Maternity Services (Belfast)

Points of Order – in the Northern Ireland Assembly at 4:00 pm on 31st January 2000.

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The following motion stood on the Order Paper in the name of Mrs I Robinson:

This Assembly endorses the decision of the Health, Social Services and Public Safety Statutory Committee to locate maternity services in Belfast at the City Hospital.

Photo of Alex Maskey Alex Maskey Sinn Féin 4:15 pm, 31st January 2000

On a point of order, Mr Speaker. I want to raise the matter of the competence of this motion. The motion states

"This Assembly endorses the decision of the Health, Social Services and Public Safety Statutory Committee to locate maternity services in Belfast at the City Hospital."

As I understand it, the Committee cannot decide to locate anything anywhere. I fail to see how this Assembly can endorse a decision which cannot be taken in the first place and which certainly cannot be taken by that particular Committee.

Photo of Lord John Alderdice Lord John Alderdice Speaker

As the Member is aware, when the motion was tabled and agreed to by the Business Committee, the Health Committee had made a decision. Subsequent to that, and subsequent to the publication of the Order Paper, the Minister made a decision. It would not have been possible, at that point, to withdraw what was a reasonable and competent motion.

One could have some debate about the precise wording of the motion. There are clearly issues of competence, not solely in relation to the motion but in relation to decisions that will be the subject, to some extent, of the amendment. It was not unreasonable for the motion to be regarded as competent when it was tabled, agreed to by the Business Committee and put on the Order Paper. Subsequently, a ministerial decision was made and an amendment put down which addresses that ministerial decision. In that context it is appropriate for the Assembly to debate this, and that was agreed to by the Business Committee.

Photo of Alex Maskey Alex Maskey Sinn Féin

Further to that point of order, Mr Speaker. The Health Committee cannot decide to locate anything anywhere. It may decide to recommend, but it cannot decide to locate. It does not have that power. I want that established for the record.

Photo of Lord John Alderdice Lord John Alderdice Speaker

For the record, it is not for the Speaker to give such a ruling. The Speaker gives a ruling on matters inside the Chamber. The Member is speaking about legal matters — potentially, constitutional legal matters — outside the Chamber, and I cannot give a ruling on them. This is completely unfair to those who will move the motion.

Photo of William McCrea William McCrea DUP

On a point of order, Mr Speaker. Are certain Members of the Assembly entitled to be on their feet while you are speaking when others have to sit down?

Photo of Lord John Alderdice Lord John Alderdice Speaker

It does not seem to me that it is only Members on one side of the House who try that one.

I call Mrs Robinson.

Photo of Iris Robinson Iris Robinson DUP

I beg to move the following motion:

This Assembly endorses the decision of the Health, Social Services and Public Safety Statutory Committee to locate maternity services in Belfast at the City Hospital.

At the outset may I establish that the Health Committee knew, throughout its deliberations, that the Royal and the Jubilee maternity hospitals both have outstanding records in providing the best possible care for mothers and babies. Additionally, may I remind the Assembly of the McKenna Report, which specifically examined, in minute detail, the factors governing the best location for maternity services in Belfast. This investigation was rigorous and took approximately nine months to evaluate. McKenna found in favour of the Belfast City Hospital, and the then Minister, Malcolm Moss, endorsed this view. Following intervention and predictable outcry from west Belfast politicians, Mo Mowlam was prevailed upon to institute a further review.

Although seriously lacking, in respect of the clarity of its terms of reference, the Donaldson review generally endorsed the recommendations of the McKenna Report with one exception — the location of the new maternity hospital.

We are all aware how "meddling Mo Mowlam" reversed the original decision only to find herself successfully challenged in the High Court on that. This led to the issuing of a further consultative document, which only added distortion to confusion. It was clear that, ministerially, the only desired political result was to be a west Belfast Hospital to satisfy Nationalist west Belfast.

Then came the Assembly and the appointment of the Health, Social Services and Public Safety Committee to consider all aspects of this matter on its behalf, and in the best interests of all the people of Northern Ireland. Following the most intense, deliberate and conscientious investigation, we arrived at our conclusions and reported our view accordingly.

Let us be absolutely clear about what we reported. We agreed unanimously that the best solution was a new maternity hospital: a centre of excellence. We were forced to accept that, in the meantime, services would be combined temporarily on the Royal Victoria Hospital (RVH) site. This was because paediatricians at the RVH had withdrawn their support from junior doctors at the Belfast City Hospital (BCH) and because work was due to commence in April to build a new cancer unit on the Jubilee site.

As a Committee, we were in favour of siting the new hospital on the BCH site. Two thirds of the Committee voted for this option. We arrived at this decision honestly, on the basis of what we considered to be in the best future interests of all the women and children of Northern Ireland. We gave the greatest weight to a consideration of clinical aspects and medical opinion. We were amazed when the Minister’s statement suggested that her decision had been made on clinical grounds.

Let us consider the medical opinion. The clinical arguments in favour of the BCH site are irrefutable. Established practice throughout the United Kingdom requires obstetrics, gynaecology and neonatal services to be combined on one site. The Royal College of Gynaecology has clearly spoken of the need to keep maternity and gynaecology services together. All medical opinion agreed that, as we plan for a new century, a regional centre of excellence for the care of women is the answer to our present and future needs. This centre should combine on one site the full range of services: genetics, maternity, prenatal, fertility, gynaecology and cancer services, all centred on the specific needs of women.

Like the medical experts, our Committee considered all the criteria by which the centre of excellence was to be judged. We acknowledged that the clinical requirements could best be met at the BCH site. Additionally, we concluded that it would be safer for women, being directly linked to the tower block, to have direct access to acute and intensive care facilities, including computerised tomography (CT) scanning for babies. This combination would enable the in vitro fertilisation (IVF) unit and the genetic research facility to be on the same campus as well.

On the matter of accessibility for those using and visiting the hospital and from the point of view of centralising midwifery services, BCH was also the choice. Some in this Chamber may not like to face this, but there is a chill factor at the Royal. Sixty per cent of women surveyed in Belfast are reluctant to go to west Belfast to attend the Royal — that is a matter of fact. The Lisburn Road site is more attractive, given its close proximity to road and rail transport. Our decision was not arbitrary. We considered the issues and the facts. As a permanent solution, the RVH met none of the considered criteria. It is an acceptable site only as a short-term, interim arrangement.

Photo of Jim Shannon Jim Shannon DUP

Does the Member agree that this is an example of what we, as a party, predicted? The Minister has overruled her Committee, in this case the Health, Social Services and Public Safety Committee, but the same will probably happen to the Education Committee. Does the Member therefore agree that decisions taken by the Sinn Féin Ministers have been and will be politically motivated and will disenfranchise the Unionist people in this Province?

Photo of Iris Robinson Iris Robinson DUP

I agree. Unfortunately, I have no great faith in Sinn Féin/IRA’s ever taking a holistic approach.

That was the conclusion of the Committee. The seven-to-four majority came as a result of genuinely democratic procedures followed by people who had considered all the advice and information available. It was a cross-party majority. We were sure that the BCH site would be best for mothers, babies, staff and visitors and best too from a long-term financial point of view, although that was not our main priority.

It was the clear majority view that no substantial clinical case can be made in favour of the Royal. In relation to the Royal’s suitability as the site for a new maternity hospital, my contention is that it may be possible for those who have examined the clinical arguments to make a successful legal challenge to the Minister’s decision.

The behaviour of the Royal’s paediatricians in this matter has been a serious cause for concern. Their behaviour was unworthy of people in their profession, and if not illegal it was shameful and unethical.

Many members of the Health, Social Services and Public Safety Committee have expressed disappointment and even anger at the role played by the Committee’s Chairman following the Committee’s decision to support the BCH site. When a Committee takes a democratic decision it expects its Chairman to articulate that position or remain silent. Not only did he not fulfil the role of Chairman and argue the Committee’s case; he sought to undermine his Committee by advancing his personal, partisan opinion. This behaviour is unworthy of him and renders the role of Chairman meaningless and farcical. If a Chairman is not speaking for his Committee, he is a Chairman without standing and authority.

I have looked at the amendment in the name of Dr Esmond Birnie. It seems to deal only with the procedure adopted by the Minister in taking her decision; it does not question the decision that she made. The purpose of the motion in my name is for the Assembly to declare itself in support of the City Hospital option. I cannot therefore support the amendment, which evades the issue, although I agree that the manner of the Minister’s announcement was totally unacceptable.

I now turn to the Minister of Health, Social Services and Public Safety. It is self-evident that her announcement was brought forward to pre-empt the debate in the Assembly today. In her headlong rush to avoid the Assembly’s endorsing the Committee’s decision and thus adding to the weight of opinion in favour of the City Hospital, she jettisoned every recognised procedure for communicating her decision to those directly, and indirectly, involved, and that calls the integrity and professionalism of the Minister and her staff into question. To my mind, the Minister behaved in an unforgivable manner by failing to inform the Health, Social Services and Public Safety Committee of her decision before the announcement was made to the media. The Committee was snubbed, but just imagine how the staff of BCH must feel, having been disregarded in this way. The fact that she had neither the decency nor the manners to come and face the Committee is indicative of a lack of moral courage on her part.

Did she make the decision or was she instructed by her party and its associates to make the decision?

In any event, it is my considered opinion that her conclusions were based on narrow political interest.

Photo of Lord John Alderdice Lord John Alderdice Speaker

I am afraid that your time is up.

Photo of Iris Robinson Iris Robinson DUP

With the intervention, may I just take —

Photo of Lord John Alderdice Lord John Alderdice Speaker

I am afraid not. The intervention from a Colleague was taken by choice. I must ask the Member if she begs to move the motion.

Photo of Iris Robinson Iris Robinson DUP

It is the view of the great majority of people throughout the Province that a west Belfast Minister made a decision in favour of a hospital in west Belfast —

Photo of Iris Robinson Iris Robinson DUP

I seek support for the motion.

Photo of Esmond Birnie Esmond Birnie UUP

I beg to move the following amendment: Delete all after "This Assembly" and add

" , recalling that the Belfast Agreement provides for key decisions to be taken on a cross-community basis, rebukes the Minister of Health, Social Services and Public Safety for not raising the question of maternity provision in Belfast with her ministerial colleagues, for not consulting properly with the Statutory Committee, and for attempting to pre-empt consideration of the matter by this Assembly, and calls on the Minister to bring the issue before the Assembly in a proper fashion."

I move this amendment because there is a matter of great procedural importance in last week’s decision by the Minister of Health, Social Services and Public Safety. It is even more important than the question of the location of the hospital, important though that is; and I agree with the majority view of the Health, Social Services and Public Safety Committee on that matter.

The question at stake today is this: are Government arrangements going to work to the benefit of all the people of Northern Ireland or will they simply degenerate into narrow partisanship?

First, let us look at the timing of the Minister’s decision and her announcement. There was an unseemly rush to pre-empt today’s debate.

Secondly, her decision overrode the Committee’s clear, majority verdict, and insult was added to injury in that most of the Committee members, other than the Chairman, only heard of her decision through the media on Thursday morning.

Thirdly — and this is equally damning — this was an Executive decision taken by the Minister, but not brought before the Executive Committee. Many Members have a strong suspicion that the Minister and, indeed, her party came to this issue of the Royal or the Jubilee with their minds already made up.

Has the Minister adequately discharged all the responsibilities of her office? I would point to the Belfast Agreement, to the terms of the Minister’s pledge of office and to the code of conduct, whose provisions relate to equality, to the prevention of discrimination and to good community relations. I ask whether having a large maternity hospital at the Royal, a second, relatively-small one, at the Mater and a third, medium-sized one, at the Ulster Hospital for all of Belfast is compatible with the terms of the Belfast Agreement that are to do with equality, the prevention of discrimination and good community relations.

To recap, there are clear and important issues of precedent that we want to resolve this afternoon. First, should the Minister have consulted with, and informed, her Executive colleagues? Secondly, in the event of a conflict between a Minister and his Committee, should it become standard practice to attempt to resolve that internally by allowing the Committee a longer period for research, reflection, deliberation and, indeed, a further vote? Thirdly, if the Minister and the Committee cannot resolve a matter internally, should it be brought before the House to enable the Assembly to offer its opinion and guidance?

In all of this, there is a striking, massive and, indeed, sad irony: we have a Health Minister, indeed, a Sinn Féin Minister, who has replicated all of the worst neo-colonialist and unrepresentative features of direct rule. It is an irony worthy, perhaps, of George Orwell’s ‘Animal Farm’: yesterday’s self-styled radicals and revolutionaries have, through their style of decision making, become the reactionaries and oppressors of today. I urge the House to support the amendment.

Photo of Lord John Alderdice Lord John Alderdice Speaker 4:30 pm, 31st January 2000

The Minister will have to respond to both the amendment and the substantive motion — and they address slightly different issues. The maximum time that will be available to her will be 10 minutes — five minutes in respect of each.

Photo of Dr Joe Hendron Dr Joe Hendron Social Democratic and Labour Party

We want to discuss, in a very serious way, what is best for mothers and babies in Northern Ireland. All of our people are entitled to the best service. We are talking about a regional hospital service for Northern Ireland: maternity services for Belfast, but a regional service for Northern Ireland, and I want to put great emphasis on that. If we were just talking about Belfast, we could toss a coin between the Royal or the City. But we are talking about a regional service for Northern Ireland; we are talking about a regional neo natal unit for Northern Ireland to care for sick or premature new-born babies; and we are talking about a regional paediatric service for Northern Ireland. There is only one major regional paediatric hospital in the North of Ireland, and it is not my fault if that happens to be in west Belfast.

Photo of Dr Joe Hendron Dr Joe Hendron Social Democratic and Labour Party

I would give way, but I have been informed that I have only a few minutes left.

To give mothers and babies the best regional service, all three of the services that I have just mentioned should be together if at all possible. There is only one site in the North of Ireland where that is possible, and that is the Royal site in west Belfast, which contains the regional neonatal unit and the Royal Belfast Hospital for Sick Children.

The decision on this matter must be a clinical one. As a public representative, but more importantly as a doctor, I have led this discussion for the past five to six years, and my endeavours have included an Adjournment debate in the House of Commons and many meetings with previous Ministers.

I am not canvassing for votes in west Belfast or anywhere else. The only issue here is a clinical one. It is a question of what is best for mothers and for sick or premature, newborn babies throughout Northern Ireland — not just those in Belfast.

I have a profound respect for the City Hospital and the Jubilee. I worked in the Jubilee many years ago, and recently the Minister of the Environment, Mr Sam Foster, when he was spokesperson for the Ulster Unionist Party on health issues, and I led, in a political context, the promoting of the City Hospital as a top cancer unit. I believe that it will be one of the best in the world, and we have had meetings with Dr Ric Klausner from the United States cancer unit at Bethesda, Maryland.

I listened carefully to Mrs Robinson, and, as Chairman of the Committee, I am embarrassed, and I apologise. I realise that it is a great honour to be Chairman of the Health, Social Services and Public Safety Committee, but one must adopt the maxim "To thine own self be true". Members of the Committee will accept that at the very beginning I informed them that this issue was coming up and that I had to go along with what I had been doing for years on clinical grounds. I thought that they understood and respected that. I certainly respect the decision of each member of that Committee. I offered to stand down temporarily when it came to the discussion on maternity services, but they kindly did not accept that.

Members mentioned timing and how we were informed by the Minister. Last Wednesday the Committee had a marathon meeting that lasted from 2.00 pm until after 6.00 pm. It was not about maternity services, but during it I received a note asking me to phone the Minister. The note did not say "urgent" or what it was about. I came out of the room at about 6.15 pm, had a cup of tea and phoned the Minister at approximately 6.50 pm. The Minister gave me the information on her decision.

At that stage some Members were still around, but others were en route to various parts of Northern Ireland. It was difficult for me to inform all of them because I did not have their telephone numbers, but I take some blame for that and apologise to my Committee for it.

It would have been helpful if the Minister had sent somebody, such as the permanent secretary, or had come herself, even for five minutes, to inform the Committee of the decision. There was a breakdown in communication.

Malcolm Moss made a decision, and the Donaldson Committee of experts was set up. There were no experts on the McKenna Committee on sick, newborn babies, and every paediatrician in Northern Ireland supports the points that I have made.

Photo of Mr John Kelly Mr John Kelly Sinn Féin

Go raibh maith agat, a Chathaoirligh. I come from a rural constituency, and my only disappointment is that, while Belfast has a choice of two sites, people west of the Bann have no site to choose. There is no doubt that both the Royal and the Jubilee provide excellent maternity services, but both the Minister and the Committee agreed that a new facility should be built to house the combined maternity units. The key question, a Chathaoirligh, was where the new hospital should be sited.

The Minister selected the Royal because maternity services would be adjacent to the Royal Belfast Hospital for Sick Children and to the Royal’s accident and emergency department — both very serious medical considerations. The Minister has again been accused of making a political decision because the Royal is in her constituency.

As Joe Hendron said, the Royal is also in his constituency, but he was not canvassing votes in west Belfast for the Royal. No matter what decision the Minister came to take, she would be damned if she did, and damned if she did not. I am quite sure that her decision was no more politically motivated than the decisions of those who voted against the Royal — that is if the latter was politically motivated at all, which I doubt.

Wednesday’s decision concluded years of wrangling, not only over future regional services but, more critically, over where those services should be located or relocated. The 1996 McKenna recommendation that the Royal and the Jubilee should be closed and relocated on two floors of the City block caused an unprecedented campaign to be waged by medics, residents, politicians and trade unionists.

The debate about the siting of maternity services has been long and acrimonious, embroiling no less than five health Ministers, thousands of residents, and scores of gynaecologists, obstetricians and paediatricians from as far away as America. Wednesday’s decision concluded those years of wrangling, and the Minister pledged, on taking office, that any decision she made would be made on professional grounds, in this case putting the care of mothers and babies first. The Minister has carried out her promise to the nth degree and should be congratulated for the forthright way in which she has approached this matter rather than being belittled for making a decision that people have been crying out for for years.

Professionals, nurses, doctors, obstetricians, gynaecologists, politicians and the public all have an overriding responsibility to ensure that the Minister’s decision is implemented with all the professionalism and resources that expectant mothers, their unborn children and newborn children deserve and about the future of this part of the island.

Photo of Kieran McCarthy Kieran McCarthy Alliance

It is unfortunate that we do not have more time to deal with this very important subject. Had it not been for points of order from Members who should know better, we would have had more time.

I congratulate the Minister, whatever her party. For years we have been shouting for devolution in this part of the world. At last we have accountable democracy and, whether we like it or not, we have someone who has had the courage to make this decision. Previously we had Northern Ireland Office Ministers who did not have that courage.

It is clear to the Alliance Party that the Royal Maternity Hospital and the Jubilee Hospital are both centres of excellence with worldwide reputations. Both sites offer a full range of high quality obstetric and gynaecological services, with back-up from intensive care and other services.

It would be easy for my party to back the City Hospital to serve constituency interests. However, the Alliance Party has decided to follow the clear balance of opinion among medical professionals and support the Royal as the best site for the regional maternity unit. Therefore we cannot back the motion. There is a number of reasons for regarding the Royal as the better regional maternity site, but the existence of a full range of specialised paediatric services on the Royal site must be regarded as the decisive factor. For that reason the better option for centralised maternity services in Belfast is the Royal site, adjacent and connected to the Royal Belfast Hospital for Sick Children.

The opinions of and evidence from domestic and international experts support the concentration of maternity, neonatal and paediatric services there.

Speed is very important when complications arise with a newborn baby. Transport from other hospitals adds time and can create further complications. Most women who will give birth at the Royal will not need paediatric services, and not every birth will be at the Royal, as it mainly serves Belfast.

However, it makes sense to try to maximise the number of births with easy access to specialised paediatrics. Article 3 of the United Nations Convention on the Rights of the Child states that any decision affecting an individual child or children should be taken with their best interests as the most important consideration.

Mothers want, need and, indeed, have the right to be near their sick children, and if maternity services were not centred at the Royal, more mothers would be parted from them. Women require a service that makes them feel safe and in control, a service that lets them choose the type of care best suited to them and their babies. Regional and national policy and guidance for maternity and related services all emphasise the need for women-centred care, continuity of care and choice.

There is a full range of gynae services on both the Royal and the City sites. Both offer a wide range of methods of childbirth. In short, the current services at the City and the Royal are not just women centres but women-centred. A women-centred service is not a building but an ethos, and it should be possible to create a regional maternity unit which combine the best in the ethos of both the current services.

It should also be borne in mind that there are plans for a new cancer unit on the Jubilee site. If this does not go ahead, there will be knock-on effects on the treatment of cancer throughout Northern Ireland. Surely we should be most concerned about this.

Before concluding, I want to make some points on how this issue is being handled and the politics involved. First, the motives of those proposing the motion are not entirely clear. Are they doing this because they are convinced of the medical case for the City, or are they doing this to embarrass the Minister simply because she is from Sinn Féin?

Secondly, some parties are seeking to portray this as a clash between the interests of women, babies and children. That is totally misleading and out of order. Surely the interests of women and children are inextricably linked.

Finally, the decision of the Health Committee was hardly clear-cut: some people are arguing that the vote was cross-community. The evidence for this hardly adds up. The vote was seven to four.

Photo of Mr Norman Boyd Mr Norman Boyd NIUP

This debacle is further discrediting this fundamentally flawed process of government. In spite of claims by some Members, including the last Member who spoke, that each Minister will be brought to account for his actions, the reality is that we have had the very opposite graphically demonstrated in recent days by the Sinn Féin Health Minister. Not only has she ignored the wishes of the Health Committee, but she did not even inform its members of her decision.

The reality is that the Ministers are accountable to no one in the Chamber. The sole function of the Scrutiny Committees under Standing Order 45(1)(a) is to advise and assist Ministers in the formulation of policy. Even if 107 Members in the Chamber were to vote today to reject the Sinn Féin/IRA Health Minister’s decision on maternity provision, we would be unable to change that decision. We cannot remove any Minister, even if he or she is deemed unacceptable, because political expediency dictates that the necessary cross-community consent will never be forthcoming.

The Belfast Agreement has therefore given full executive powers to members of Sinn Féin/IRA in the areas of health and education over the citizens of Northern Ireland without their being accountable in any way. The Sinn Féin/IRA Minister has already been censured by the Assembly. How some Ulster Unionists claim, therefore, that Unionists have gained from the Belfast Agreement defies logic. Dr Birnie’s amendment talks of the Belfast Agreement’s providing for key decisions to be taken on a cross-community basis. Obviously this concept is either a fanciful theory or maternity provision is not regarded as a key matter, which is rather alarming.

Perhaps the Ulster Unionist Party is now starting to realise that the Belfast Agreement is fundamentally flawed. One of its so-called principles is that of consent. This is no more than a mythical aspiration. We hear the expressions "transparency", "accountable democracy" and "consent". They are all loosely used, and no doubt we are going to witness more abuse of power in favour of Nationalist areas and Nationalist constituencies, particularly when it comes to health and capital expenditure on schools.

I recall that the Education Committee was also left completely in the dark about recent decisions, but let us examine the abuse of power by the Sinn Féin/IRA Health Minister. I quote her words from page 2 of a recent edition of ‘Andersonstown News’:

"The Falls Road Hospital held a special place in the hearts of west Belfast people. I wholeheartedly believe that the Royal is a crucial part of the economic and social fabric of west Belfast and I want to ensure it remains so."

My party’s decision not to participate in the scrutiny Committees has been totally vindicated. Even the Chairman of the Health Committee has been discredited. It is widely accepted that a chairman in any walk of life acts with impartiality and fairness. However, I was surprised and saddened to hear the Chairman of the Health Committee, Dr Joe Hendron, put on his party political west Belfast hat and publicly be at variance with his Committee and even with one of his party’s Assembly Members.

As someone who met with the previous Northern Ireland Office Health Minister, Mr John McFall, prior to devolution, who met with members of the Jubilee Action Group and who made a submission to the Department of Health last year during the consultation process, I want to highlight some important points.

There will be the loss of the ethos of the Jubilee Maternity Hospital. It would be much easier to preserve the ethos of the Jubilee if both maternity units moved on an equal footing into a new hospital, rather than having the Jubilee merged with an existing facility. There will be the loss of maternity services in south Belfast. In 1997 there were 2,668 births at the Jubilee Maternity Hospital, and mothers came from areas such as Belfast, Castlereagh, Lisburn, Ards and Downpatrick as well as from areas covered by the Northern, Southern and Western Boards. The Royal Maternity Hospital had only a slightly higher number of births for the same period — 2,896. I live in Newtownabbey, and my two children were born in the Jubilee, and many mothers from the Northern Board area go to the Jubilee too.

There is also the vital issue of security force members and their families, who continue to be particularly vulnerable when travelling to the Royal Victoria Hospital. There is evidence that 60% of Jubilee mothers will shun the Royal and opt for the Mater, Lagan Valley and other hospitals.

There will be a lack of impetus for a new hospital once amalgamation has taken place. If the Jubilee is closed an excellent maternity service will be lost, and any leverage on the Department of Health to press ahead with the promised new hospital will be gone. Is the necessary funding available? How will it be found? What other services will suffer in order to find the necessary funding?

The proposed amalgamation amounts to a cut in services and will reduce the current high standards of care which both hospitals provide. Even if money did become available, it would still be a number of years before a hospital could be built, and that is totally unacceptable to women who will be expected to accept an inferior or overcrowded service in the meantime. The view that at least £15 million of private investment will be required to fund a new maternity hospital will cause alarm. According to Dr Peter McFall, one of the Province’s top gynaecologists —

Photo of Prof Monica McWilliams Prof Monica McWilliams NIWC

I do not intend to go over the lack of consultation and communication. I have no doubt that at the Health Committee meeting on Wednesday these issues will be gone into in some considerable detail, as they should be. I was concerned about the lack of consultation with members of the Health Committee and, indeed, with those of us who represent the constituency that is affected by the decision to close the maternity hospital. We should have been consulted more fully. I have already made the point that under direct rule we might have been. I called an informal emergency meeting of the Committee on the Thursday to clear up the lack of proper decision-making because I was concerned that rumours about who knew what and when during the previous evening were flying around and needed to be cleared up. I remain concerned that the press was informed before Members.

I now turn to the debate on clinical effectiveness. On the matter of maternity services, when the hospital in Tyrone was closed did not every Member say "Wait until we have locally elected, accountable Members of the Assembly, and then we will decide who makes these decisions."? Will it be the Royal College of Paediatricians, or will the issue come to the Assembly for a decision? This elite group — the Royal College of Paediatricians — has made the decision for us. Why are we sitting here when we can simply go to the Royal College and ask "Where would you like all the hospitals to be in the future?"?

It comes down to one paediatric surgeon being recruited. Because that paediatric surgeon has not been recruited, there is going to be an interim move of 3,000 mothers to a hospital on the Royal Victoria site. As I said before, two old hospitals into one old hospital will not go. The brave decision would have been to keep both hospitals open, to have stood up to the Royal College and to have told it to come to the Committee and give its evidence. To obtain the Royal College’s report I had to go to the Royal, sit before the regional advisor for Northern Ireland, who is also based at the Royal — I ask myself whether there is a conflict of interests here — and read the report under supervision. Where is the freedom of information for those of us who are supposed to be making decisions when this is the sort of access we get to the report of the Royal College of Paediatricians?

I do not believe that there was a case to be made on the basis of clinical effectiveness. I have looked at the evidence, and I am in a position from my previous job to analyse data and to know whether, given the empirical evidence in front of me, a case stands up. This one does not. Not one baby has died during transfer from any hospital to the Royal. Why are we not also closing Altnagelvin, Craigavon and all the other hospitals? With regard to the Royal College’s making this decision, I note that the Minister’s statement says

"My conclusion was that maternity services would be more clinically effective if located adjacent to the regional paediatric services at the Royal."

The entire decision was made on that one conclusion, and that concerns me greatly.

There is also the issue of gynaecological cancer. Prof Paddy Johnston has spent his life building the oncology unit at the City Hospital, which treats 250 gynae-cancer patients annually. Where are these patients going to go if we split obstetrics from gynae cancer? The gynae obstetricians were so concerned that they delivered a letter to my door last night. It says that the reports are there and that the draft report which has just been issued — I am sure the Minister is aware of this — says that the City is the only hospital in Northern Ireland that meets the criteria for treating gynae cancer at the moment. If this service is moved, those criteria will not be met.

Dr Henrietta Campbell, the Chief Medical Officer, was given the task of looking at the services for cancer patients throughout Northern Ireland. Was she consulted about what would happen to gynae cancer at the City? If the case is being made, as it seems to be, around clinical effectiveness, I would argue that clinical effectiveness for sick mothers is extremely important.

Photo of Robert McCartney Robert McCartney UKUP

Politics is not confined to politicians. Medical men lobby very successfully, and with political skills, in their own interests. Many arguments can be advanced in respect of both sides. The question is which ones are spurious and which ones, as Monica McWilliams has pointed out, are substantiated by real data.

The fact that clinical paediatricians have come out on the side of the Royal is not surprising, since the paediatric unit is at the Royal and they are based there. Having said that, I should point out that I have worked closely over many years with almost all the leading paediatricians in the Royal Victoria Hospital, and I have not the slightest doubt that, no matter where this hospital is ultimately located, those professionals will give of their best when treating their patients.

Let me turn to Dr Birnie’s amendment. This issue, though about the location of a hospital, throws into bold relief what happens to the fundamental principles of democracy in this Chamber and under the institutions of the Assembly. If this decision had been taken by a Minister in another place, the Cabinet would be backing it. There the Cabinet represents the majority party in Parliament, and its decisions are endorsed by that party, so the full democratic process is behind any ministerial decision.

The difficulty with this Assembly, and one of its democratic deficits, is the relationship between the Assembly and the Executive powers of individual Ministers. This, of course, is highlighted by the decision taken by the Minister of Health in this matter.

As I understood it, the purpose of the Statutory Committees was to scrutinise the Ministers’ decisions and to advise the Ministers, in advance of decisions, on the best way forward. In a sense, because those Committees comprise Members from almost every party, they represent, at first instance, the feeling of the Assembly. The Committees are, as it were, a litmus test for what the Assembly as a whole might think. In this instance, and on a cross-party basis, a majority of the Health Committee was of a particular view, which was communicated to the Minister. The Minister then took the decision, ignoring the majority view of the Committee. That decision having been taken, the question is this: can it be reviewed by the Assembly?

As Dr Birnie pointed out, the decision did not have the benefit of discussion in the Executive Committee, and it was certainly not brought to the Floor of the Assembly for debate by Members. The Minister simply took the decision, and we will all have to decide what import this has for the future running of the Assembly and for democracy here.

Are we to accept that every time Ministers make decisions, regardless of how they have been advised or what consultation they have undertaken, they are not accountable to the Assembly? What if, on a cross-community basis, a majority of the Assembly takes the view that a Minister’s decision is wrong? In what circumstances can it be put right? The Assembly will have to take note of the balance of power between itself — and it is made up of elected representatives of the entire community — and individual Ministers of the Executive, selected not by the community but by their parties, taking decisions on a party basis.

The problem here is the suspicion — it may be no more than that — that the decision of the Minister was influenced entirely by political considerations relating to her party. That, indeed, is the accusation that is made by the Chairman, and I believe that he was fundamentally wrong to advance his personal views when he chaired that Committee. He should simply have left his views on the record, as they have been over many years, without advancing them in these circumstances.

Photo of Mrs Joan Carson Mrs Joan Carson UUP

I agree with Dr Birnie’s amendment.

The provision of maternity services in Belfast is a most serious matter that has been the subject of a tug-of-war for many years between a number of different and differing interests. My concern is for those who really matter — mothers, newborn babies and the dedicated professional staff in both hospitals. This issue has been gravely mishandled from the beginning.

Devolution of power to the Assembly was greeted by everyone as a major step forward towards giving Northern Ireland politicians hands-on authority over local services. There was an expectation that, through the d’Hondt principles, the structure of the Statutory Committees and the allocation of ministerial posts to provide a fair distribution of responsibilities to the parties represented in the Executive, there would be an open consultative process at all levels on major issues.

Now we have the Minister of Health, Social Services and Public Safety taking a very divisive decision, which, she claims, it is her prerogative to take and which, she states, cannot be challenged.

As a member of the Health, Social Services and Public Safety Committee I was present at briefings by staff in the Royal Victoria Hospital and the Jubilee Action Group. The Committee, by a majority vote, decided in favour of the Jubilee. The Committee was meeting last Wednesday when the Minister made her decision. Some of the Committee members learned of it from the press later that evening, and others got no information about it until after 10.15 am on Thursday when a press release was issued. The only exception to this was the Chairman.

If the Minister was not prepared even to consider the Committee’s decision, it would have been mannered at least if she had informed the Committee of it before the public announcement. Furthermore, given the absence of Executive policy, she should have advised the members of the Executive of what she was intending to do and given them an opportunity to participate in the decision-making process.

It was obvious that the Minister had been fully briefed by her officials, but the Committee did not have such briefing. How and when the Assembly was informed about this, and the authority or influence that it should have had over a decision on a matter of cross-community interest are matters of grave concern.

We have all received a copy of the latest publication from the Executive Information Office telling Northern Ireland’s public what the role of a Committee is. It is to

"consider and advise on departmental budgets and annual plans … [and] … in forming policy".

Definitions of "considered" include: looked at carefully; thought or deliberated on; weighed advantages and disadvantages with a view to action; and showed regard or consideration for. And a definition of "consider" is: recommend, inform or consult with.

I submit that in this case the Executive, the Committee and the Assembly were given no opportunity to consider or advise on the decision-making process prior to the Minister’s announcement.

I ask Members to support the amendment.

Photo of Carmel Hanna Carmel Hanna Social Democratic and Labour Party

I wanted to be a member of the Assembly Committee because I am passionately concerned with health issues, and I want to be in a position to influence change. I am glad that we are debating the future of Northern Ireland’s regional maternity hospital today. Decisions such as this must be taken in the most open, democratic and transparent way. Everyone in the House knows my views on this, and I speak from the perspective of a woman, a mother and a midwife. However, today I speak as an elected representative, and not in any personal or professional capacity.

The Minister’s statement says that she concluded that regional maternity services would be more clinically effective if located adjacent to regional paediatric services. That statement appears to be the extent of the clinical argument for opting in favour of the Royal. Any new regional maternity hospital, wherever it is sited, will inevitably attract the best midwives, obstetricians, gynaecologists, neonatologists, and paediatricians. There will be no question of having to transfer a very sick baby to the Children’s Hospital. The experts will be on site in the new unit, and that clinical argument is therefore flawed.

There is a second inconsistency in the key argument: surely it would be much more clinicially effective to build a new regional maternity hospital beside the gynaecology department, which is on the City site.

This is normal practice throughout the UK. Is there any medical evidence whatsoever that the Royal Maternity Hospital has provided a better service because of its proximity to the Children’s Hospital? I believe that there is none. A neonatologist is a paediatrician who specialises in caring for the newborn. These specialists will be on hand in a new regional maternity hospital. If there is a long-term problem, a specialist paediatrician may be called in. Health care should bring the doctor to mother and baby, not the other way around.

Furthermore, do we have any idea where the money for a regional maternity hospital is going to come from? Has the Minister taken into account the fact that the City site might more easily attract public/private finance for a new building? The Royal Group recently announced a rather large capital spend on a new hospital. Can we therefore assume that we should now add a further figure of about £15 million to that outlay?

What are the plans for the future of the City Hospital? Will it continue to be asset-stripped? The fractures department has already gone to the Royal, and accident and emergency services are going the same way. If maternity services go, can gynaecology and gynae-oncology be far behind? My Colleagues have all referred to this. We are talking about part of the new cancer unit. The Minister’s decision, like that of a previous Minister who implemented the Donaldson Report, may not stand up to a judicial review.

We know that a clear majority of the Assembly’s Health Committee does not support her decision. It will be for the Assembly as a whole to judge it. This decision may have repercussions for any future decisions on local hospitals. This is not just a Belfast matter, nor just a struggle between two Belfast hospitals. It affects all women and babies in Northern Ireland.

Photo of Mark Robinson Mark Robinson DUP

When the Minister for Health made public her decision to locate regional maternity services at the Royal Victoria Hospital she quite clearly exposed the nonsense that is Belfast Agreement and the democratic body that that agreement claims this Assembly to be.

The Assembly’s Health Committee spent a considerable amount of time and effort listening to both sides of the argument. After showing due care and attention and examining all the relevant data and information available, the Committee took the considered view that maternity services would be best located at the City Hospital. It is worth noting that, in taking its decision, the Committee did so on a cross-community basis with a majority of seven to four.

Of course, none of the Health Committee’s endeavours on this matter cut any ice whatsoever with the Minister of Health. Despite previous assurances to the contrary, she did not advise the Committee of her decision before making it public. This attitude was reinforced by her rather inadequate performance at Question Time earlier today, during which she was dismissive and contemptuous and showed a total lack of regard for the Assembly.

Since a West Belfast Minister, aided and abetted by a West Belfast Chairman of the Health Committee, decided in favour of a West Belfast hospital, Members can only draw their own conclusions.

Is it not reasonable to suggest that the timing of the Minister’s decision has more to do with political expediency than with medical and clinical considerations? What other explanation is there? Surely it is much easier to ignore seven members of a Committee than a more sizeable and, perhaps, significant vote in the Assembly at the close of today’s debate.

We must take a further point into account when considering the Minister’s motive for taking such a crucial decision at this time. As we are all aware, there has been some speculation over recent days about whether the Secretary of State will find it prudent to suspend the authority of the Executive.

He will feel that he has no other choice, as Ms Brown and her colleagues in Sinn Féin/IRA have signally failed to address, in any meaningful way, the vital issue of decommissioning.

In the light of the recent events which I have already outlined, and given the fact there is a widespread perception that this decision was based solely on political reasoning, how can Members, not to mention the public, be assured that any future decisions facing the Minister will be taken properly rather than as now on the basis of what is best for west Belfast?

I support the motion.

Photo of Sue Ramsey Sue Ramsey Sinn Féin 5:15 pm, 31st January 2000

Go raibh maith agat. I oppose the motion and also the amendment by the Ulster Unionist Party.

As a member of the Health Committee, I believe that this is the most complex issue that it will be faced with, either now or in the future. I was one of the four members who voted against the proposal to build at the Belfast City Hospital site, and instead voted for a new Royal Maternity site. I came to this decision after examining closely documentation and presentations from interested groups, including the Falls and the Shankill Women’s Centres. Clinical arguments show that the Royal Maternity will provide a women-centred, family-led service, where a full range of medical care can, and will, be provided. Women and families want this, as do the doctors and nurses in the Royal Hospitals.

In 1994 the then Government set up the acute hospitals reorganisation project, under the chairmanship of Dr McKenna. Of his 28 recommendations, 27 were accepted by both hospitals. The issue of maternity services was controversial. The Labour Government commissioned a second report from an independent medical review panel, chaired by Prof Donaldson. He concluded that, clinically speaking, the best possible arrangement was to provide maternity and paediatric services side by side. As this hospital will be the new regional maternity hospital, as well as being the local one, it is important to have the closest links to the Belfast Hospital for Sick Children. That would mean a faster, more effective response to babies experiencing difficulties before, during and after birth.

There is also clinical evidence to suggest that neonatal intensive care units without on-site paediatric specialist support have higher mortality rates. Transportation of sick babies — and some people do not believe this — would be easier and safer in a new maternity hospital linked to the Children’s Hospital. It would also ensure that mothers and babies remained on site. Removal of the maternity unit from the Royal Victoria Hospital, whether Members like it or not, would have an adverse effect on the communities of north and west Belfast, two of the most economically and socially deprived areas in the North.

The full Health Committee did not endorse the recommendation for a new hospital at the Belfast City Hospital site. The Committee agreed unanimously that the Jubilee and the Royal Maternity Hospitals should both remain open until a new regional maternity hospital was built. However, because of the decision taken by the Royal College of Paediatricians, there is no alternative but to locate maternity services at the Royal Maternity in the interim.

Other Committee members, especially DUP members, say that the decision by the Minister was a political one. This from a party whose member, when he had the chance to question the Minister on this very subject, withdrew in protest. This from a party which called for the Minister to resign over the flu epidemic two weeks after taking up her post. She has also been accused of making this a political decision because the Royal Victoria Hospital is in her constituency of West Belfast, but, on the clinical facts alone, the Royal Victoria Hospital always had a strong case. I await with interest to see what the DUP wants the Minister to resign over next week.

There was also concern on the issue of the Committee’s not being informed. As a matter of courtesy, the Minister took the step of contacting the Chairman of the Health, Social Services and Public Safety Committee on Wednesday evening. She informed him of her decision on the location of maternity services in Belfast. So far as I am concerned, by informing the Chairman the Minister was informing the Committee.

Once again, I oppose this motion, and I also oppose the Ulster Unionist Party’s amendment.

Photo of Alan McFarland Alan McFarland UUP

I rise to support the amendment. The situation is of concern. The Minister has scorned the Executive and ignored the Committee. She has taken a decision which mirrors Sinn Féin’s previously stated position as well as her own. I wonder how much constituency considerations influenced. I quote:

"I wholeheartedly believe that the Royal is a crucial part of the economic and social fabric of west Belfast, and I want to ensure that it remains so."

It might be worth having a look at the background to this. The McKenna Report is quite interesting. The McKenna group was made up of eminent people from both the City and the Royal, including chief executives, a director of public health and clinical directors. There were 12 or 14 of them in all. They decided that maternity services should go to the City site. This clearly did not suit the Department, and it promptly commissioned another report from four eminent people who came across from England. Of course, they produced a different recommendation, which was that it should move to the Royal site.

The interesting thing about this is that the main pillar of both the Donaldson report and, indeed, the Minister’s report, is that the clinical arguments came down to the potential linkage of the new hospital with other, on-site clinical services and to its closeness to the Royal Belfast Hospital for Sick Children. It is worth looking at the number of children who are transferred across each year. My understanding is that it is fewer than 1% from across the Province.

There is confusion, and a smokescreen was presented to the Committee by paediatricians about what happens when a baby is born and is poorly. After babies are born, they are stabilised by neonatologists. Neonatologists are paediatricians who have specialised in looking after newborn babies. The other paediatricians at the Royal Belfast Hospital for Sick Children are people who specialise in children’s brains, hearts, legs, and so on. There is a turf war going on here between the two groups.

The neonatologists are tasked with stabilising the babies once born, so there is no question of a baby’s being born, being poorly and being thrown into an ambulance and rushed to the Children’s Hospital. The neonatologists stabilise the child, or, if the situation is very serious, a paediatrician operates. Otherwise the baby is stabilised and can then be moved. There is no rush. The idea that all hospitals have to be close to the Royal Belfast Hospital for Sick Children is clearly nonsense, but it is one of the basic premises on which all this was based.

Another key consideration in both the Donaldson and McKenna reports was that no one should separate obstetrics and gynaecology. Gynaecology and obstetrics are two different things, but they must not be separated. What has happened now? As of 1 February, obstetrics is being moved to the Royal. [Interruption]

Photo of Alan McFarland Alan McFarland UUP

Gynaecology is staying at the City. They are splitting them up — the one thing that the Royal College of Obstetricians and Gynaecologists said should on no account be done. This decision has done that.

Let us look at the question of a mother’s choice. The Department’s own consultation paper says

"However, the Department recognises that whatever option is chosen, some Belfast mothers may choose not to use the new combined maternity hospital, but to seek maternity care from another maternity hospital such as the Mater, the Ulster, Lagan Valley and perhaps even Antrim."

I wonder if the medical services are ready, for research has shown that 60% of the mothers at the City do not and would not wish to have their babies at the Royal. This needs to be taken into consideration.

The action of the Royal College of Paediatricians was mentioned in detail in our letter to the Minister. They knew that the Committee was looking at the matter, and they deliberately went ahead with a force majeure that obliged maternity services to move from the City to the Royal. What is interesting — and the Mater needs to take note of this — is that towards the end of a report to deal with this, and concerned with the removal of specialist registrars from the City site, it says

"Paediatric cover of the Mater Maternity Unit needs to be reviewed since after the rationalisation of neonatal services" —

Photo of Mr Billy Hutchinson Mr Billy Hutchinson PUP

On a point of order, Mr Speaker. Can Mr McFarland explain what he means by his references to babies coming out and women’s bits and pieces?

Photo of Lord John Alderdice Lord John Alderdice Speaker

Regrettably, that particular medical treatise had to be brought to a close.

Photo of Alex Attwood Alex Attwood Social Democratic and Labour Party

The SDLP will be opposing both the motion and the amendment. Before explaining why, I must mention the comments that have been made about the Chairman of the Health Committee, which have ranged from his "being unworthy" to "being discredited". The Chairman outlined his personal views on this issue to the Assembly, gleaned over a lifetime in medicine. He also told the Committee that he was prepared to step down when this matter was being discussed. He has outlined his anxiety and difficulty over this issue in a very honest and frank way in both the Committee and the Assembly. Given this, I trust that those Members who made those sorts of comment would acknowledge that he acted as he saw fit out of high principle at all times.

I trust they would acknowledge that he was in a difficult situation but behaved honourably and as best he could in the circumstances. I hope that the Chamber will recognise and acknowledge that. It is ironic that, in this Chamber of all places, two Assembly Members have referred to the "chill factor" involved in going to the Royal Victoria Hospital. There is a chill factor about this Building for a political tradition in this city, which has spent a lifetime not coming into this Chamber and is now spending a lifetime in it. If a chill factor can change with respect to a political institution, then it can also change with respect to a medical establishment. It is the responsibility of political leaders to say that the attitudes which served in the past, and which might have been justified in terms of people’s concerns and anxieties, will no longer serve our needs in the future.

It is the responsibility of political leaders to say that things have changed and that people can now do things differently. We have done it in coming to this Chamber, and people can do it by going into west Belfast, where they will get the best service and the best medical care. It is those factors which will determine whether people go to the Royal — not whether people are prejudiced about west Belfast or the perceived history of that constituency in recent years.

I do not intend to go into the clinical arguments. They have been exhaustively rehearsed in the Chamber and elsewhere. However, in my judgement — and I am trying not to be partial, although that is difficult — the compatibility and the complementarity of the services on the Royal site are much higher in respect of mothers and children than is the case elsewhere in this city. That complementarity and compatibility make the argument in clinical terms more compelling than the argument in respect of the City site.

The decision should be taken on clinical grounds, but it has to be acknowledged that a wider factor is involved. West Belfast — all of west Belfast, the Falls and the Shankill — is exiting from years of discrimination in respect of one tradition and years of disadvantage in respect of both traditions. Every decision taken is legally required to be equality-proofed. It is also essential, if a new economic and social order is to be introduced in the North, that issues of economic and social discrimination and disadvantage be taken into account.

I am putting down a marker that those factors will have to be taken into account for every decision and judgement made by the Assembly when working out best practice and policy.

Photo of Alex Attwood Alex Attwood Social Democratic and Labour Party

No, the time is short. Otherwise I would give way.

Finally, I want to deal with the points raised by Esmond Birnie and the thoughtful speech of Bob McCartney. The Ulster Unionist Party’s amendment is of relevance, but the SDLP cannot support it at this time.

It is of relevance because there are three important themes raised in the amendment that need to be acknowledged.

First, there was a process of consultation and that must be acknowledged. Whether that process was adequate, either in the fine detail or in its conclusions, has yet to be fully determined. The Assembly will have to decide what is, and is not, adequate consultation in terms of managing its own business.

Secondly, it is arguable that the Minister’s decision — and it is an executive power that we have to be careful to protect, otherwise we will impede executive authority — was right or wrong. We think that it was right, but we accept that there is an argument that needs to be fully rehearsed and determined.

Photo of Sammy Wilson Sammy Wilson DUP

I would like to deal with Dr Esmond Birnie’s amendment.

First, the amendment is fundamentally flawed as it throws the responsibility back to the Minister to bring this issue before the Assembly.

Members consider that the Minister has treated the Assembly with contempt. She treated it with contempt by ignoring the Health Committee. She treated it with contempt by putting out a statement on a most important and controversial issue at midnight, rather than bringing it before the House, where she could be questioned and asked to explain the reasons for her actions. She treated it with contempt by ignoring the Executive Committee, as Dr Birnie has said. And, as we have seen today, she treats the House with contempt when matters are raised with her. Members ask her questions in English, and she answers them in the language of the leprechauns, which nobody understands.

Despite this contempt, we have an amendment which throws the ball back into the Minister’s court. It says "You bring it back to the Assembly and let it make a ruling". That is why I believe that, despite there being some aspects of the amendment with which we would agree, it is flawed and it is weak. Once again the Ulster Unionist Party are giving IRA/Sinn Féin the benefit of the doubt with this amendment.

With regard to the Minister’s actual decision, I am not on the Committee, but through my role in Belfast City Council I have heard all the arguments advanced by both sides in this debate. Medical politics seem to be as cut-throat as party politics. There were no holds barred in the way the arguments were put forward.

On the surface there would appear to be a strong case for the retention of services at the City Hospital. The fact that, out of the 214 maternity services across the United Kingdom, only 12 are linked to children’s hospital facilities indicates that it is not absolutely essential to have the two linked. Even the Royal College of Obstetrics and Gynaecology points out that the link is not between the children’s hospitals and maternity units; rather it is the other way round.

When it comes to the evidence we have heard so far — Dr McKenna’s report and the decision of the previous Minister — it is significant that those who have advanced the argument for the Royal have talked about the economic importance of this unit to west Belfast. They have stressed that west Belfast is an area of economic deprivation and that therefore the facility should be maintained at the Royal. It has nothing to do with medical reasons; it is for economic reasons. It is significant too that the Minister represents the area.

If we do not lay down rules in the House quickly to ensure that Ministers are democratically accountable, we are going to see this happening time and time again with a Minister from a minority party. All parties in the House are minority parties. All Ministers represent minority parties, and if a Minister can take decisions against the wishes of the majority of the people of the Assembly, we will not have gained democratic accountability. We will be back to the old direct-rule system with Ministers who are not accountable. We must sort this out very very quickly.

The Minister ought to be censured for the contempt in which she has held the House. She has displayed this contempt since she was appointed — over the holiday period she was more interested in tearing down flags than dealing with the crisis in the Health Service. This is yet another example of that type of —

Photo of Bairbre de Brún Bairbre de Brún Sinn Féin

Go raibh maith agat. Ba mhaith liom a rá ar dtús báire go bhfáiltím roimh an deis an cheist seo a phlé sa Tionól. Tuigim go bhfuil ceist úsáid na Gaedhilge agus úsáid an Bhéarla ag gabháil a bheith idir chamánaibh roimh i bhfad, a Cheann Comhairle. Mar sin de, labhróidh mé go gasta i nGaedhilg agus rachaidh mé ar aghaidh i mBéarla.

I very much welcome the opportunity to debate this important issue. The issue of the use of languages was raised earlier this afternoon, and the Interim Presiding Officer has indicated that he will be looking at it. Having spoken briefly in Irish now, I will speak only in English for the rest of this debate.

Photo of Ian Paisley Ian Paisley Leader of the Democratic Unionist Party

On a point of order, Mr Speaker. Is it right for the Minister to refer to you as the Interim Presiding Officer when you are now the Speaker of the House?

Photo of Lord John Alderdice Lord John Alderdice Speaker

I do get called quite a lot of things, as Members are aware. Technically, of course, the Member is absolutely right: I am to be referred to as Speaker or perhaps Ceann Comhairle.

Photo of Bairbre de Brún Bairbre de Brún Sinn Féin

Gabh mo leithscéal.

I would like to reiterate to the Assembly my view that the Jubilee and Royal Maternity Hospitals both provide crucial, regional maternity services as well as more local services to mothers-to-be in Belfast. My aim throughout has been to guarantee the provision of the highest possible care and treatment for women, mothers and babies.

In coming to my decision, I took great care to consider the relevant information. I considered and reviewed the responses to the consultation process carefully, and that included responses from individual women, mothers from community groups, a wide range of health professionals and support groups from both hospitals.

I also made a point of visiting both maternity hospitals to see the situation for myself. I spoke to management, staff and mothers. I also spoke to the groups in support of each maternity hospital. All the people I met asked me, in the interests of the maternity services, to decide quickly on their future location.

In addition, I also considered the specially commissioned PAFT analysis and high level economic appraisals of the long-term and interim options. Copies of these documents, along with the summary of the consultation responses, will be placed in the Assembly Library. I also benefited from the advice of the Assembly’s Health Committee.

It is worth placing on record that not only did I go to the Committee, speak to it and ask it to provide me with further advice corporately as a Committee, but I also invited individual members who wished to do so to advise me on a personal basis. I took all of this into account, along with the other factors that I have mentioned that were my responsibility.

It is also worth placing on record that I agreed with the Committee that a decision was needed urgently; that a new maternity hospital was required, and not a refurbished one; that a decision was needed at the same time on the interim and long-term solutions; and that the interim solution should not become the final solution.

I also recognised the Committee’s preference that the Jubilee and Royal Maternity should both remain open, but I agreed with their advice, stated in a letter they sent to me, that in the prevailing circumstances

"There is no alternative but to locate maternity services at the Royal Maternity in the interim."

The arguments from the consultation process in my Department’s own analysis underlined the need to provide a new-build maternity unit. Choice between the new build on either site was a close one. Given the points that Members have made, I reiterate that this argument was one of a number which I looked at, but in the final analysis the clinical arguments came down to the potential linkages of the new hospital to other on-site clinical services.

My conclusion was that maternity services would be more clinically effective if located adjacent to regional paediatric services at the Royal Belfast Hospital for Sick Children and near to the accident and emergency department. My decision does not adversely affect gynaecological oncology, as gynaecology is currently provided on both sites. No decision has been made on the future provision of gynaecology.

When compiling his report, Dr McKenna did not have the opportunity to consider the new-build option, for it was not an option at that time.

With regard to the Committee’s being informed of my decision, I totally acknowledge the points made by Dr Hendron. I sought to speak to the Committee Chairman. I sent word, and Dr Hendron returned my call. I advised him of the detail of my decision and that a press release was being drawn up for that evening. The press release was issued after 8.00 pm. I spoke to Dr Hendron at 6.45 pm, and the content of the press release was embargoed until midnight — several hours after I had spoken to him. There was no intention whatsoever of treating the Committee with anything other than reverence, and I pointed this out to the members during my visit.

Regarding the amendment, I would like to pick up several of the points raised by Dr Birnie. The decision on the future location of maternity services in central Belfast is an important one for women regionally and locally. However, I cannot accept that it could be described as a key decision. It was primarily an operational one, and I did not identify any significant cross-cutting dimensions which would have suggested that the matter should have been raised with ministerial colleagues.

Consequently I am confident that this decision was dealt with appropriately. While I do not accept that this decision was a key one as provided for in the Belfast Agreement, I made no secret of my intention to reach an early decision. As stated previously, those I met while taking views on board asked me to make an urgent decision, and at all times in those conversations, in the press, in briefings from my Department to the First Minister and the Deputy First Minister and in press releases, which are routinely copied to the Executive information service, it was clear that my intention was to reach a decision as soon as possible — certainly before the end of the month.

All of these were routinely available and copied as a matter of course to the Office of the First Minister and the Deputy First Minister.

Regarding Dr Birnie’s point about the failure to engage with the Health Committee, I took care to work with the Committee in the lead-in to my decision. I wrote to the Chairman of the Committee before Christmas and copied the PAFT analysis and an initial summary of consultation responses to Committee members prior to meeting with them. And I made a point of ensuring that there would be an early meeting; I met with them on 10 January.

At that meeting I invited members to give me their views on the way ahead, in advance of my decision, and I explained the urgency to them. They agreed with me on the urgency, and I asked them to have written responses with me by 20 January in order to ensure that I could give their comments due weight when I came to take the decision. I took close account of the advice from the Committee, and I accepted a number of the points, as I outlined earlier, such as the need for the decision to be made urgently and the need for a new maternity hospital.

I carefully considered this alongside the outcome of the consultation process, my visits to the maternity units, my meetings with management, staff, health professionals and support groups as well as the PAFT analysis, the economic appraisals and the professional advice from my Department. I also sought Dr Campbell’s advice on oncology.

Photo of Lord John Alderdice Lord John Alderdice Speaker 5:45 pm, 31st January 2000

Order. The time is up.

I call Dr Birnie to wind up.

Photo of Esmond Birnie Esmond Birnie UUP

The clinical arguments in favour of the Jubilee as opposed to the Royal Maternity have been well rehearsed this afternoon, but I moved this amendment because the Minister has overridden her Committee and made a unilateral decision without further reference to her Executive Colleagues or the Assembly.

If a decision that involves the spending of £15 million is not a key decision, I tremble for the future of budgetary arrangements in her Department. We could be establishing a very dangerous precedent this afternoon with regard to how decisions are made, and it is essential that the House understands the implications.

We were told that powerful Scrutiny Committees would lie at the very heart of the new arrangements. Now we are in grave danger of seeing a Sinn Féin Minister knocking down the edifice of accountable government through the exercise of untrammelled Executive power. Our point about procedure would remain valid even if, in spite of what has been argued this afternoon, the decision by the Minister were, in itself, a wise decision, which it is not.

It is important at this early stage of devolution that we establish the ground rules for making important political decisions, especially in circumstances such as those we face now where a Minister is in confrontation with her Committee. At the moment the Health Minister’s decision cannot be treated as final because it was not made in an open, full and public manner. My concerns and, indeed, the Ulster Unionist Party’s concerns are reflected by the Assembly and by a majority of the general public.

Photo of Paul Berry Paul Berry DUP

We have all heard arguments today about maternity services in Belfast, and it is crucial that we, as an elected Assembly, endorse the motion and give support to the Committee that has been diligent in its examination of the matter. I ask all parties to give their support. Failure to do so will throw the Chamber into confusion.

There is also the question of the role that Committees will play in the future. If a Minister can make decisions which are diametrically opposed to the opinion of his or her Committee, that is saying, in effect, that the Committee is of little value. There was overwhelming agreement in the Committee across party lines. The Democratic Unionist Party, the Ulster Unionist Party, the Women’s Coalition and a member of the SDLP fully supported the siting of maternity services at the City. This makes it vital that Members support the motion.

The Health Minister has failed to come up with a point of any weight to support her decision. She followed only her own narrow political interests. The grounds for that decision, in spite of the high-sounding claims that she has made on television and elsewhere, have not been substantiated today.

In fact we have had a very intelligent and powerful set of arguments that have shown the correctness of the Committee’s view. I read the recent article in the ‘Belfast Telegraph’ by the Royal Victoria Hospital’s clinicians, which amounted to one point — the transfer of sick babies and the location of paediatricians. If they were correct, then all maternity services in Northern Ireland should be at the Royal. I note with interest that Dr Hendron, who is the Chairman of the Health Committee, was talking about a regional neonatal unit, although that is not what they call it. It is not a regional unit; there is no such thing. There are neonatal units at Altnagelvin, Antrim and Craigavon.

We cannot afford to follow what is a vested interest in one issue and then try to ignore it in another. As Mrs Robinson said, and it is an inescapable point, Barbara Brown has set out in a number of articles her political agenda with regard to the Royal.

I have listened very closely to the debate this afternoon. First of all, we had a member of Sinn Féin/IRA, Alex Maskey, trying to stop this debate. What area does he represent? West Belfast. Then we had the Health Minister, Barbara Brown. Where does she represent? West Belfast. We also had the Chairman of the Committee, Dr Joe Hendron, and Alex Attwood speaking against the motion. These people all represent West Belfast. If this is not political I do not know what is. It is hypocrisy on their part.

Before this debate today, politics were brought into the situation. Dr McKenna’s recommendations went against having the maternity services at the Royal Victoria Hospital. The Nationalist politicians said "No way. We must have another review". Then Prof Donaldson moved in, and he recommended that the services be transferred to the Royal Victoria Hospital.

The Minister has done a serious injury to the whole issue of maternity services and caused divisions where none should be. She cannot discard the Health Committee because it has adopted a more rational policy than she has. The Minister has tried to circumvent the work of our Committee. We had substantial consultations. We sat one evening for six or seven hours with the various groups, and people accused us of being political. We went through all the clinicians’ arguments. We had the medical men and the support groups coming in to give us their views. The Committee then had a cross-community vote, which was seven to four in favour of the City Hospital. That must not be ignored.

The mothers who will be affected by this must not be ignored. There were 500 responses to the consultation process, plus a pro-City petition of 40,000 names, which appears to have been ignored. That is the way the mothers in this part of Belfast feel this evening. They feel ignored and betrayed. The Minister has tried to cover herself —

Photo of Paul Berry Paul Berry DUP

I would like to say in closing —

Photo of Lord John Alderdice Lord John Alderdice Speaker

Order. The time is up. The Member will resume his seat.

The amendment and, if we come to it, the substantive motion will be decided on a simple majority vote. If the amendment is carried, we will not proceed to the substantive motion because the amendment, in effect, supersedes it.

Question put

The Assembly divided: Ayes 24; Noes 40.

Ayes

Ian Adamson, Pauline Armitage, Billy Armstrong, Roy Beggs, Billy Bell, Tom Benson, Esmond Birnie, Joan Carson, Fred Cobain, Robert Coulter, Ivan Davis, Sam Foster, John Gorman, Derek Hussey, Danny Kennedy, James Leslie, David McClarty, Alan McFarland, Michael McGimpsey, Dermot Nesbitt, Ken Robinson, George Savage, John Taylor, Jim Wilson.

Noes

Alex Attwood, Eileen Bell, P J Bradley, Joe Byrne, John Dallat, Bairbre de Brún, Arthur Doherty, Pat Doherty, Mark Durkan, David Ervine, Sean Farren, John Fee, David Ford, Tommy Gallagher, Michelle Gildernew, John Hume, Billy Hutchinson, John Kelly, Patricia Lewsley, Alban Maginness, Alex Maskey, Kieran McCarthy, Donovan McClelland, Alasdair McDonnell, Barry McElduff, Eddie McGrady, Martin McGuinness, Gerry McHugh, Mitchel McLaughlin, Eugene McMenamin, Monica McWilliams, Jane Morrice, Conor Murphy, Sean Neeson, Mary Nelis, Danny O’Connor, Dara O’Hagan, Eamon ONeill, Sue Ramsey, John Tierney.

Question accordingly negatived.

Main Question put.

The Assembly divided: Ayes 53; Noes 37.

Ayes

Ian Adamson, Fraser Agnew, Pauline Armitage, Billy Armstrong, Roy Beggs, Billy Bell, Tom Benson, Paul Berry, Esmond Birnie, Norman Boyd, Gregory Campbell, Mervyn Carrick, Joan Carson, Wilson Clyde, Fred Cobain, Robert Coulter, Ivan Davis, Nigel Dodds, Boyd Douglas, David Ervine, Sam Foster, Oliver Gibson, William Hay, David Hilditch, Derek Hussey, Billy Hutchinson, Roger Hutchinson, Gardiner Kane, Danny Kennedy, James Leslie, Robert McCartney, David McClarty, William McCrea, Alan McFarland, Michael McGimpsey, Monica McWilliams, Jane Morrice, Maurice Morrow, Dermot Nesbitt, Ian Paisley Jnr, Ian R K Paisley, Edwin Poots, Iris Robinson, Ken Robinson, Mark Robinson, Peter Robinson, George Savage, Jim Shannon, John Taylor, Denis Watson, Jim Wells, Jim Wilson, Sammy Wilson.

Noes

Alex Attwood, Eileen Bell, P J Bradley, Joe Byrne, John Dallat, Bairbre de Brún, Arthur Doherty, Pat Doherty, Mark Durkan, Sean Farren, John Fee, David Ford, Tommy Gallagher, Michelle Gildernew, Joe Hendron, John Hume, John Kelly, Patricia Lewsley, Alban Maginness, Alex Maskey, Kieran McCarthy, Donovan McClelland, Alasdair McDonnell, Barry McElduff, Eddie McGrady, Martin McGuinness, Gerry McHugh, Mitchel McLaughlin, Eugene McMenamin, Conor Murphy, Sean Neeson, Mary Nelis, Danny O’Connor, Dara O’Hagan, Eamonn ONeill, Sue Ramsey, John Tierney.

Question accordingly agreed to.

Resolved:

This Assembly endorses the decision of the Health, Social Services and Public Safety Statutory Committee to locate maternity services in Belfast at the City Hospital.

Photo of Iris Robinson Iris Robinson DUP

On a point of order, Mr Speaker. Will you now give the Minister an opportunity to reconsider her decision in the light of the Assembly’s vote?

Photo of Lord John Alderdice Lord John Alderdice Speaker

That is not a point of order, as I suspect the Member knows.

The sitting was suspended at 6.21 pm.