Point of Order - Personal Statement

Rev Dr Ian Paisley:

On a point of order, Madam Deputy Speaker. In a previous debate a savage attack was launched on me and on what I was doing when the Minister of Agriculture and Rural Development was speaking. I make no apology in the House to anybody when I am representing those who have been bereaved, shot and maimed by the IRA. I was with the Minister of State with responsibility for security, on her invitation; she brought the meeting forward so that I might make an issue of those who have suffered so tragically in recent days in the constituency that I represent. To be told that that is a stunt is an insult to the memory of the people who have suffered.

Order. I am aware that the Member was interested in making a personal statement, but I advise him that he must seek permission from the Speaker to do so. That personal statement may or may not be made following the Speaker's decision tomorrow morning.

Further to that point of order, Madam Deputy Speaker. Given the comment made by the Minister of Agriculture and the representations made by Dr Paisley, will you offer the Minister the opportunity to withdraw her comments?

This issue was discussed in the debate when the remarks were made, and the request was made for a personal statement. I have given Mr Paisley the opportunity to write to the Speaker so that his request can be considered. Both Members were given the opportunity to explain themselves during the debate, and I will leave it at that.

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Maternity Provision in South Belfast

Ms McWilliams:

Clearly, there is as much concern about the needs of women who are giving birth - [Interruption].

Order. Members must leave the Chamber quietly.

There is a great deal of concern about maternity services in the Belfast area. I want to detail the times that women have been promised a centralised maternity hospital in Belfast. In 1996, 'Seeking Balance', which became known as the McKenna Report, was published, and that was followed in 1997 by the Donaldson Report.

In the minutes of a meeting of the Eastern Health and Social Services Board on 15 April 1999, Mr William McKee, chief executive of the Royal Victoria Hospital, said that he had been invited to draw up a business case in spring 1998 for a new hospital costing approximately £19 million. Then in 1999 - when there were maternity services at the Jubilee Maternity Hospital and the Royal Maternity Hospital - a consultation document was published, and on 27 January 2000 the Minister, making an announcement about the interim arrangements, said that people should be reassured that it would not be the final move.

On 27 January 2000, the Minister said:

In June 2001, the findings of a review group on acute hospitals were published. In November 2001, a specification for a new centralised maternity hospital was issued. In June 2002, 'Developing Better Services' was produced. It was the outcome of the review group's findings on acute hospitals. A footnote on chapter 4 states:

By June 2002, the Committee for Health, Social Services and Public Safety was informed that the specifications for the Royal Jubilee Maternity Hospital would be produced and then subjected to a 12-week consultation. From 1996 to June 2002, there have been consultation documents, requests for specifications and references in documents that reviewed maternity services in Northern Ireland, but we are still awaiting the outcome of the consultation. On and on it has gone, and the morale of those awaiting the outcome has been at such a level that some serious questions need to be asked. There is no mention in the draft Programme for Government of the new centralised maternity hospital in Belfast.

The physical inadequacies of the Jubilee Maternity Hospital and the Royal Maternity Hospital were highlighted as far back as 1996. The Jubilee Maternity Hospital has now gone, and there has been a merger between it and the Royal Maternity Hospital, but, undoubtedly, the physical inadequacies remain. Mr McKee, the chief executive of the Royal Group of Hospitals, pointed out at the time, when accepting a refurbishment cost of £1·8 million, that it would only be a temporary measure as he wanted a new centralised hospital.

In 1997, the Donaldson Report stated that the ultimate goal was to develop a new unified hospital with a regional perinatal centre. It stated that plans should be drawn up without delay, and an unambiguous timescale should be established for their implementation. Instead of that new build, two old hospitals have been combined into one hospital, and there have been two costly judicial reviews.

In the review of acute services, comments were made about what might happen to the maternity services in Lagan Valley Hospital and Downpatrick Maternity Hospital. In Downpatrick and Lagan Valley there are 1,556 births; in the Mater Infirmorum Hospital there are 1,059 births; and in the Royal and Jubilee Maternity Hospital there are 4,712 births. Therefore, there are potentially about 7,327 births - and there could be multiple births among those figures. That means that many people will be affected by this decision.

What would a women-centred service look like? Women should be asked what they want, and their levels of satisfaction with the current service should be tested. Does the service, as it stands, have the support of women who use it? Is it producing good clinical outcomes for mothers and babies?

In 1996, the cost in the reports was predicted to be between £10 million and £15 million. In 2002, the cost is estimated at an exorbitant £204 million, following an economic appraisal, which was carried out two years ago. Is there any commitment to provide resources for a new centralised maternity hospital, given the costs that have been highlighted in the appraisal, because, search as I may, I cannot find them? Yet we remain with questions on the safety of a small and rather old maternity hospital, which continues to be refurbished. I understand that the refurbishment is continuing with the installation of a pipe system for lab specimens.

For the majority of mothers, giving birth should be a normal experience that takes place without the need for complex medical treatment for either the mother or the child. It should be recognised that maternity services should be centred on women, who should be considered to be partners in the decision-making process. They should be offered fully informed choices about the type of care that they will receive, and every effort should be made to accommodate the choices that they make.

I welcome the review of acute hospitals' proposals for midwife-led units. However, as I understand it, only one pilot unit will be created between the Downe and Lagan Valley Hospitals. That has implications for the new centralised maternity hospital. I understand that some women have the choice of case-led and midwife-led care, but we are left with a question about what we will do about over 7,000 births in the near future.

Midwives' morale is low. Some of the staff of the Jubilee Hospital chose not to move to what is known as the Royal Jubilee Maternity Hospital, so the complement of midwives and neonatal specialists is down. Often the neonatal units are under so much pressure that they must find space for mothers and babies in other hospitals, and sometimes the mothers who are moved out must be moved back again. That raises serious questions about the care that they receive.

The number of mothers electing to give birth in the Royal Jubilee Maternity Hospital is decreasing. Those women are going elsewhere. In January 2001 six consultants in obstetrics and gynaecology wrote to me and to the Minister. That letter, which demonstrates their morale, said:

Although that letter was written in January 2001, they are still waiting for an outcome.

There is great concern about all the services. When will the Minister decide on, and confirm funding for, a new centralised maternity hospital, given the promises that she made as long ago as 2000? Will she give priority to the provision of centralised maternity and gynaecological services in Belfast in the final Programme for Government, given that it was not even mentioned in the draft programme? How can Members support the Minister's securing early funding and a commitment to a fast-track project timetable?

We have waited for more than six years for that project. A decision is to be made after the 12-week period of consultation, which will follow the submission of two specifications from the Belfast City and Royal Hospitals, which were promised at the start of the summer. I initiated this debate on the Adjournment because I was led to believe that consultation would begin at the start of this parliamentary session, but we are still waiting. It is extremely important, therefore, to know when the consultation document will be prepared to enable the project to begin.

What has the Minister done to secure funding - funding for this mainstream capital project does not seem to be mentioned in the Budget? Has the Minister visited the Royal Jubilee Maternity Hospital, and is she aware of the current conditions there? I understand that recent steam and sewerage problems on the site have given much cause for concern.

I have raised the issue of hygiene standards in the House before; the serious problems with the steam and sewerage systems on that site, which we know is old, are obviously dangerous.

How will the Minister ensure that the views of women who are using obstetric and gynaecological services are heard? When I say "a women-centred service", I mean that both for maternity and gynaecological services. We know the links that must be made with oncology, particularly in relation to urology. Those are women's complaints, so any service must address them together rather than separately.

Has relevant UK evidence-based research on the location of maternity and gynaecological services, and the links between them, been taken into consideration? We are more than aware of links made with paediatric services. However, I continue to emphasise that, if we are to have a women-centred hospital like there are elsewhere in the United Kingdom, we must constantly prioritise the interaction between gynaecological services, which are lifelong, and those for maternity.

Finally, how will the Minister ensure that gynaecological services are given appropriate consideration in the current consultation? I say that because, when I first entered the House as a Member for South Belfast, I had high hopes that it would not be long before we found ourselves with a new, purpose-built hospital. It now looks like the Assembly is going down, but even had it lasted to March or April 2003, I would have left office without any purpose-built, centralised maternity hospital having been secured. I made that a priority when I was elected, and I sincerely hope that, as I go around the doors, I shall be able to tell my constituents that it has not been lost for ever.

I am grateful to Ms McWilliams for giving us an opportunity to consider this important matter. In fact, it is at least the third time in the life of the Assembly that the issue has been addressed. As Ms McWilliams rightly said, there is a long history to how we got to where we are now - the McKenna Report, the Donaldson Report and, more recently, the judicial review.

In a sense, we must start from where we are rather than where we might ideally wish to be. At the time of the earlier debate on the choice between the Royal Victoria Hospital and the Jubilee Maternity Hospital sites, a fear was expressed that a merger of the two units, especially at a single location at the Royal Victoria Hospital, would lead to a "shoehorning" into one inadequate building. As Ms McWilliams has pointed out, there is some evidence that that has become the case. The worrying aspect, as Ms McWilliams also said, is that what we were told would be an interim solution seems to be becoming an unsatisfactory medium-term or even relatively permanent solution, to the detriment of the well-being of mothers, mothers-to-be and their babies.

In their previous existences, both the Royal Victoria Hospital's maternity unit and the Jubilee Maternity Hospital seemed to have a distinct ethos of care, especially in the style of treatment during delivery. One point that I should like to raise is that, in the management of the single combined unit, there should be an attempt to take what is best from the ethos of both sides of the merger. Admittedly, that will be a difficult task, but I hope that it will at least be attempted in order to maximise choice for mothers-to-be. Perhaps preserving, maintaining and improving choice should be an underlying theme in this debate. Of course, that is subject to the two other main considerations - cost and coverage for emergency cases. Much uncertainty has been generated by the current situation, and some of the ill effects were well evidenced in Prof McWilliams's speech. Finally, I urge the Minister to end that uncertainty and to secure ring-fenced funding for this care and treatment.

I am pleased to take part in the debate. I agree with the last two Members that we must act urgently to ensure that better maternity services are available for Belfast, and south Belfast in particular. The question of maternity services has been unresolved for far too long. Other Members have outlined its various phases, events, reviews and inquiries. The longer the debate continues, the longer the Health Service provision for women suffers. It is far below what is acceptable.

I was glad that Ms McWilliams introduced the issue of women's health in general. It is not just a matter of maternity services; it covers many complex issues, which, along with maternity services, must be placed at the top of the Assembly's health agenda. Full gynaecological services must be maintained to a high standard, and they must be built, maintained and developed on the Belfast City Hospital site. Gynaecological services need considerable investment. Much of that investment must be made in parallel with the new cancer centre at Belfast City Hospital, because much gynaecological ill health is associated with cancer risks and scares.

New life - the pregnant woman, the unborn baby and the newborn child on its mother's knee - stirs an emotional response in most of us. However, many women incur disease or injury as a consequence of maternity and childbearing,. Because we were concerned by the publicity over certain issues of women's health, a few years ago my partners and I carried out a survey of about 200 women between 45 and 55 who were not seeking medical attention. Of the 200, 199 required attention but were not seeking it. Many of those women's problems arose either directly or indirectly as a result of childbirth. Consequently, many of those women were severely embarrassed, if not severely handicapped.

It is not enough to discuss childbirth; the Assembly must make women's health a higher priority. As a GP, I have found that many middle-aged women between 45 and 55 look after everybody but themselves - their children, their grandchildren, their husbands and, often, elderly parents. Their own priorities and health are not served.

I hope that the Minister responds to my plea. It is essential that we resolve the debate about maternity services and attempt to ensure that services are not only maintained but improved in a brand new hospital designed to meet the needs of all mothers. Shoehorning the Jubilee into the Royal Hospital was perhaps efficient and cost-effective, but it was certainly not as effective as regards patient satisfaction as it should have been. There is an overload. The building cannot cope because its facilities are inadequate most of the time. We should remember that not all babies are born to schedule. There may be a large number of births one week and a smaller number the next. The hospital could cope if the number remained level, but in some weeks there are more births than others.

Choice is necessary and important. Cost may be an issue, but the quality of care, including the surrounding social care, is equally important. It is not just an issue of the mother and her unborn child; extended families must also be considered and accommodated.

Every child has the right to be born in circumstances that provide the best possible start to life. The debate between the Jubilee and the Royal Maternity and the opposing claims and counter-claims drew the focus on the rivalry between the two institutions before their amalgamation. It became a political football, and the focus of the debate was switched from where it should have been - building the new hospital. The new hospital should have been half-built by now and well on its way to being established.

The old Jubilee site was user-friendly and accommodating. Many are worried that, since the move, the Royal has dominated maternity services. Traditionally, the Royal was seen as less user-friendly and perhaps more clinical. I hope that that will change. Any new hospital should be extremely user-friendly, not just for the mother and the child but for the extended family.

Unfortunately, many will see the debate about the new maternity hospital as one institution's ambitions of empire building. Although the debate was not absolutely conclusive, the argument that the maternity hospital had to be based close to the children's hospital appears to have won. Extended gynaecological services, and women's health services generally, should perhaps be located close to the new cancer centre at the City Hospital in the long term. They are not a thousand miles apart, but that proximity is nevertheless important for the plethora of gynaecological needs that relate to cancer pathology rather than maternity provision.

Madam Deputy Speaker, in welcoming the opportunity to take part in this discussion today, I would commend Monica McWilliams for securing this timely Adjournment debate on an issue of such importance.

Due to the political and legal wrangling which previously surrounded the debate on the location of maternity services in Belfast, nearly three years later we are no nearer to a decision. The fact that the report, which will be made available this month, will then be put out for a further 12-week consultation process once again delays the making of a final decision. I cannot understand how such an important subject has been allowed to fall so far behind schedule.

This debate has been ongoing for a number of years, and the length of time which the Department of Health has taken in producing this report has, in fact, further damaged the delivery of maternity services in Belfast, thus posing further delays on the building of a state-of-the-art maternity unit which would provide many benefits to expectant mothers.

I trust that this consultation process will be used far more effectively than it was previously, when the most important people in the debate - mothers - were not adequately consulted. It is important that all parties concerned are afforded the opportunity to take part in the consultation process and to have their views made known. The primary concern in the debate is that any decision which is made will be of benefit to those requiring the use of maternity services and that women will receive the best possible maternity services.

The process has been dogged by delay after delay after delay. Unfortunately, the Department, which will be making its report available later this month, has allowed the process to fall further behind schedule. This delay is further damaging the Health Service, which is already at breaking point and is lurching from one crisis to another. Since maternity services were located to the Royal Hospitals, it has become clear that it is not adequately equipped to take on the extra responsibility which came with this change in location. Maternity wards at the Royal Victoria Hospital are under severe pressure and are severely overcrowded, meaning that many new or expectant mothers are not receiving one-to-one personal care from midwives.

Staffing levels are also under tremendous pressure and morale is at an all-time low, which accounts for the increase in the numbers leaving the profession. We cannot afford to get this decision wrong. Modern maternity services require modern maternity facilities and unfortunately the Royal Hospitals are currently not in a position to offer that standard of service.

The decision which is made regarding the location of maternity services in Belfast must not be politically motivated and must be based on what is best for the people who will access these services. Any decision which is reached must take into account the views which are received during the consultation process. These opinions cannot and must not be ignored. That consultation process will take up much time and money, money that would be better spent being pumped into our health system, which is at breaking point.

Go raibh maith agat, a LeasCheann Comhairle. I do not want to rehash the unseemly political wrangle that occurred during the debate about services for the Royal Victoria Hospital and Belfast City Hospital, which led to a judicial review after the Minister had made her decision.

The underlying theme of the debate should be care for the mother and the child. It should focus on care of pregnant women who are at the stage when they must go to hospital and the need to ensure that proper services are provided for them wherever they are taken. There is no doubt that all of Belfast needs adequate maternity services. Moreover, services in the rest of the North of Ireland are inadequate. A new state-of-the-art facility is needed in Belfast, but I understand the Minister's caution, given the possibility of another judicial review.

We must examine maternity services throughout the Six Counties. Rural areas deserve a first-class service as much as any other area. When that debate took place three years ago, rural residents were angry that two major hospitals that stood cheek by jowl were engaged in a controversial argument over where the maternity services should be placed, while west of the Bann and other areas had no adequate maternity service. I welcome the introduction of the two pilot stand-alone midwifery-led units in Downpatrick and west of the Bann, which will give women more choice. I urge the Minister to instigate a review of those pilot units as soon as possible.

I was not aware that a decision had been taken on where the midwifery-led unit for the east of the Province is to be situated. I know that it was to be a choice between Lagan Valley and Downpatrick. Perhaps the Member knows something that we do not.

I am aware that people in rural areas may have asked those questions about the Royal and Jubilee Maternity Hospitals. However, I emphasise that it is the regional centre and, at that time, there were more than 6,000 births. Women from rural areas were, therefore, dependent on the decision regarding the location of the new centralised maternity hospital because, in the long run, many of them would have to use it.

Perhaps I should have said "east of Belfast", but Mick Murphy was whispering in my ear and that might have put Downpatrick into my mind.

East of Belfast and west of the Bann, I was urging the Minister to provide women with greater choice, and the two pilot stand-alone midwifery-led units will do that and get away from the controversy between the Royal Victoria Hospital and Belfast City Hospital. I urge the Minister to instigate a review of those pilot units as soon as possible to enable the establishment of as many midwifery-led units as are needed. It is an excellent idea which should be pursued. People west of the Bann - and I must be parochial - are very much taken with it.

Is ceist thábhachtach le tamall anuas í soláthar seirbhísí lárnaithe máithreachais i mBéal Feirste. Tháinig athruithe suntasacha ar sholáthar seirbhísí máithreachais i mBéal Feirste le blianta beaga anuas, agus is beag ábhar a bhí chomh conspóideach nó a spreag oiread spéise agus díospóireachta. Léiríonn díospóireacht an lae inniu go bhfuilimid uilig aontaithe go bhfuil na seirbhísí is fearr tuillte ag máithreacha agus ag leanaí. Glacaim leis go bhfuil difríochtaí móra agus dáiríre ann maidir le conas is fearr seirbhísí máithreachais a sholáthar. Tá sé de chúram ormsa a dhéanamh amach cé na socruithe seirbhíse is fearr a sholáthróidh seirbhísí máithreachais éifeachtacha sábháilte nua-aimseartha i mBéal Feirste agus taobh amuigh de.

Tá mé tiomanta an t-ábhar seo a thabhairt chun críche; críoch a chinnteoidh go mbeidh na seirbhísí máithreachais is fearr agus is inmharthanaí ann do mhná, do mháithreacha agus do leanaí sa todhchaí.

Mar is eol do Chomhaltaí, nascadh seirbhísí an Ospidéil Mháithreachais Ríoga agus Ospidéil Mháithreachais na hIubhaile i mBealtaine 2002. Ní raibh sé seo beartaithe ach mar bheart eatramhach, agus ag an am sin ba é an t-aon rogha praiticiúil é. Tuigim an imní atá ar Chomhaltaí go bhfuil an foirgneamh seo sean agus nach bhfuil sé cóirithe le seirbhís mháithreachais ardchaighdeáin a sholáthar don aonú agus fiche céad. Sin an fáth a bhfuil mé ag féacháil le cinneadh a dhéanamh ar shocruithe seirbhíse sa todhchaí.

For some time, the provision of centralised maternity services in Belfast has been an important issue. There have been significant changes in the delivery of maternity services in Belfast in recent years, and few issues have proved so controversial or generated so much interest and passionate debate.

Today's debate has, once again, demonstrated our shared agreement that women, mothers and babies deserve the best possible services. I appreciate that there were genuine and strongly held differences of opinion with regard to the best configuration and delivery of maternity services. It is my task to determine the arrangements that best deliver modern, safe and effective services which cover Belfast and beyond. I am committed to bringing this issue to a conclusion that ensures that we have the best and most sustainable maternity services for women, mothers and babies in years to come.

During the debate, Members said that services at the Jubilee and Royal Maternity Hospitals were amalgamated at the Royal Maternity Hospital in May 2002. That was intended only as an interim measure and, at that time, was the only practical option available.

I recognise Members' concerns that the current building is old and ill equipped to deliver a quality maternity service for the twenty-first century, which is why I am seeking to reach a decision on the future service arrangements. Recognising that the current facility has deficiencies, I fully endorse Members' comments on the commitment, and it is vital that we ensure that the new facility is brought forward to the benefit of all. I also pay tribute to the dedication of the staff of the hospitals and all the staff of the Royal Jubilee Maternity Hospital are to be commended for delivering a high-quality service in sometimes less than ideal circumstances. I fully accept the need to resolve the issue. Staff deserve a modern working environment, and mothers and babies deserve the best possible service.

Members referred to the various delays since 1996 in bringing the issue to a successful resolution. Monica McWilliams, in particular, referred to my statement of January 2000, in which I said:

I also said:

At that time, my decision was overturned, which, of course, impacted on the timing of the project.

In respect of the forthcoming consultation and the process that I have re-established, I have been determined from the outset to ensure that the process is open, thorough and inclusive. This has taken some time. However, if we are finally to move towards a new hospital, I need hardly remind Members of the importance of getting the process right. We can ill afford another round of delay, occasioned by a further legal challenge.

The current process is built around a specification for the new maternity unit. When I announced details of it in June 2001, I stated:

At that time, I also confirmed that the trusts' proposals would form the basis of a second consultation process, which has the advantage of being open and transparent.

Importantly, it also gives ownership of the options to the two trusts and facilitates an open and free discussion of the issues. I could have initiated a less complex process, which would have allowed me to arrive at a decision much earlier. However, I determined that it was much more important that the approach was sufficiently robust to address the concerns of all parties, to provide for a final decision demonstrably based on the facts, and that such a process should address some of the questions that Members asked today about the involvement of those who wish to make use of the service.

In the light of the responses to the initial consultation process, the specification had to be amended, primarily to enable the trusts to consider the option of centralising gynaecology services alongside, or as part of, the centralised maternity hospital. In the light of that additional option, it was necessary to extend the time frame for the development of the proposals. Officials did, however, make it clear to the Committee that they expected the document to be available by the end of September 2002. I can confirm that the consultation document is being printed and will be issued within the next two weeks.

That document is extensive. It incorporates the trust's proposals as well as the health estates' professional assessment of the existing Royal Jubilee Maternity Service. Both trusts have sought to demonstrate the particular advantages that their respective sites can offer.

The inability of the neonatal unit to accept admissions is an infrequent occurrence, but it has happened three or four times in the past two and a half years. Indeed, it occurred in the Royal Maternity Hospital and in the Jubilee Maternity Hospital prior to the amalgamation.

Ms McWilliams asked whether I had visited the Royal Jubilee Maternity Service recently. I visited that unit to observe its operation, but in recent weeks senior officials from my Department have visited the hospital on three occasions. I am being kept fully informed of the state of the services there.

In the summer there was an incident in which a sewer in the hospital became blocked, but relevant experts addressed the problem immediately. Unfortunately, the contractor worsened the problem briefly before it was resolved rapidly. That is not a repetitive problem. The steam problem was caused by a broken bedpan washer and was repaired immediately. Such incidents can and do occur in any such facility.

An economic appraisal suggested that a new hospital would cost £204 million. The likely cost of such a hospital is expected to be between £30 million and £40 million at today's prices. It is unclear from where that figure of £204 million comes; it could possibly represent the present net value of a time stream of services over an extended period.

In line with normal practice, funding for a new facility is not determined until the final business case has been agreed, and this is still some way off. I cannot seek to commission a new building before I have reached a formal decision about its necessity. The accepted rules about public sector investment require that my Department consider a range of options. Those include a refurbishment option, which will be included in the consultation document; however, in this case, I am certain that this is not a viable way forward. As I have said, the health estates have taken that forward. I will examine the best route to secure funding once I have reached a decision. My previous decision on the matter was overturned, so I must make a new one.

I have deliberately chosen to follow an open and transparent approach to developing and consulting on proposals that will ensure that mothers are adequately consulted. Interest groups and patients' representatives have been involved at each stage. I look forward to mothers and families being involved fully in the forthcoming consultation process, and I encourage them to play a full role. As I said, I shall issue the document for public consultation within the next two weeks. I am committed to reaching a final decision as soon as is practicable. However, Members know that there are certain question marks over how that will proceed in the present circumstances.

I have made no decisions about the merits of either site or the need for linkages to particular services. I aim to make the information available so that a considered and informed debate on this important issue can take place. As I have stated previously, mothers and babies deserve, and have the right to expect, the best possible maternity services. That must be our primary concern.

The debate today has flagged up some important issues that I hope will be picked up on more fully in the forthcoming consultation. I listened carefully to Committee members' views and look forward to their further advice as the consultation proceeds. I am delighted that, as a result of the matter being raised by Ms McWilliams, we have been able to consider it.

I encourage Members to consider the consultation document carefully and to reserve judgement on the location of the maternity hospital until they have had a chance to consider and digest the proposals presented by the trust.