Mrs Nelis:

Go raibh maith agat. Willie, I might give you a third position and confuse you entirely.

Mr McFall is very welcome, and I want to thank him for presenting us with this document, a document that needs very careful scrutiny. None of us would disagree with the mission statement of 'Making it Happen' which promises to provide us with a modern, effective hospital service and primary care through a community health service which guarantees equally high quality care to everyone.

I do not know who advised the Minister, but I believe that this paper has not been properly thought out and that the case for change has not been properly made. The Western Board Acute Services Review Committee which has many sub-groups and an extensive consultation programme is not due to report until 1999. 'Putting it Right' upstages that consultation process, and I wonder whether those engaged in it will have to repeat the exercise.

4.15 pm

I welcome the fact that the Minister is endeavouring to address the crisis in Health Service delivery. Market forces dictate health services. Patients are now referred to as clients, and hospitals are coming down with men - and a few women - carrying briefcases. One of the key issues in the document is the Ambulance Service. I welcome the injection of much-needed cash to the Ambulance Service, but I hope that it is not at the expense of downgrading some of our area hospitals. I am concerned that the paper is preoccupied with the notion that big is beautiful. "Big" in terms of hospitals and 'Making it Happen' seems to refer not to the golden six as Willie McCrea says, but to the golden two. Excellent hospitals they may be with excellent staff and facilities - I am talking about the Royal and the City - but they are within an area which does not provide services to the majority of people west of the Bann.

I hope that the Ambulance Service review will address the crisis in the service which has always been the Cinderella of the entire Health Service. In Derry City, where I live, ambulance crews have to cover not only the entire city and the surrounding areas, but are constantly on call to deal with transfers to Belfast. That is because Altnagelvin was not given proper financial and medical resources to treat many serious illnesses.

Frequently, only one ambulance crew is left to service Altnagelvin, which is supposed to be an acute hospital. Last year in our city there was a serious housefire in which parents and two children died because there were not enough ambulances to transfer them to hospital. When another ambulance eventually arrived, the crew attempted to revive people, but without success. Others had to be driven to hospital by a policewoman. This is not an isolated incident. In the Western area many patients regularly have to be transferred to hospitals by taxis and other vehicles.

There is no point in having the best facilities at hospitals if patients cannot get to them. I welcome the review, but I am also concerned that the review body was rather exclusive. For example, it did not include trade union members or members of the health councils, although such people have hands-on experience of the Ambulance Service and certainly would have had a good input to the review.

Some Members raised concerns about the closure or run-down of maternity services and units. That issue is insufficiently addressed in the document. Women who are fortunate enough to live near a hospital where maternity services have not closed are being discharged from hospital some six hours after giving birth. We are all familiar with the case of the woman who gave birth about two years ago in her husband's lorry en route from Omagh to Altnagelvin while stuck behind a tractor in a queue of traffic.

We know of the woman who almost died in similar circumstances with a postpartum haemorrhage. The maternity services look like replacing the ambulance services as the Cinderella of the Health Service. A review of the maternity service is needed.

There are other concerns, such as the training of highly specialised nurses, who then leave because they cannot get a contract, and the managerial structure of hospitals. A theatre porter recently told me that he had seven superiors. The issue of trust executives is scandalous. They have salaries of £92,000 per year while nurses, porters, auxiliaries, canteen and cleaning staff are all expected to live on wages that are well below the poverty level. I urge the Minister to give more consideration to this document. I support the calls that no decision be made until the Assembly shadow Executive and Ministers are in place and we have had further time to discuss the issue.

Mr McCarthy:

I wish to thank the Minister and his Department for the very sensible decision that they made on the funding of the three integrated colleges last week. When other Members and I met with the Minister about the matter I asked that he give us a good Christmas present. I am delighted that he did.

The Initial Presiding Officer:

Your comments are outside the bounds of this debate.

Mr McCarthy:

I was expecting that.

I have a few comments to make about the document today. I welcome the references on pages 3 and 11 to the fact that patients are entitled to to receive the right treatment in the right place at the right time, delivered by the right person. No one in this Chamber could possibly disagree with those sentiments, but how can we achieve such a goal? There are many ideas and suggestions in the Minister's document, and I hope that it contains the answer we are looking for.

On page 5 the document, under the heading "Why Change is Necessary", says

"Services in some smaller hospitals are being stretched to breaking point. Some patients are currently being admitted to hospitals that are not adequately equipped to provide the full range of tests and support they need."

How right that is.

The Ulster Hospital at Dundonald, which is one of the major hospitals, has frequently been at breaking point. Patients have had to endure the indignity of lying not on a bed but on a trolley, and not in a ward but in a corridor, for many hours. On occasions, because of the lack of attention, patients were taken home to receive some form of comfort. This cannot be tolerated. The Strangford constituency, which includes the tip of the Ards peninsula, expects, and must have, better. The sooner improvements can be made at the Ulster Hospital the better.

The sooner that improvements at the Ulster Hospital can be made the better. I pay tribute to the dedicated staff of that hospital, who work under tremendously stressful conditions. We can only hope that their lot will be dramatically improved.

The document mentions the new community hospitals in Newtownards and Bangor. I welcome those developments, which are a response to the withdrawal of acute services from Newtownards and Bangor some years ago. I appreciate the co-operation of all those who were concerned in those ventures, particularly our local general practitioners.

If community hospitals are used and managed properly, our people will enjoy better health provision. The development of a highly effective ambulance service is vital for people in rural areas. Those living on the Ards peninsula could be facilitated with an ambulance out-service in the centre of the region. I thank the Minister for the document. Things can only get better, and the new Assembly will put matters right, provided it is given the necessary funding.

Mr R Hutchinson:

I thank the Minister for taking time to speak to the Assembly. My colleague Mr Boyd and I met the Minister on 19 October. At the meeting I put the case of a constituent, Mr Cowden, to the Minister. Mr Cowden's wife had been admitted to the Broadways Nursing Home in Larne. Mr Cowden was in another Fold and wanted to be with his wife. The Minister looked into the matter, and on 28 October Mr Cowden was moved to the Broadways Nursing Home to be with his wife. Sadly, Mr Cowden survived for only four weeks. At least he was able to have four weeks with his wife, and I want to put on record my thanks to the Minister for his help.

There are many good things and many bad things in the report. I represent East Antrim, and I have some concerns about the rural part of my constituency. It is difficult for people living in Islandmagee to get to Whiteabbey Hospital. If the Minister's proposals for that hospital go ahead, the majority of patients will have to travel to Antrim area hospital. Many of the proposals in the Government paper rely on a good Ambulance Service. I ask the Minister to reconsider his plans for Whiteabbey Hospital. Perhaps, as my colleague Mr Boyd so ably put it, the Minister should listen to people in the area.

An ambulance service is central to the Minister's paper and his plans. I do not know whether the Minister is aware that an ambulance in Larne with the highest mileage in the Province has broken down on several occasions and left people stranded. This is not an adequate service, and I am delighted that £15 million will be put into the Ambulance Service, which is central to the working of the new organisation.

4.30 pm

As there is only one ambulance crew, no one should take ill on a Sunday or Monday night in Larne. Should there be an emergency in Ballymena or in any other area within the constituency, the ambulance crew has to go there first. Therefore, if you take sick you have to wait for the ambulance to return. That is not an adequate service for the people of east Antrim. I ask the Minister to examine the situation.

The Ambulance Service and the Northern Health Board have promised me that Larne will have two new ambulances by the end of December. Perhaps the Minister will check to make sure that that happens.

It is harrowing to be approached by the families of mentally handicapped or disturbed people in Muckamore Abbey. Some of them have been there for 30 or 40 years, and it is sad for their relatives to see them put out to be looked after in the community after such a long and happy time in a place which has become their home. The families did not put them there because they did not love them or were embarrassed by them. They put them there because the care in Muckamore Abbey is second to none. I pay tribute to the doctors and the nursing staff who deserve better treatment than the proposals suggest. I would ask the Minister to rethink some of the proposals for Muckamore Abbey.

Rev Robert Coulter:

I welcome the Minister to the Assembly. I am sure that after 17 speakers he will agree with the philosophy of Henry Ford, who said

"The longer the spoke, the greater the tyre."

Much has been covered already, but I should like to ask the Minister about the philosophy of the analysis. Who were the members of the team involved in this? Many of the gaps in the analysis have been pointed out, but I am concerned that my constituency is not mentioned and there will not be a local hospital in the constituency of North Antrim.

Ballymena hospital has been closed, and Moyle, Ballycastle and Ballymoney hospitals are not mentioned, yet the core philosophy of the analysis is that people will get quality care no matter where they live. Local hospitals offer valuable short-term respite and palliative care to allow patients to recover following surgery or illness. How can that happen in North Antrim? Patients would be treated at the acute hospitals, but could not return to a local hospital for further recovery time. Where do the patients of North Antrim go when they have no local hospital?

Ballymena Borough Council has been arguing since the Waveney Hospital closed for a minor accident and emergency unit in the town because if a child cuts his finger in school, two teachers have to go with him to Antrim. However, as it is not a serious injury the child has to sit there for approximately four hours before the injury is attended to. That means that two teachers are out of school for half a day, which is a loss of their valuable services to the pupils. When the hospital trust's board members talked to the council about this matter, they told us that we had to decide whether to have cancer care in Antrim or a minor accident unit in Ballymena. It is totally unfair for any board member to ask that of a locally elected representative. That is a decision for the board.

Does this document state that that kind of charade will not go on in future? Can we take it that there will be adequate representation on the boards? I ask this because the only member of the United Hospital Trust's Board who has any contact with Ballymena has "formerly Ballymena" in brackets after his name. Why are the other members not "formerly Belfast" or "formerly Newtownabbey"? There is no one on that board from the Ballymena area.

There are many other matters that I could raise, but I want to draw to the Minister's attention the fact that this document proposes that Ballymena lose its last service. It says

"Some changes to services in Ballymena are proposed. Assessment and rehabilitation services for older people, together with dedicated stroke and orthogeriatric services presently at Braid Valley Hospital, would be centred at the Antrim Hospital."

North Antrim in its entirety is to be bereft of any of the services proposed in this document. What is the philosophy behind the analysis? Who took the decision on that? Will there be adequate discussions with us before we proceed further with any decisions along that line?

Dr McDonnell:

I thank Mr McFall for his attendance, for his interest and for the extra funding that has been announced. In doing so, I also want to endorse Mr Coulter's comments. As a son of north Antrim, I agree with him that it is time the constituency had a new MP because it has been politically neglected all these years.

I should like to deal with the important issue of the crisis in the Health Service and the response to 'Putting It Right'. A forthcoming report from the four Colleges of Surgeons in England, Ireland, Scotland, and Wales was leaked to a newspaper last week. The report, if true, certainly indicates that we are in crisis. According to that report, only four of 17 acute hospitals meet clinical standards. The article stated that because of those failing standards, recognition and junior staff will be withdrawn and the hospitals will be clinically paralysed.

This debate has come at an appropriate time. We need to get to grips with the broad web of crucial issues affecting the Health Service. Time and time again we receive contradictory documents. The current document is certainly acceptable and reasonable and makes a contribution, but it follows the recent 'Fit For Nothing' document, which had a totally different angle.

A total lack of clear vision on the overall provision of health care is the greatest problem. We need a clear set of objectives and practical targets - markers or baselines against which we can measure achievements. The shifting goal posts have been referred to time and time again in the debate. The goal posts are on wheels, and you are never quite sure where you are going to kick the next time - they are going round and round until some of us are dizzy.

Could the Minister tell us whether we in Northern Ireland are to have a disease service or a health service? This is a fundamental question. Is the Health Service here to cure or to try to stall disease for as long as possible, or is there to be a realistic Health Service in the twenty-first century meaning of the word? If the Department of Health and Social Services is engaged in rationing health care, the Department should say so openly and not leave it to the lengthening hospital queues and to the GPs like myself at the coalface to try to stretch £100 million of funding to get £120 million worth of work. You can stretch it a bit around the edges, but it will not stretch that far.

In the context of the rationing that is taking place, the Department of Health and Social Services must stop creating limitless public expectations in the face of very significant constraints, because the two just do not fit. We should not have a situation in which the sky is the limit in terms of what people are entitled to when we do not have enough money or enough people to deliver such a service. Until the Government put real effort and money instead of lip service into new technology and telemedicine, the efforts of GPs will be wasted.

Northern Ireland will remain in a backwater while everywhere else in the world is at the cutting-edge of technology and facing twenty-first century problems with that new technology. The Government must stop making simple things complicated, and in many cases a very simple problem is turned into a very complicated one. The Government have to stop creating artificial obstacles merely to protect vested self-interest - and there is a lot of that around. That creates problems, and the Government have to deal with it.

The Government need an open and honest leadership to drive this health agenda forward. At present it is unclear what or who, if anyone, is setting the agenda. It is all piecemeal, and the Government must decide whether it is the Department of Health and Social Services, the medical profession, the administrators, financial constraints, social services or political considerations that decide policy.

The Assembly should not have to spend the next 10 years debating structures, administrators and mechanics and paying very limited attention to clinical standards or popular choice. People are entitled to some choice. Members have to decide if personal choice, people's feelings and clinical standards are more important than structures.

While I do not agree with all the details of 'Putting it Right', I welcome the publication because it has opened up a debate on the Health Service. However, these proposals were rushed out in a pre-emptive response to offset the negative report coming from the College of Surgeons. The Department of Health and Social Services is not on top of the situation, and it needs to get on top of it. This debate affords Members the opportunity to begin to focus on, and get to grips with, all the complexities in the health and care services. Major decisions need to be taken to improve the well-being of all our communities, and hospitals are a central element of this service. But before dealing with hospitals I would like to touch on a couple of other points.

It is essential to have a policy that is comprehensive and provides for a totally integrated approach to health and social care. When I use the word "comprehensive", I have in mind, and I mean, a holistic and proactive approach to health and well-being: an approach led from primary care; an approach led at the simplest level; and an approach led from the ground up but designed both to prevent and to cure illness, with the emphasis on prevention.

Health promotion and disease prevention must be at the core of any Health Service of any distinction. If a more effective preventative strategy existed, there would be fewer people in hospital. The Health Service is impotent, as far as I can see, in the whole campaign on health promotion. We are all aware of the lethal impact of cigarette smoking on health and its well-proven links with cancer and heart disease.

We should be aware of the massive cost to the economy generally and to the Health Service specifically of alcohol abuse, but little or nothing has been done about that. Time does not permit me to go into detail, but I again emphasise that tobacco kills one in six of our population, and is responsible for more than 90% of lung cancer deaths.

Last year in Northern Ireland 773 people died from lung cancer. Those are the ones we know about, and they did not need to die. They could have lived another 10 years. I have noted in my own practice that people who smoke normally die 12 to 15 years earlier than their non-smoking brothers and sisters. The useful economic activity that is lost when they die is just the tip of the iceberg. Massive morbidity is associated with smoking.

Time does not permit a listing of chronic ill health. Some 25% of hospital beds are occupied every winter because of chronic bronchitis and emphysema, both of which are smoking related. Those issues need to be dealt with. There is no point in having a disease service that provides hospital beds for people who have smoked themselves almost to death. There is no point in providing such people with death grants. That would be not a Health Service but a disease service.

Prevention is essential, and it is not just an individual responsibility. Prevention of illness and the promotion of good health are the collective responsibility of everyone in Government. Central Government has a key role and a moral responsibility in the wider context to pursue policies and strategies that promote and ensure good health. Promoting healthy living and ensuring a framework of attitudes, laws, rules, regulations and policies that enable people to follow a healthy lifestyle must be an essential part of any health care programme.

One would think that the debate was on hospitals rather than on the Health Service. The Health Service began and ended with hospitals. Joe Hendron said that 90% of health care is provided at primary level, and it is important to realise that that is where all the work is done.

4.45 pm

The Initial Presiding Officer:

Please bring your remarks to a close.

Dr McDonnell:

When considering the Health Service and the role and potential of hospitals, we must also consider primary care. There must be scope for GPs to work closely with hospitals. Can new technology and tele-medicine not be made to work for us by linking peripheral GPs to district hospitals, and by linking GPs and district hospitals to area and regional hospitals?

We should be able to bring first-class care and service to places as peripheral as Belleek and Garrison.

The Initial Presiding Officer:

I must ask you to bring your remarks to a close.

Dr McDonnell:

There must be deeper debate on health. Overall vision is lacking, and the tension surrounding the provision of hospital services arises because people believe that they are losing a service, and that there is nothing to put in its place.

The Initial Presiding Officer:

I must ask you to bring your remarks to a close.

Mr Morrow:

I welcome Mr McFall to the Assembly. I am not enthusiastic about his document, but that is understandable because I am a rural dweller with a rural constituency. The document shows that rural dwellers will soon be second-class citizens in the Health Service.

The Minister stated that the future of the Health Service would be one of the greatest challenges facing this Assembly, and that may well prove to be true. However, by the time that the Assembly is in a position to address this issue, far-reaching decisions will already have been taken. Guidelines in the 'Putting It Right' document lead inevitably to one conclusion. According to the document and the Minister, none of our hospitals will close. They will not close today, but it will be death by a thousand cuts.

The strategy document concentrates on the golden six which are in the populated areas of Northern Ireland. Those of us who live in, and represent, rural constituencies will not fare so well. Those living in rural areas are fast becoming second-class citizens in terms of health-care. The document states that smaller hospitals are being stretched to breaking point and then proceeds to recommend withdrawal of certain services. The South Tyrone Hospital has recently had maternity services withdrawn and the rundown is well and truly under way.

Over the years the medical and ancillary staff in the South Tyrone Hospital have done an outstanding job. Page 9 of the document states

"Patients must be treated by properly trained doctors."

Does this imply that this has not been the case in the past? If hospitals continue to be run down, it will be very difficult to attract staff to work in them.

The document, on page 11, says

"Patients want to be treated close to home."

That will not happen as a result of this document, not in my area anyway. Local hospitals will constantly be under threat and resources will be concentrated on the golden six. Rev William McCrea touched on the real point when he cited the fact that there are three hospitals in this document. Members across the Assembly smiled when he said that, but in years to come he will be shown to have been correct.

I would draw the Minister's attention to a recent incident when a critically ill cancer patient had to wait two and a half hours to be collected from his home in Fivemiletown to be taken by ambulance to the Erne Hospital because Fivemiletown is situated between Enniskillen and Dungannon. This document severely disadvantages communities in rural areas, like the Clogher Valley. The rundown of rural hospitals will also result in a substantial loss of jobs. It is estimated that 200 jobs could be lost in the Dungannon area as a result of the removal of maternity services. This document does not adequately recognise rural communities.

I would like the Minister to take on board what I consider to be a glaring omission - there is no mention of an Information Technology infrastructure to service the various hospitals and primary-care centres. A patient was given a scan in a local hospital but, as it could not be interpreted, the patient had to go to the Royal on a six-month appointment. He had the same scan on an identical machine and had to go to the seventh floor and wait one and a half hours. A consultant then gave an interpretation which was identical to that given six months earlier. On enquiry there was a refusal to operate a simple fax machine. If the Minister cannot reply on this point today, perhaps he could reply in writing.

Mr M Murphy:

Go raibh maith agat a Chathaoirligh. I also welcome the Minister. The document 'Putting It Right' is exciting and challenging. We do not have the option to wait until a new Minister is appointed before we tackle this issue, as hospital services are facing a critical time.

The Health Service is facing a critical period, caused by the decisions made by the current British Government. There is widespread unease in local communities about cut-backs and the general rundown of local hospital services. It would have been better if the Minister had introduced these plans before the general rundown of acute services began. It is a fact that a wide range of services in smaller hospitals are being stretched to breaking point. Nevertheless, I would like to take this opportunity to pay tribute to the services which these hospitals have provided over the years.

The Minister will claim that the standard of care in some of these hospitals is not as good as it should be, but the fault lies with Mr McFall and his predecessors who have failed to make the necessary resources available. We need a regional investment plan, to be drawn up as soon as possible, to ensure that the proposed capital developments will result in hospitals adequately equipped to deliver acute services.

On behalf of my local hospital, Daisy Hill Hospital in Newry - mentioned on page 29 of the document - I appeal to the Southern Health and Social Services Board to appoint an accident and emergency consultant as a matter of urgency. Daisy Hill Hospital urgently needs a CT scanner for its accident and emergency department, and I call on the board to invest in the necessary facilities. I call on GPs and hospital managers to work together to ensure that all the services outlined on page 29 of the report are provided. A cross-border body should be established to take account of the fact that the population of north Louth also lives in the catchment area of the hospital.

I am delighted to see that there has been investment in the Ambulance Service, but, in order for this service to be fully effective, we need better roads. The Department of the Environment and the Department of Health and Social Services should work together to ensure that the road network in south Down and south Armagh is improved substantially, and should do this as part of an integrated plan for the area. If the Downe Hospital is to be closed down, the roads must be updated so that the Ambulance Service can provide patients with the service that they need but for which they now have to travel considerable distances.

Mr J Wilson:

I thank the Minister for coming here today to hear our views. Today's bulletin from the Northern Ireland Information Service, under the heading Mental Health and Learning Disability Services, states

"We [the Government] are committed to the development and improvement of services for people with a mental illness or learning disability, particularly to allow people the dignity to live as individuals in community settings rather than be lost souls in large and impersonal institutions."

I note also that the Government are allocating £5 million, in addition to the £25 million already allocated, to the community-care budget, to enable boards to meet particular pressures in their areas. I welcome that.

5.00 pm

However, I have received a fax today from the North and West Belfast and Muckamore Abbey Branch of the public service union, UNISON, which says that residents in Muckamore Abbey are unhappy, and in some cases suffering, because reprofiling in its current form has not been a success.

It says that staffing levels cannot be maintained because of the £491,000 which has been taken out of the Muckamore Abbey budget and that this poses a serious risk to residents, as well as a drop in professional standards of care. It goes on to say that there is a serious risk of more upheaval to accommodate more ward closures in the future.

Further, the union says that the trust's chief executive has instructed the site director to dispose of 40 members of staff, disregarding the fact that this will pose a serious risk to the welfare of the hospital's patients. Finally, and this is very important, it says that there are, as predicted, mixed-gender wards and unsuitable groups living in care together.

Given that situation, does the Minister accept that there are, unfortunately, people living in institutions who could not and should not go out to live in the community? Can he assure the Assembly that some money will be directed to those institutions, such as Muckamore Abbey in my constituency, so that the patients to whom I refer can live and enjoy the same dignity inside the institutions as others living with their families in the community?

Ms Lewsley:

I welcome the Minister and the opportunity to speak in this debate.

I want to raise the matter of the Lagan Valley Hospital in my constituency, which Mr Close has referred to. The Minister's vision for the future sees Lagan Valley as a local hospital, but I see it as more than that. When the decision is finally made on area hospitals, and specifically on Belfast City and the Royal Group, what will be the possibilities for local hospitals to facilitate area hospitals in the medium-to-long term?

The Lagan Valley Hospital is in a unique position, being close to the motorway, with easy parking access and upgraded ward facilities. It could form a partnership with the area hospital by providing, for example, day procedures and elective work, thus lightening the load of the area hospitals which, in the medium term, will be experiencing a severe workload.

I hope that the majority of accident-and-emergency and midwifery services will be kept in the Lagan Valley Hospital, especially given the fact that its maternity services were awarded a Charter Mark in 1997. This, of course, can only happen with adequate consultancy back-up and, I hope, with the expansion of the new telemedicine in the near future.

Many of us are very conscious of the need for a better Ambulance Service, which is vital to ensure that people in all rural areas, including part of Lagan Valley, get as high a standard of care as those in the urban areas. It is important that the Ambulance Service work in partnership with the local hospitals.

These are just a few of the benefits which Lagan Valley Hospital can offer to complement the area hospitals and provide a better service for patients in the local and wider communities.

Mr Wells:

I welcome Mr McFall's visit here today, and I want to thank him for taking the health spokesmen of the parties into his confidence before he launched this document. That is a very welcome trend, and one that I hope will continue.

There is a mythical conveyor belt heading towards one Assemblyman, and on that conveyor belt is the ultimate poisoned chalice, stamped "Minister of Health and Social Services". Someone in this Chamber will drink from that chalice, and I do not envy him or her that predicament. It won't be me.

We have heard a lot this afternoon about the various colleges. Down District Council, in its response to the Minister's decision - that Minister being Mr Worthington - on the future of Downe Hospital, pointed out that the colleges do not all agree on this issue. After the Minister took that decision, the report of a joint working party was published which made interesting reading. The Department does not seem to have taken the joint working party's recommendations into account when coming to the decisions outlined for Downe in this document.

One of the conclusions in that report was that in America 50% of all graduate doctors are being encouraged to specialise in general medicine. They think the trend towards specialisation has gone too far, and they are hoping to have half the qualified doctors performing a general surgical role rather than specialising. The report argues that often, and particularly with elderly patients, a patient has a wide range of complaints. What that person needs is to be treated not by a series of specialists, but by someone who has a general training and can call upon a specialist if needs be. It is better for a person to be taught by someone with a much wider knowledge.

We can quote the surgeons, but they do not agree. Even if they did agree, this process should not be driven entirely by the Royal Colleges. There are many things in life which seem to need specialisation or concentration, but that takes no account of the needs of the ordinary, individual patient. We could concentrate many services in Northern Ireland on one or two major facilities - education is the obvious example. There would be logic behind a proposal to concentrate the teaching of a certain language or subject in one school in the Province, but that would take no account of those who live in rural areas.

The question I ask is one which no one has satisfactorily answered: does someone who falls and breaks his leg in Main Street, Strangford get the same treatment as someone who breaks his leg in Royal Avenue in Belfast? The answer must be "No." The patient in Strangford has to be ferried to Downpatrick, but instead of being taken to Downe Hospital, under these proposals, he would then have to make the 30-mile trip to the City or the Royal in Belfast.

I know that the Minister has a chauffeur-driven car - I would love to have one myself, but I never will; Back-Benchers do not get chauffeur-driven cars - but has he ever tried driving from Ardglass or Killough to Belfast on a wet Saturday night in November or December? Has he ever tried that? Does he see how practical, or otherwise, the proposal is that a person who has had a serious accident or a heart attack in a rural area should be driven to Belfast?

Unfortunately, traffic in Belfast is now utterly horrendous at night, particularly during the rush hour between four and six, and in the mornings. Even during the day there are long queues. It would be physically impossible for an ambulance to get through. And yet, the Minister says in this document that he is putting the care in the right place at the right time. I simply cannot accept that. If he can convince us, in the few short months before he hands over the poisoned chalice, that that person will be getting the right treatment in the right place at the right time, I will be the first to admit that I was wrong.

The community that I represent in South Down thinks quite the opposite. The local GPs want acute services retained at Downe, and the surgeons want to retain those specialties in Downe Hospital. A major selling exercise would have to be done before anyone would be convinced that the best interests of the people in Down district are not served by the retention of the acute services at that hospital.

It is recognised in the document that accessibility is an important issue, that it is impossible to expect somebody from Strabane or Omagh to be ferried to Belfast. The same conclusions can be reached when considering Downe Hospital because of the rural nature of that part of the constituency of South Down. The same criteria should be used when considering that hospital.

Ms de Brún:

Ba mhaith liomsa chomh maith fáilte a chur roimh an Aire inniu, agus ba mhaith liom chomh maith fáiltiú roimh an phlépháipéar agus roimh an deis a tugadh dúinn todhchaí na n-otharlann agus na ngéar-sheirbhísí sláinte eile a phlé.

Mar a dúirt baill eile den Tionól seo romham, tá ceisteanna deacra le freagairt, agus cinneadh ollmhór le déanamh againn uilig amach anseo.

Aontaím go gcaithfidh seirbhísí a bheith fiúntach ó thaobh costais de. Caithfimid bheith in ann caighdeán ard seirbhíse a chur ar fáil chomh maith. Is gá, mar sin, moltaí a aimsiú a chomhlíonann na critéir sin. Caithfidh na moltaí bheith raidiciúil.

Cé go n-aontaím go gcaithfear pleananna s'againn a thomhas ó thaobh costais de, ní féidir an cheist sin a chur sa chéad áit mar phríomhphrionsabal. Bá chóir tús áite a thabhairt do riachtanais ár muintire uile.

Fáiltím roimh an ráiteas ón aire inniu nach mbaineann moltaí s'aige le gearradh siar ar chaiteachas.

Cibé cinneadh a dhéanann an Tionól seo maidir leis na seirbhísí sláinte, tá sé rí-thábhachtach nach do chostas amháin a thugtar tús áite.

Deirtear sa cháipéis go mbeidh cuid de na h-otharlanna áitiúla in ann seirbhís níos ginearálta a chur ar fáil: i gCúl Raithin, in lúr Cinn Trá agus i ndeisceart Bhord an Iarthair. Is léir go dtuigeann an t-aire tábhacht na gceanntracha sin, agus labhair an t-Uas Foster agus baill Tionóil eile nach é ní ba luaithe ar riachtanais muintir a ndáilcheantair féin.

Dá thairbhe sin, caithfimid amharc arís ar liosta na n-otharlann ar cuireadh an "ciorcal órga" orthu le cinntiú go bhfuil an t-seirbhís cheart á riar ar an phobal san áit cheart.

Agus caithfimid cinntiú go bhfuil coiste feidhmiúcháin curtha ar bun go práinneach sa Tionól seo le go dtig linn uilig an t-seirbhís atá de dhíth orainn a chur ar fáil don phobal s'againn go luath.

I would also like to welcome the Minister here today. I welcome the paper and the opportunity to discuss the future of the hospitals and acute services. As other Members have said, there are hard questions to be answered and major decisions to be taken by us all.

I agree that services must be cost-effective, that they must deliver a high standard of service and that they must be able to meet the needs of the whole community. Proposals which meet these criteria must, therefore, be identified and put in to practice. They need to be radical and far-reaching. While any proposals need to be measured against cost, this must not become the overriding principle. The health needs of people, particularly when it comes to acute services, must always be paramount. It is vital that when the Assembly comes to take decisions on this question, cost-effectiveness should not take precedence in respect of the provision of health services.

5.15 pm

I note that it also states in the document that some smaller hospitals will be able to provide more general acute services in Coleraine, Newry and the southern part of the Western Board. Mr Foster and other Members spoke very eloquently about the needs of their constituents. We must look again at the list of the golden six hospitals to ensure that the right number are providing the right service, in the right place, to the right people. When we look at the provision of services all these questions will need to be taken into account.

An executive committee must be established urgently so that the service which is so badly needed by everybody can be provided.

The Initial Presiding Officer:

We are due to finish at 6 o'clock, thereby allowing four hours for this debate. Should the House wish to proceed with the remainder of the Order Paper, I have enough Members - many of whom have been waiting for a very long time - to take us two and a half hours beyond 6 o'clock. I propose, therefore, to remain faithful to the existing arrangement and limit the debate to four hours.

Other business has been identified for tomorrow, and this is likely to mean that a substantial number of Members who wish to speak are going to be unable to do so. For the remainder of the time available, Members will be given the opportunity to speak for a time proportionate to the size of their parties.

Although it will be a matter for the business of the House, it seems to me that health issues will require substantial attention at an early stage. For now, it is important that we adhere to our time constraints.

Mr Bradley:

Will the Minister accept a written presentation?

The Initial Presiding Officer:

That is a question for the Minister, but he has indicated that he is eager to receive Assembly Members' representations. If matters have been raised to which he has been unable to respond verbally, I believe that he will be prepared to reply in writing. With regard to matters not raised because Members did not have the opportunity to speak, I feel certain that the Minister will try to respond.

Mr Savage:

I too wish to welcome the Minister, but for a reason quite different from that of some other Members. I represent Craigavon, and I am glad to see that Craigavon Hospital has been elevated into a different category.

Earlier, my good friend, Rev William McCrea, said that I was sitting here smugly. That may be so, but I am very concerned about the possibility of hospital closures. I was in Craigavon Hospital a few weeks ago as a patient and had to sit for an hour and a half.

I am very concerned about the extra burdens that are going to be put on hospital staff, and would like to pay tribute to those staff who have been working under difficult circumstances and a great deal of stress, not knowing which category their hospital is to be slotted into. Staff in these hospitals face a huge challenge, because so much is being asked of them. We all know that young doctors want to be trained in a big catchment area; it may be the same in respect of nurses. We must recognise the challenge facing the nurses and provide them with an incentive to carry out their work.

A number of months ago, it was brought to my attention that there was an advertisement in the local press for people to work on bin lorries. Another advertisement which appeared was for a trained nurse in a specialised post. It was noticeable that the assistants on the bin lorries were being paid more than the trained nurses. There is something wrong with that; we cannot do without nurses, and they must be given every incentive.

I have watched Craigavon Hospital develop over the years into one of the major hospitals in Northern Ireland. I sympathise with people whose area hospitals have closed over the years. Just 18 months ago the Banbridge Hospital closed, and that was a big drawback in the Upper Bann constituency.

People do not like change but change will come anyway, so we must face up to it. I am glad that the Ambulance Service is going to get a boost - it certainly needs it. I hope that money is provided to bring the service up to date. One Member mentioned that some ambulances have been is use for so long that they are well past their sell-by date. We cannot expect ambulance drivers to carry out the work unless they have the appropriate equipment.

I am glad that Craigavon Hospital is safe. I also face the challenge - and I speak for quite a number of the people in Craigavon Hospital - of dealing with the extra burden that is going to be placed on us.

Mr Gallagher:

I also want to express my appreciation to the Minister for the time that he has devoted to the discussion this afternoon. He has, during the course of the discussion, heard many views from the west of the Province and, as the Member from the most westerly part of the North of Ireland, I want to speak particularly about provision there. I want to put forward the views of the elected representatives in the various councils with regard to hospital provision and to express some reservations about the document's references to the Ambulance Service and to the need for an improved network for GPs. I am not simply moaning about the situation - I am trying to put across the very genuine concerns and fears that people living there have about the issue of accessibility.

In the west of the Province the population density is one quarter of the average for Northern Ireland, and the provision of health and hospital services requires very careful consideration as the people who live there are scattered across a very large area. Unfortunately, this aspect has not been considered in the document. The paper is very general and assumes, without providing any detailed analysis, that one acute hospital based in either Enniskillen or Omagh is capable of serving the needs of the people in the south-western area.

This assumption was not borne out by a review of acute hospital services in the Sperrin Lakeland Trust carried out in 1996. The review was commissioned jointly by the trust and the three councils in the area - Strabane, Omagh and Fermanagh. It explored the options and recommended a strategy for hospital provision in the west - namely, that one hospital on two sites (Omagh and Enniskillen) was the best basis for the development of acute services.

This document has ignored that review and the combined views of the three councils, Omagh, Fermanagh and Strabane, which serve Counties Fermanagh and Tyrone. Instead of setting out an appropriate response for delivering important medical services to rural areas, it recommends a solution more befitting an urban problem.

In the document there is much reference to the provision of a modernised and highly effective ambulance service. The Minister said today that this service was "the key to unlocking the way forward". The reality is that Fermanagh has the worst roads infrastructure in Ireland. The main road between Omagh and Enniskillen is in very poor condition and deteriorating. It is impossible to achieve improvement in ambulance response times.

The paper refers to improvement in the service provided by GPs. In April 1998 the GPs in Fermanagh set up an out-of-hours co-operative. The centre is in Enniskillen and claims to provide a service for the entire county. There are grave concerns among the people of Fermanagh about that arrangement. Already a number of incidents are under investigation. In some cases it can take 45 minutes - in others it can take longer - to reach a patient in an emergency.

The paper draws attention to the important issues of efficiency, effectiveness, standards, recruitment and training, but the primary issue is accessibility. Common sense tells us that state-of-the-art services which are not accessible when required are useless. In a medical emergency time is all important. This is overlooked in the document. We must find a solution which addresses the needs of the people in Fermanagh and in west and south Tyrone.

Mr Hilditch:

I welcome the Minister. I have listened to submissions by my Colleagues Mr Hutchinson and Mr Boyd on Whiteabbey Hospital. What assurances can the Minister give to the people of east Antrim, particularly the large rural community and those isolated in areas such as Islandmagee, Ballycarry and the north of Larne, regarding the standard, in the future, of the accident and emergency services? Response times are sometimes up to 45 minutes, and there is no minor injury unit in Larne.

The area is not without a history of serious incidents. My Colleague Mr Dodds and I share these concerns, having been involved in a tragic bus crash in the area some years ago when five lives were lost. Fortunately, Whiteabbey Hospital saved many more lives that evening. Does the Minister agree that as four hospitals in our constituency have been lost, there is a need to upgrade and improve the accident and emergency services and the cardiac unit at our only remaining facility? Since we have a strategic position in relation to the seaport and the flight paths of both airports, any review must take account of those services. Extra miles cost lives.

Mrs Ramsey:

I welcome Mr McFall. In his opening remarks in the document he says

"This paper is not a blueprint for change. It is an analysis of where we are and a vision of what needs to be done".

I suggest that any proposals for change in the Health Service are checked against equality issues, and that there must be an appraisal to ensure that they do not limit access or discriminate against a section of the community on the basis of location and membership of disadvantaged groups. I recommend that a policy appraisal and fair treatment exercise be conducted.

I ask Mr McFall to tell us how bad the crisis in the Department of Health and Social Services is.

5.30 pm

Ms E Bell:

I shall be brief, as I am sure the Minister is suffering from speech fatigue. The Minister has listened to concerns in respect of every part of the Province. I commend him for Bangor Community Hospital. As a member of the council's health committee, I had experience of the old hospital, which should not have been closed, and of the new hospital which is now in a beautiful centre and which I hope will continue to expand and develop.

The document reads more like an impossible dream than a realistic vision. If the Minister's strategic vision that patients receive the right treatment at the right place from the right person is to be realised, we will need a lot of resources. Those resources must be guaranteed if we are to implement the proposals in the document and provide a health service for all of the people of Northern Ireland.

The document is a good base for good practice needs. However, successive Governments have found it impossible to address some of the problems in the Health Service, most of which have been caused by lack of resources. Health Service staff are very good, and proper tribute has been paid to them. However, resources are needed to put matters right, and the Minister will have to help us with money.

Mr McFall:

If Mr Wells would like a chauffeur-driven car he can have mine. I come with gifts at Christmas and they are refused.

I thank the Assembly for the manner in which the debate has been conducted. I am indebted to Members for their constructive approach, and I am privileged to be discussing this issue with them.

After only one week in this job I was on duty in Omagh, and was privileged to witness the heroic work following the bomb there. What struck me was the fact that the whole of the National Health Service is greater than the sum of its parts. That led me to look at the Health Service in Northern Ireland as a whole - not disparately. Community and local issues are important, but it is also important to look at the whole picture. When I discovered that it had been 40 years since the last comprehensive review of the Health Service, I resolved to publish this document so that the debate could take place.

People think that hospital services in Northern Ireland are fine, but they are not. I was asked about the developing crisis in the Health Service, which has been allayed by good work at local level. However, if the trend continues people will have a second-class service, and that cannot be tolerated.

The document has been generally accepted although in some cases parochialism was evident. The document challenges people by saying that a strategic view is needed.

First, I will respond to Mr Foster's comments about the golden six. This is a very unfortunate term that has been allowed to enter the lexicon of politics in Northern Ireland, and I do not know where it came from. What we should be talking about, rather than a golden six, is a golden network, an entire network that makes appropriate provision for the Health Service. That is why I have fashioned this document to incorporate the new care networks.

There should be four levels of care in a modern NHS. First, there is the primary care level, and why so? This is because over 90% of all consultations take place at primary care level. People go to GPs, nurses and community practitioners, and the service is provided there. Now, sensible policy dictates that if the resources are there, the money must also be targeted there, so that has to change.

Dr McDonnell asked whether this was a health service or a disease service. It is a health service, and we need to make sure that we have preventative health provision at community level, and community care teams are extremely important.

Secondly, the local hospitals should be the cornerstones, and ten local hospitals have been suggested. Some have asked whether they are just going to be super clinics with GPs in attendance. The present models in Ards and Bangor, where GPs have developed their resources, should be looked at. I went to visit one of the GPs in charge, Dr Ian Clements, and asked him how long it takes people to start thinking about change and to get it going? He said that there had to be elements of remuneration and that aspects such as clinical development had to be taken care of, but that it took five or six years. Then I asked if he would change it, and he said absolutely not, because they had a service that provided patients with a local accident unit which did not abuse accident-and-emergency provisions.

People ask why I am thinking of change when we have accident-and-emergency services now and people can go and queue for four hours at a hospital. The reason is that three out of every four people who attend accident-and-emergency units should not be there - they go with minor injuries. There is a statutory requirement in accident-and-emergency units for people to be seen; that is why there are four-hour queues. Resources are not properly used in our accident-and-emergency services. That is the issue at stake here.

Dr Hendron mentioned the need to establish a Shadow Executive. I am not going into the politics now; I am remaining with health. However, I say to Members today that I am willing to ensure that we have dialogue with the Assembly health spokespersons so that, when the Assembly is established, Members will have the information.

I am not here for the next few months to hoard information and then to hand it out in dribs and drabs. I want to engage with the Assembly fully on this so that Members will be able to take those decisions from a very early stage - that offer is open. I hope that, along with both the First and the Deputy First Ministers (Designate), we can explore ideas, but the Assembly can come back to me any time on that issue.

I will quickly address the matter raised by Dr Hendron about the Mater Hospital. The trustees have plans to replace the existing ward accommodation using trust funds, and no commitment to using public funds has been given. However, a fully worked out business case will be required if public funds are sought, and decisions on the business case will reflect the strategic agenda and be influenced by the outcome of a review undertaken by the Eastern Health Board.

I mentioned primary care, and I described the 10 local hospitals as being the corner stone. One important aspect of this is that the local hospital, the area hospital and the two regional hospitals will form a network.

The Royal College has stated that acute services should be based on a population of 450,000. My own constituency has moved to that figure. It is not easy. When people are well they want to have a hospital near them, but when they are ill they want to have the best service and will travel to get it. Surveys in Northern Ireland have reflected this.

It is not possible for Northern Ireland to have three acute hospitals because of its geography and its rural element. So I have suggested four area hospitals, with three others being enhanced. Those will be allied to the two regional hospitals which at the moment are performing cleft palate, and cochlear implant operations that would not normally be provided for a population of one and a half million.

I am suggesting that there is interlinking between the hospitals and centralisation, but there is also decentralisation. We can see that with the Campbell Report on cancer care where operations are being decentralised to the local level.

Mr Gibson mentioned the 40-year-old patient in Muckamore Abbey. I have a letter copied from Mrs Hilary Smith, and I will certainly get back to him on that issue.

Mr Molloy said that in the past people have been told about what they were losing, not about what they were getting. I would like to consider this document as an audit - the books are open. Members will have to decide for themselves. Members can challenge it if they wish, and it is there to be challenged, but I believe that Members will find it very difficult to challenge its analysis. But if Members decide differently, I will be quite happy to look at it again.

Mr Molloy also asked about the provision for clinical governance at the moment. Quality is the major priority, and clinical governance is there to ensure that the proper processes and systems are in place at each hospital, those that will ensure that the best quality of care is delivered. No matter where one lives in Northern Ireland, one can be assured of the same level of service.

Mr Close focused solely on the Lagan Valley Hospital. He mentioned that he had fought the Tories and that he was going to fight others. Well, best wishes to him, because he will shortly have to fight with his fellow Assembly Members. But that will be for him to decide.

As far as I know, Lagan Valley is about 20 minutes from Belfast by road. I was reading my 'West Highland Free Press' at the weekend, and in it was a plea from a GP on the Isle of Skye. He said that there was going to be a consultancy and that the area's constituents would have to travel for three hours. So Northern Ireland is doing quite well, particularly the Lagan Valley Hospital.

Maternity services were mentioned, and I have a personal tale to tell. I do not want to see any child born in a maternity unit which does not have back-up paediatrics and anesthetists. My wife and I lost our second child, who was still-born, and my wife was taken into hospital early with our fifth child because she had placenta previa. Notwithstanding that, on the day of the birth she took a haemorrhage and had to be taken to the emergency operating theatre. The doctors had predicted that everything would be okay but that proved not to be the case. Nobody can predict with absolute certainty that everything will be okay, and that is why we need back-up paediatrics and anesthetists. I see that as being extremely important.

Maternity services have been getting on well because of the dedication of the staff, as Donaldson said in his review. We should not impose these problems on staff; and change is needed in these areas.

I do not accept Assemblyman Boyd's assertion that "centres of excellence" is just a fancy name for cost-cutting. He asked me not to take any decisions until Members can decide for themselves. I have to say, clearly and unambiguously, that I will not give a positive response to that. Very serious issues are frequently landing on my desk, so I am going to discharge my responsibility as a Minister with the integrity that the post demands. I will try to preserve quality and safety in the Health Service in Northern Ireland but I look forward to the Assembly taking up these particular issues.

5.45 pm

Ms McWilliams encapsulated Members' feelings when she said that they wanted something done, but not in their area. She mentioned community care. In the allocations announced today we have given £25 million to community care. At a dinner several months ago the directors of community care said to me that their area was the Cinderella of the Health Service and that the Government should focus attention on it.

Government is about priorities. If we focus too much on hospitals, then we let down community care. There are priorities and balances to be maintained. Ms McWilliams got it right when she citied her sister's crash two years ago. She said that her sister got the best service in the regional hospital, the Royal Victoria Hospital, where the orthopaedic services were available. That was also the case in Omagh. Triage was carried out after the bombing, and people were sent to the best places for their injuries - to Altnagelvin for limbs or to the Royal Victoria Hospital for neurosurgery, or whatever. We can provide at a local level, but when expert service is required, the Government must ensure that an appropriate network exists. That is extremely important.

Assemblyman McGimpsey asked why the Jubilee maternity unit is to be closed. This decision is the subject of an application to judicial review, and it would be inappropriate for me to comment on it at this time. However, I will look at this matter with my officials and forward a reply.

Assemblyman McGrady and I have been discussing Downe Hospital since the day I came to Northern Ireland. I remember being in my car the first day I was here, and the mobile phone rang. It was the 'Down Recorder', and ever since then I have had an affiliation with Assemblyman Wells and Assemblyman McGrady. There is an urgent need to replace the existing Downe Hospital, and I think that we would agree on that.

I have set a challenging timetable for the production of a new business case for the hospital. It has to be produced by March and once this is approved I want the project to go ahead as quickly as possible. The necessary funding will be found from the overall comprehensive spending review settlement that I announced today. I welcome the support for a quick completion of the business case shown by Assemblyman McGrady last week in his comments to the press.

Assemblyman Shannon mentioned the possibility of outstations at Ballywater and Kircubbin. I will look at this issue with my officials to see exactly what can be done in that area.

Assemblyman McGuinness said that the debate on the Health Service has been driven by the Government, by the Royal Colleges and by the boards. I want the debate to be influenced by the community, hence the 'Putting it Right' paper. It is available for debate, it is available for consultation, and it is available to ensure that the Government listen to everyone's voice. There has possibly been benign neglect over 40 years, but there is urgency to this matter now. Assemblyman McGuinness said that there is something wrong when 20,000 to 30,000 people turn out to demonstrate.

Yes, there is something wrong; there is a legacy of neglect. I do not want people to be frightened and anxious. It is therefore incumbent upon all of us to ensure that we do have a strategy. Not everyone is going to like it, but it is very important to have a strategy. Assemblyman Hutchinson made a good comment recently:

"I think the Assembly is going to have to take hard decisions. I hope that people are not parochial about this and start fighting their own corner. We are all elected by different constituencies and, of course, when we get to hell, it is a question of leadership."

It is a question of leadership for all of us - for me as much as for anybody else. It would have been better for me not to tackle this issue over the last few months, not to wander into areas of political controversy and not to have Assemblyman Haughey and others phoning the radio about me, but that would have been a dereliction of duty. It is very important that leadership is shown by yourselves and by me so that we work together to ensure that when March comes, we are doing something about the issue.

Assemblyman Haughey mentioned the west of the Bann, an important aspect of which I was acutely aware. I have set up an ambulance review, and that is going to report next year. However, I was not content with just a review, because I had heard time and time again about the various problems, and that is why the document's only explicit commitment is for £15 million for the Ambulance Service.

People ask what is the use of the extra money for the Ambulance Service. It is very valuable and everybody has recognised that today. Northern Ireland shares with Scotland a high rate of coronary heart disease as a consequence of bad diet and unhealthy living. People have heart attacks in different parts of the country. If we get a good Ambulance Service, it will ensure that we get ambulances to the places where people are ill. We have quick response times, and we are trying to improve those times. Any medic will tell you that in a critical situation, the time after the attack is extremely important: the time when one attempts to stabilise the condition.

I envisage an ambulance system with improved technology and communications and with trained paramedics linked up by cellular telephone to consultant cardiologists so that expert advice can be given at the site of an incident. A person could be stabilised there and then and taken to hospital. This is my vision for the Ambulance Service, and it is crucial that we work together on it.

Assemblyman Haughey sees a conspiratorial element in the closure of the South Tyrone Hospital. Mr Ken Maginnis, the MP for the area, took the same conspiratorial approach to me in a debate last week in Parliament. I will be very clear on the matter. I am not going to go back on anything that the doctors, the anaesthetists or the consultants at the South Tyrone have said. As John McFall, as Minister for Health, as a politician and a non-medic, I am not going to second-guess doctors when they talk to me about the safety of the service. I am very clear on that, and I will not go back on it.

Assemblyman McCrea talks of people being smug. Nobody is being smug here today on any issue. He spoke about the quality of services and the quality of the accessibility, and I am 100% with him on that. It is said that I am making it comfortable for the Royal Colleges - people have made this point to me about the Royal Colleges. It is said that the Royal Colleges have the best closed shop in the land, the best trade union you can get and that everything is being done at their dictate. I do not accept any of this. We have to work alongside the Royal Colleges to establish the best training for doctors and the best quality of care. We have to take them in to our confidence.

I have been impressed with the comments that I have received from the Royal Colleges over the past few months, and I hope that the Assembly will work with the Royal Colleges to ensure that Northern Ireland gets adequate treatment. We have had horrendous cases in the United Kingdom, such as in Bristol, and we must ensure that the best training and quality are provided.

Mrs Nelis mentioned trust chief executives' pay. I agree entirely on that point. I am not opposed to people being properly remunerated for their services, but in recent years chief executives' pay has become distorted in relation to the pay of other Health Service staff.

I have written to the chief executives of trusts and boards asking for a breakdown of senior executives' pay so that I can examine the issue and ensure that it remains within the stated guidelines. I am hoping to prepare a paper for the Assembly so that, if required, primary legislation can be introduced on the issue.

Assemblyman R Hutchinson talked about East Antrim and asked me to check about two new ambulances in Larne. I will do that.

Assemblyman McDonnell asked whether it was a disease service or a health service. The Government have produced a White Paper on smoking. He was somewhat conservative in his estimates - around 3,000 people in Northern Ireland die each year from lung cancer. It is important to have a healthy-living strategy - a social agenda for health - and that can tie in with Government's primary care vision.

Assemblyman Morrow mentioned an Information Technology structure. Telemedicine is the answer. Go, as I have done, to Ards or Bangor Hospitals and see the link up. I had a link up with a consultant in the Royal, but it could just as easily have been a consultant in Aberdeen or London. The examination takes place, information technology is used to best advantage - and this is important - the patient is treated at local level.

Assemblyman Wells mentioned, in almost biblical terms, the challenge to the new Health Minister. Maybe I will hold a competition for that, and the Assembly could work on it with me.

Assemblyman Gallagher mentioned accessibility in the west of the Province. That is at the core of this document, and I am happy to work with Members on that.

Finally, this vision is perhaps 30 years too late, but the Health Service needs to be tackled radically now - the status quo is not an option. With the status quo, an extra 120 consultants would need to be recruited. Fourteen per year are being trained, so it cannot be done. But even if it could, it would result in overstaffing, a loss of skills and the underutilisation of equipment. That is no recipe for a modern health service.

A modern health service should provide people with a service at the right level; we do not have that at present. According to the Royal Colleges, only four hospitals out of 17 satisfy surgical requirements, and on accident and emergency only six out of 17 satisfy those requirements. That is not good enough - change is needed.

6.00 pm

This document is all about the right people, the right technology and equipment, and the right hospital buildings and facilities. It focuses on the patient, irrespective of where he lives in Northern Ireland, so that proper treatment and care can be given at the right time, in the right place, to the right person. I look forward in the next few months to working up this document with the Assembly and thank Members most sincerely for their courtesy this afternoon.

The Initial Presiding Officer:

On behalf of the Assembly, I should like to thank the Minister for his presentation, for listening so intently to Members, for undertaking to work closely with the Assembly in its shadow period, and for agreeing to make specific written replies to those Members whose questions he was unable to answer satisfactorily today. It is clear that Members appreciate this very much.

Question put and agreed to.

Resolved:

That this Assembly takes note of the report 'Putting it Right - The Case for Change in Northern Ireland's Hospital Service', as presented by Mr John McFall MP, Minister for Health and Social Services.

The sitting was suspended at 6.01 pm.

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