reach a ridiculous situation in which the maternity unit is closed but where a large increase in births means that a unit is needed on our doorstep.

I do not understand the mentality that suggests that all services must be centralised. I can understand to some extent the logic of the royal colleges' assertion that consultants must attend at numerous births if they are to develop the full range of specialities and have experience of complex births. Why can those specialities not be concentrated in Downpatrick? Why must they be concentrated in Greater Belfast? The consultants' tail may be wagging the Department's dog. Perhaps consultants enjoy living in the leafy suburbs of south Belfast or on the gold coast of north Down and think that Downpatrick is on the edge of the universe. The Government in Northern Ireland - even post-devolution - believe that the world ends at Glengormley, and the really adventurous believe that the world ends at Carryduff. There is life beyond Carryduff. Many live fulfilled and happy lives in south Down. They do not believe that the concentration of services should be entirely in Belfast.

Possibly the only point that Mr ONeill did not raise was that the maternity unit offers employment opportunities to people in south Down. So great is the lack of industrial investment in south Down that the two major employers in Downpatrick are the district council and the hospital. They are essential employers. I got an e-mail this morning from Sir Reg Empey's office saying that he was visiting Downpatrick. I immediately rushed to find out which factories he was visiting. As it turned out, he was going to a function to celebrate the work of Mr McGrady - a very good cause, I must say; I do not condemn him at all. It shows, however, how little industrial investment there is in Downpatrick. It would not take very long to visit all its factories.

The maternity unit is a vital employer in the town, and it would be appalling to lose it. The campaign will go on, and I am convinced that the community will rally round to hammer home the point that Downpatrick is not prepared to be a second-class citizen to Greater Belfast. We must retain the unit. As Mr ONeill said, if the unit closes and a mother dies tragically in labour or a newborn child dies in an ambulance that is caught in a traffic jam on the way to Belfast, people will then realise what a dreadful mistake it would be to have closed this unit.

I thank Éamonn ONeill for bringing this serious problem before the Assembly. I am very disappointed that only two members of the Committee for Health, Social Services and Public Safety are present. That shows how seriously they take the Downe Hospital.

To maintain the safety of the facilities, and the good health of mothers and babies in South Down, we need a fully staffed and equipped maternity service. There has always been a high standard of quality and safety in Downpatrick Maternity Hospital, where arrangements for mothers and babies have worked very well. I wish to see those standards maintained, and I take this opportunity to pay tribute to the staff, who have maintained those standards under extreme difficulties over this period of uncertainty.

Under the Hayes Report, those standards are being undermined. I want the same quality of service for the people of east Down as is enjoyed by those in Newry and Mourne and south Armagh. The people of Kilcoo, Leitrim, Legananny, Castlewellan, Newcastle, Ballynahinch, Dromore and Drumaroad need a proper service and a proper roads infrastructure for easy access. Those considerations have not been properly addressed in the Hayes Report.

I shall now address the most important issues relating to the provision of a proper maternity service for a new hospital in Downpatrick. It is the right of every woman to have the required expertise available and to have the birth experience that she wants. Pregnancy and giving birth have become medicalised. We have some of the highest rates of hospital births in Europe and high rates of medical intervention in labour - Caesarean sections and other surgical interventions. Our intervention rates are far higher than they need to be. The majority of births are normal and require no specialist or medical intervention.

I am convinced by many of the arguments put forward by the Royal College of Midwives in favour of midwife-led maternity teams. Indeed, the early evidence suggests that women making use of the midwife-led maternity teams in Craigavon are very happy. This also means that we need to re-evaluate the role and status of the midwife, with the creation of the consultant grade midwife becoming standard.

However, in the small minority of cases that do require medical intervention, it is important that the highest levels of professional care and facilities are available. Sinn Féin in south Down rejected the proposal for a £15 million cottage hospital because it would not have retained acute or maternity services in Down. We have consistently argued that a new hospital in Downpatrick needs both. Sinn Féin in south Down will not settle for far less than is needed for the local population, or less than they deserve. That is why we argued against a smaller hospital with less capacity and fewer services. The SDLP appears to be prepared to accept less than people deserve. That is not surprising, given that it has happily settled for less than people need or deserve on policing. The people of County Down must not be short-changed.

The future of maternity services is tied to the review of acute hospitals and the Hayes Report. I look forward to having the opportunity to examine the proposals put forward by the Minister of Health, Social Services and Public Safety, Bairbre de Brún, when they have been approved by the Executive. The Hayes Report acknowledges that radical changes in the organisation of our acute hospitals, and a dramatic increase in resources, are required.

The Hayes Report has broken with convention, and it offers proposals that will create significant change in how services are delivered. It highlights the key role of patients and service users in making decisions. The proposals will be judged on their ability to deliver equality of access to services. The Minister, Bairbre de Brún, has begun to win the argument with the Executive for increased resources to put right the struggling scheme that she inherited. Everyone will welcome the SDLP's commitment to lobby their Finance Minister to support Ms de Brún.

One of the key issues that has affected the delivery of maternity services in the Six Counties is the power of the royal colleges to set quotas for the number of births that must take place on a site in order for consultants and junior doctors to be given accreditation. The removal of maternity services from Tyrone clearly demonstrates that the operation of quotas is detrimental to the accessible delivery of a quality service. The requirements of the medical service for groups of doctors to work together stems from the fact that doctors are no longer covering the full range of a speciality but, rather, are increasingly developing their expertise in more focused areas of work. Larger teams have to be assembled to support this approach, and that is leading to the concentration of caseloads on fewer sites.

As part of maintaining official recognition, doctors and nurses need to see a certain number of patients with a specific condition in order to maintain their expertise. The royal colleges have said that training recognition may be withdrawn from a hospital if there is an insufficient number of patients to enable trainees to get the right experience, or if there is insufficient supervision for trainees. It is quite clear from this approach that the maintenance of medical status is being prioritised above the requirements of creating a high-quality service that is accessible to the people of Down.

It is clear that meeting targets is more important than the treatment of patients. Guidelines and standards have been set in relation to minimum patient numbers that must be achieved to maintain services. Some 1,500 to 2,000 deliveries are required to sustain a maternity service. In this case, sustaining the service means that the royal colleges have decided to set quotas that need to be achieved in order for an acceptable quality of service to be developed.

Women might have to travel greater distances, perhaps without the benefit of personal transport. It has been said that it takes an hour to travel from Down to one of the hospitals in Belfast, but there is no way that it would take an hour or less to travel from Newcastle at the height of the tourist season. That does not appear to be a concern for the royal colleges.

The monetary considerations, the status of the medical profession and the setting of targets all call into question the goal of achieving a balance between high quality and access to the service, with the latter failing to be taken into proper account. These decisions highlight the power of vested interests - the very interests that have medicalised the natural process of pregnancy and giving birth.

I call on the Executive to give priority to making the resources available for this new hospital in Down. The people of east Down require acute and maternity services, not a cottage hospital.

I welcome the opportunity to participate in this important debate and to endorse what my party Colleague from south Down, Mr ONeill, said when he opened the Adjournment debate.

As has already been said, Downpatrick Maternity Hospital has been under threat for 20 years - even before the original hospital was built - given a constant barrage of undermining activity by the Department. There is no question about the quality of care in Downpatrick Maternity Hospital. Antenatal care, delivery care and postnatal care are excellent, and that has been acknowledged by professionals. The surroundings of the hospital for the mothers and the babies are also excellent, and if only we could get mothers from any part of Northern Ireland through the door, they would be registering in the Downpatrick Maternity Hospital for their deliveries.

There are, however, a number of impediments to that. It is not of the Minister's doing, but of her predecessor's. It may not even be of her predecessor's doing, but of the Department's doing, and that is the policy of centralising maternity services. Unless the Minister and the Executive can redirect departmental policy, centralisation will continue to be the policy and the drive behind the closure of hospitals such as the Downpatrick Maternity Hospital. That is why it is so important that we target the source of problem - the policy decision to centralise.

Many Members have correctly quoted - and it has been quoted often - the Royal College of Obstetricians and Gynaecologists which has made certain insinuations regarding throughput. I want to place on record a reply to a letter that I sent it. The Royal College of Obstetricians and Gynaecologists replied on 26 June 1998, and I quote directly from it:

It has not issued any guidelines, yet this is what has been said time and again as part of departmental PR spin of the centralists. The Minister and the Department must tackle this. That came out officially in the Baird Report some 20 years ago, and that is where the figure of 2,000 came from.

A few years ago the Eastern Health and Social Services Board dealt with the points made by Members about geographical isolation and the needs of the communities of Down and Mourne. I quote from its strategy document:

Again I direct the debate to where the problem lies: the centralisation policy in the Department must be changed immediately. For instance, when Maurice Hayes was asked to carry out a review of acute services, his terms of remit specifically excluded maternity services because they were already under the diktat of the policy decision of the Department. This was before the Minister's time, so she is not responsible for that. However, that is where it still is, so the Minister is responsible for continuing that policy if that is what we get in the post-Hayes era.

The constant undermining of the Downpatrick Maternity Hospital has sadly led to the anticipation that only 54% of all births in County Down will take place at that hospital. Why is that? As I have said, the care and the surroundings are excellent, and my Colleagues have spoken about that. There is the constant black propaganda of the Department, which is undermining the confidence of young mothers-to-be or not so young mothers-to-be that the service will be available by the time their deliveries take place, so they do not register in that wonderful setting. We only have to look back to the events of 18 March, when the anaesthetists from the hospital took unilateral action that almost led to its immediate closure. That was not a decision of the board, the trust or the Department - the Department did not know what was happening.

Much has been said about the difficulty of travelling from the catchment area of the Downpatrick Maternity Hospital to Belfast. Equally important, modern medicine tells us that a substantial part of the recovery programme for patients is family support. Families can easily and frequently visit a hospital like Downpatrick to give support to mothers-to-be or the mothers and their babies. That accelerates their sense of well-being and they get well quickly.

However, there is a problem with service delivery in the Downpatrick. For example, the paediatric consultant does not have full facilities, and there is no epidural procedure available because of the infrequent attendance of anaesthetists. These are money-led restrictions, and there is no reason, with an equality agenda, for those facilities' not being made available on a partnership basis with the Royal Maternity Hospital or the Lagan Valley Hospital to mothers-to-be who want them. That would give additional facility and confidence.

If the policy of centralisation, which is another word for closure, continues, what is to happen to the expanded population in these areas? The area served by Downpatrick Maternity Hospital is one of the few areas outside Belfast which is expanding rapidly - it is the most rapidly expanding area in Northern Ireland, according to the last census. For those reasons, this matter must be addressed once and for all. The remit of the Hayes Report did not include maternity services - I am subject to correction on this - but it said that maternity services would be centralised in Belfast. However, the Hayes Report was dealing with acute services in general medicine and surgery, not with maternity services, which was a stand-aside subject at that time. In another context the Hayes Report suggested partnership as a way forward.

It is with regret that I note that Mr Mick Murphy, the Sinn Féin Member for South Down, introduced party politics to an apolitical subject. Sinn Féin did the same locally to great detriment, and now it is doing the same in this debate.

Does the hon Member also agree that it does enormous damage to the united community front in the Down area, where the entire community is united on preserving the hospital, when one element uses the issue as a party political football to undermine the campaign to return acute and maternity services to Downpatrick?

I can only concur with the hon Member's remarks.

The facts were also grossly wrong; therefore the record must be put straight. First, as stated, the new hospital for Downpatrick was accepted and supported as the way forward by me, the SDLP and the entire cross-party membership of Down District Council, with the proviso that it must include proper acute services. The support was for the building, rather than for the services that were suggested for it.

Secondly, that building - that new start - would have been under construction as we speak. I am confident that in that building we could have had enhanced facilities for acute medical and surgical services and for the maternity hospital. We would have had one campus for the consultants and their various disciplines, whereas we currently have two campuses. However, the money that was set aside for that building has gone and must be found again. The procurement of the highest technology, which was in train, was cancelled and must be started again.

I will take no sermons from Sinn Féin in that respect. I regret very much that party politics has crept into the debate again. That party even opposed the planning permission for a hospital, never mind the detail of the plan itself. In that context, it ill behoves the Sinn Féin Member to try to divide the community again, when it is totally unanimous in its support for the Downpatrick Maternity and Downe hospitals. We know, as local residents and as patients, that we are getting a first-class service from consultants, doctors, nurses and staff at every level. Their humanity and their expertise in their respective disciplines have helped them to achieve a record that is the envy of any part of Northern Ireland. The cost-effectiveness and the medical effectiveness of both hospitals have been commented upon time and again.

The essential decision about maternity, as distinct from acute, services is that the policy of centralisation, which has been prescribed and promoted by the Department, should be changed. Unless it is changed, the natural and inevitable consequence of centralisation will be the closure of rural hospitals in favour of central ones. That would sound the death knell of flexibility. As has been proven time and again by reports, without access to the Downpatrick Maternity Hospital 24 hours a day, mothers and their unborn babies will be put in danger.

In spite of all the requirements of the consultant-led diktats, the safety and performance records of the Downpatrick Maternity Hospital at the last audit were the best in Northern Ireland. Are we going to throw away the best?

I am aware of the time limit that was set for this debate by the Business Committee. With that in mind, I call Mr Tom Hamilton to make a brief contribution.

I will make my speech brief, Mr Deputy Speaker; I will not even attempt to go over all the facts and figures, which Mr ONeill, Mr Wells and Mr McGrady so ably contributed. However, Mr Wells touched upon one aspect, which concerns my constituents in Strangford. A proportion of constituents in Strangford do not look to the likes of the Ulster Hospital - much less to Belfast - for services, including maternity provision.

That group of people seek to receive their services from the Downe Hospital. However, due to uncertainty about the future of general services at the hospital, those people no longer look towards Downpatrick for their services, despite it being their first preference when given the choice.

Mr Wells mentioned that babies do not choose the most convenient time to be born. Ambulances may have to travel from the southern part of my constituency via Comber to the Ulster Hospital in Dundonald. I do not know if the Minister has ever visited Comber, or if she is aware that at the best of times it is a difficult town through which to drive. Rush hour is an absolute nightmare. A bypass is in the pipeline, and that has been welcomed. However, it will be several years before it is completed.

It is no exaggeration to say that, in an emergency, an ambulance trying to get through Comber during rush hour may not be able to reach the Ulster Hospital. Recently, the local press highlighted a case in which a fire engine that was trying to get from one side of Comber to the other during rush hour was unable to do so. A tender had to be dispatched from a fire station in Carryduff. An emergency vehicle was caught up in Comber traffic and was prevented from reaching its destination because it could not get through to the other side of the town. If that can happen once, it can happen twice. It could happen when an ambulance is trying to rush an expectant mother through Comber to the Ulster Hospital.

I am indebted to the Deputy Speaker for allowing me to contribute to the debate at such short notice. The people who live in the part of Strangford that I represent, who look to the Downe Hospital for maternity care, have a right to receive it there and to be given access to the highest level of care, delivered in the quickest possible time. That can be found at Downpatrick Maternity Hospital. I congratulate Mr ONeill for tabling the Adjournment debate.

Go raibh maith agat, a LeasCheann Comhairle. Gabhaim mo bhuíochas leis an Uasal ONeill as an díospóireacht seo a tharraingt anuas inniu.

Dála gach seirbhís ospidéil, caithfidh seirbhísí máithreachais caighdeáin nua-aimseartha agus an cleachtas is fearr a léiriú. Éilíonn an dea-chleachtas nár chóir leanbh a shaolú más dóiche go mbeidh seirbhísí de dhíth ar an bhean nó ar an leanbh nuabheirthe nach bhfuil teacht orthu ar an láthair. Rangaítear an tseirbhís mháithreachais i nDún Pádraig mar aonad riosca ísil atá faoi cheannaireacht comhairleach, agus le roinnt blianta anuas féadtar mná torracha a aistriú má mheasann cliniceoirí san ospidéal iad a bheith ar riosca ard.

Ar ndóigh, is tábhachtach go ndéantar athbhreithniú leanúnach ar na critéir riosca le teacht ar mheá chothrom idir riosca agus rochtain. Deirtear liom go ndearnadh iniúchadh ar scagthástáil atreoruithe ag Ospidéal Máithreachais Dhún Pádraig mar chuid den athbhreithniú sin. Tá obair den chineál chéanna á déanamh in ospidéil eile. Mar shampla, tá critéir aistrithe ann cheana féin in Ospidéal Ghleann an Lagáin agus in Ospidéal Mater Infirmorum.

I thank Mr ONeill for tabling the debate. As with all hospital services, maternity provision must reflect modern standards and best practice. Current good practice requires that deliveries should not take place when there is a significant likelihood that the mother or the newborn baby will require services that are not available on site. The maternity service at Downpatrick is classified as a low-risk, consultant-led unit.

Arrangements have been in place for several years for the transfer of pregnancies judged as high risk by clinicians at the hospital. In his opening address, Éamonn ONeill asked about those risk criteria. It is important that risk criteria be kept under review to achieve the right balance between risk and accessibility. I am advised that the screening of referrals at the Downpatrick Maternity Hospital was examined as part of that review process.

Similar work is also being undertaken in other hospitals. For example, transfer criteria are already in place at Lagan Valley Hospital and the Mater Infirmorum Hospital Health and Social Services Trust. I am also advised that many variables must be considered as part of the risk assessment process and that those may lead to the development of different criteria for different units.

I am further advised that Down Lisburn Trust's recent audit of the new criteria confirmed that less than one transfer per week has taken place as a consequence of the revisions to the risk management criteria. The Eastern Health and Social Services Board considers that that small increase in transfers should not cause significant difficulties for other units that have been experiencing declines in the number of overall births in recent years.

The number of babies born at the Downpatrick Maternity Hospital remains the lowest of any of maternity units here. By way of comparison, between 1 April 2001 and 31 March 2002, Lagan Valley Hospital had 1,086 births and Downpatrick Maternity Hospital had 462. During that period, the Royal Jubilee Maternity Service delivered 4,708 babies and the Mater delivered 1,058. Mick Murphy and Eddie McGrady both referred to royal college guidelines regarding the number of births. I do not accept that 1,500 to 2,000 deliveries are necessary to sustain a consultant-led maternity service. That would not take account of the needs of people here.

Although deliveries at Downpatrick are fewer than those at other maternity units, I fully appreciate the high regard in which that unit is held, and the skill and expertise of all staff at the hospital. Indeed, I recently met a delegation of midwives from the hospital to discuss developments there, and I was extremely impressed by the excellent work that they have undertaken to enhance and develop their skills for the good of all those who use the service.

Jim Wells talked about the growing population in the Down area. However, in the past 10 years, births fell by 20% in the Eastern Board area as a whole, in the Down area by 14% and in the Downpatrick Maternity Hospital by 30%.

In his opening comments, Éamonn ONeill asked about consultation and choice. I am advised that the Eastern Health and Social Services Board extended the criteria in consultation with medical and midwifery staff at the unit earlier this year, and that some of those staff are members of the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists.

With regard to consultation with other units, I am advised that the trust considered that the one additional transfer a week could not cause difficulties. As I said, the trust's recent audit of those criteria has shown that to be the correct number. I am further advised that the decision to extend the criteria was based on clinical judgement and that such decisions are considered necessary for ensuring the safety and well-being of service users.

On the question of underfunding of the Down Lisburn Trust and whether that has undermined the maternity service, the trust's most recent annual general meeting confirmed that the maternity service at the Downpatrick Maternity Hospital is receiving £500,000 more in funding than it did three years ago.

Mick Murphy asked about support for midwife-led units. I fully support, and will actively promote, the careful development of midwife-led maternity units that are within, or adjacent to, a consultant-led maternity unit. I am also aware of pilot stand-alone midwife-led units being established in England, Wales and the South of Ireland. I am keen to explore the opportunities for such developments here.

Members raised concerns about the future of the service, with particular reference being made to the report of the acute hospitals review group. That group was not constrained in any way from looking at maternity services, and it has made recommendations on them. The report addressed maternity services in Downpatrick and noted the difficulties in sustaining an inpatient maternity unit with 24-hour anaesthetic and paediatric cover. The review group recommended the phasing out of inpatient maternity services in Downpatrick, but considered that it should be possible to provide the whole spectrum of maternity services, with the exception of inpatient care, at the time of birth.

I have on several occasions in the Assembly made it clear that no decisions have yet been taken on the future of acute hospitals here. Proposals for the future of maternity services in Downpatrick will form part of a package of proposals that will be published for consultation after discussion by the Executive. A draft memorandum has been forwarded to the First Minister, the Deputy First Minister and the Minister of Finance and Personnel for clearance before consideration by the Executive. When proposals are put out to consultation they will provide communities and their representatives with an opportunity to comment on and contribute to the development of acute services here. In the meantime, I expect the Eastern Health and Social Services Board and the Down Lisburn Trust to do everything possible to maintain services at Downpatrick, pending strategic decisions on future arrangements for hospital services.

Several significant steps have already been taken to sustain the Downpatrick Maternity Hospital, and mention was made of some of those in the debate. I pay tribute to all involved at every level in the service who have worked together to make many of those steps possible. For example, the arrangements involving Belfast anaesthetists have been introduced to maintain a robust anaesthetic service at Downpatrick Maternity Hospital, and I understand that those are working well. Five extra theatre nurses have been appointed to assist with the 24-hour anaesthetic rota. Moreover, the training programme for midwives has been reviewed, and all midwives are now offered the opportunity for advanced life-support training. Those measures demonstrate a clear commitment to sustaining high-quality maternity services at the Downpatrick Maternity Hospital, pending the outcome of the acute hospitals review.

I recognise that there are problems in sustaining our smaller hospitals, and I am aware of the discussion generated by the acute hospitals review. I appreciate that all the staff at the Downe Hospital and the Downpatrick Maternity Hospital have worked tirelessly to maintain safe and effective services, and to provide the highest standard of care to the local community. I recently visited the hospital and had the opportunity to meet staff and patients. I saw at first hand the high regard in which the hospital and staff are held. My aim is to ensure that the skills and expertise of all the staff at Downpatrick continue to be used in providing effective, high-quality maternity services in which the community - and women, in particular - can be confident.

Adjourned at 6.13 pm.