House of Commons Hansard Debates for 23 Feb 1993

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political will, the new world disorder that we see at the moment will be a mere temporary phase in the long course of world history. 9.40 pm

The Minister of State, Foreign and Commonwealth Office (Mr. Douglas Hogg) : As is right and as was to be expected, the debate has coverea great deal of ground. Some 27 or 28 hon. Members have spoken and a score or so issues have been addressed and, as the hon. Member for Hamilton (Mr. Robertson) said, there has been general agreement on many of them.

I recognise as I start that I shall not be able to respond to all the individual points that have been made and I apologise for that in advance. I should like to identify the three main themes that have been spoken to in the debate and to deliver my response within that framework. Those themes should be and are the United Nations, the events in what was Yugoslavia and the middle east.

The United Nations has been the subject of perhaps the greatest discussion in the debate. The role of the United Nations, as has been emphasised by almost every hon. Member who has spoken to the issue, has developed enormously during the past five years, and for that there are three or four reasons.

Those reasons include the collapse of the former Soviet Union ; the fact that the Russian Government are willing to play a constructive role within the Security Council ; the success of the Security Council in the context of the Gulf war ; and the fact that there is a virtually universal recognition that only the United Nations--though sometimes regional organisations as appropriate--can tackle the crises and wars that, as my hon. Friend the Member for Carshalton and Wallington (Mr. Forman) properly remarked, are beamed into our homes by television and radio.

I agree with the right hon. Member for Tweeddale, Ettrick and Lauderdale (Sir D. Steel) on the importance of underpinning action with a moral basis. Force which is disengaged from a moral basis is unsustainable and wrong. By that he means, and by that I mean, that, when the members of the United Nations act in a forcible manner, either they should do so within and under the authority of the United Nations or that which they do should be authorised by the principles of international law.

Mr. Bowen Wells (Hertford and Stortford) : Will my right hon. and learned Friend give way?

Mr. Hogg : No, I am afraid that I will not at this stage. I come first to the question of peacekeeping. It is clear that peacekeeping will now play an important part in the career of a typical British soldier. That is inevitable, although it was not true a few years ago. But we need to be cautious about it and there are a number of principles to which we should adhere.

The first and perhaps the most important point is that the British Government's responsibility for the safety and security of British service men serving in a peacekeeping role is as great when they serve under the authority of the United Nations as it is when they serve under the direct authority of the British Government or the generals who command. Because of that, when we talk about peacekeeping we must hold to certain principles that were

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touched on by a number of right hon. and hon. Members--including the hon. Member for Stockton, North (Mr. Cook), my right hon. Friends the Members for Westmorland and Lonsdale (Mr. Jopling) and for Chertsey and Walton (Sir G. Pattie), and my hon. Friend the Member for Arundel (Sir M. Marshall).

First, one cannot make peace by force. To use the phrase of my hon. Friend the Member for Ghertsey and Walton, one cannot insert oneself between warring factions. I entirely agree with that. Moreover, there must be a sustainable ceasefire to keep, and clearly definable political objectives. Those will usually be identified by the existence of an agreement to which parties are genuinely adhering. Secondly, there must be an effective control and command mechanism. The quality of troops deployed alongside British peacekeepers must be of high quality. I take to heart the point made by my right hon. Friend the Member for Guildford (Mr. Howell)--that humanitarian missions can often lead to something more substantial.

For those reasons, in many cases it would be right for peacekeeping forces to be deployed by regional defensive organisations acting under the authority of the United Nations. There may be many circumstances in which it would be right for control and command to be vested in NATO. That may be so, for example, in the former Yugoslavia. I can conceive of circumstances in the former Soviet Union in which that role should be performed by CIS forces. Incidentally, I agree very much with my hon. Friend the Member for Carshalton and Wallington that one cannot expect to participate in each and every peacekeeping force. We are the second largest contributor, but we must not suppose that we are under an obligation to participate in every peacekeeping force that may be mounted. There has been much discussion, rightly, about the virtues of preventive diplomacy. Clearly, that approach will be built on steadily. We see examples of that already--such as the deployment of United Nations troops in Macedonia, and the increasingly important work of regional organisations. I have in mind the work undertaken by the conference on security and co-operation in Europe--a regional organisation. The CSCE is already heavily engaged in the former Yugoslavia, with observer teams in Kosovo to be reinforced and teams in Sandjak and Vojvodina, then Georgia and Estonia. There is also the work being done by the CSCE to promote peace talks in

Nagorno-Karabakh.

In passing, I pay tribute to my hon. Friend the Member for Bournemouth, East (Mr. Atkinson) for the commitment that he has given in Nagorno- Karabakh, along with my noble Friend, Lady Cox. I strongly support the proposition that my hon. Friend brought forward in the Council of Europe.

There has been much discussion, again rightly, abut the reform of the Security Council. If my hon. Friend the Member for Carshalton and Wallington will forgive me, I do not agree with his basic proposition-- which he admitted was heretical--to the effect that the United Kingdom should cede its permanency.

My right hon. Friend the Foreign Secretary made the point that we do not want in any sense to stand in the way of debate, nor could we. He reminded the House--and others through the House, I hope--that a number of principles must be observed. First, it would be perverse to damage the functioning of the Security Council at a

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moment when, for the very first time, it is beginning to operate in the way that those who created it hoped that it would.

Any reform must surely take account of a number of principles. First, the Security Council's size must be manageable. Its present size is manageable- -but if it were greatly expanded, it would not be manageable. Secondly, one cannot have as permanent Security Council members countries whose constitutions preclude them performing the essential functions of membership. My right hon. Friend the Foreign Secretary and my right hon. Friend the Member for Guildford drew attention to the difficulties faced by Japan and Germany. Nor could one expand the Security Council's membership by those two countries and expect that discussion to come to an end, because that is not realistic. Countries should proceed slowly and cautiously, and ensure that all member nations that are part of the Security Council's permanent composition are able to perform the essential functions that are expected of permanent membership.

Mr. Wells : Will my right hon. and learned Friend give way?

Mr. Hogg : I do not think that my hon. Friend has been present for the debate. If he will forgive me, I will not give way.

My right hon. Friend the Member for Westmorland and Lonsdale mentioned sanctions. He is entirely right to say that they are an important element in the arsenal the United Nations--one that I hope we shall develop further. Let me say in passing that we are learning more about the implementation of sanctions, and about how to make them effective, as we use the policy more and more.

I hope that my right hon. Friend will forgive me if I say that I do not entirely agree with his criticisms of the way in which sanctions have operated in what was Yugoslavia. It is true--my right hon. Friend the Foreign Secretary made the point--that, fairly recently, oil supplies got through to Serbia, and that is deeply regrettable ; but it is also true that, if the oil part of the Serbian economy is excluded, considerable damage has been done to that economy by the policy of sanctions.

If we proceed no further in our talks in Geneva and New York, as my hon. Friend the Member for Sutton and Cheam (Lady Olga Maitland) rightly observed, there will be a policy of tightening sanctions yet further--if necessary, by a further resolution, which could have the effect of sealing the frontiers of Serbia-Montenegro and preventing all traffic from passing up and down the Danube.

We need to keep two points in mind. First, sanctions will not work unless the states involved implement them, and the riparian states must be told that they have a moral, legal and international duty to implement them. Secondly, there may be a cost. The rest of us must be constructive and imaginative in considering how we can best help, for example, riparian states that are genuinely implementing sanctions. Sometimes, as in the case of the Gulf war, it may be appropriate to establish a particular fund ; on other occasions, it may be appropriate to tell the international financial institutions that it is important to take account of that loss when formulating programme assistance.

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Mr. Dalyell : What is the Minister's comment on the hard statistics that I gave about the effect of sanctions on the health of children in Iraq?

Mr. Hogg : If time permits, I shall deal with that point, because it is a fair point and needs to be answered. First, however, I wish to discuss Yugoslavia.

There has been considerable agreement this evening. It has been agreed, for instance, that we must face the grim fact that there are no wholly innocent victims among those responsible for policy in the former Yugoslavia. That innocent victims exist can be seen only too clearly, but those on all sides who are driving policy forward have a responsibility. True, the Serbs are primarily responsible ; but, as has been pointed out by my hon. Friend the Member for Westbury (Mr. Faber), the hon. Member for East Lothian (Mr. Home Robertson) and others, the Croats and Muslims have also committed crimes. We are almost all agreed that the conflict in Bosnia bears all the hallmarks of a civil war. It is primarily a civil war, although it is aided and abetted by participants from outside, mainly Serbia. There is general acceptance, too, that it is impossible to enforce by external force a settlement of a civil war ; that must be done by agreement. That is why there has been general support for the main pillars of our policy--the attempt to provide humanitarian supplies, using military force in a way that is known to the House ; the lending of strong support to the Vance- Owen plan ; and the application of pressure through sanctions.

As many hon. Members have said, it is terribly important that when we pursue that policy--particularly when we talk about the use of military force in any way--we are careful not to prejudice or imperil the humanitarian efforts that are saving tens of thousands of people. It would be perverse in the extreme if any military or quasi-military action destroyed that humanitarian effort : we must guard strongly against such an eventuality.

My hon. Friend the Member for Westbury and many other hon. Members have asked what will happen if Lord Owen or Cyrus Vance comes forward and says, "An agreement has been struck by all the parties, and we want to have it underpinned by a peacekeeping force.". That question may very well be put to Her Majesty's Government. As it is hypothetical, I cannot answer it in a clear way. However, from the reservations that have been expressed during this debate and on previous occasions, I know that the Government will be subjected to very searching questions.

Those questions are likely to include the following. Is there a genuine agreement to which the parties are genuinely committed? Is there a sustainable ceasefire that will hold? Who is participating? Will the United States contribute substantial ground forces? Will the Russians commit quality troops? Who will be responsible for command and control? Will it be NATO? If it is NATO, will there be a substantial contribution by other member states? I feel certain that questions of that type will be asked and that, if we cannot respond satisfactorily to them, there will be no political support for participation by British troops in a peacekeeping role.

If there is sufficient time I shall deal with the matter of Macedonia and Albania, but I should like to come now to the question of the middle east. I shall begin by saying something about the peace process. The most urgent objective of us all must be to get the peace process under way again. Therefore, the visit of Secretary Christopher is

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of extreme importance, and I hope that he will be able to persuade all the participants of the need to get down to talks.

The right hon. Member for Copeland (Dr. Cunningham) emphasised, and I accept, that the Israeli Government's decision to deport the 415 people into south Lebanon is a serious obstacle to the peace process. We supported Security Council resolution 799, and we have made repeated representations to the Israeli Government that they should comply with it. My right hon. Friend the Foreign Secretary made the point that what has been done is a useful first step, but he said also that it is but a first step, that we seek compliance. I go further. The Israeli Government say that they hope that the absence of full compliance will not stand in the way of further talks. I hope that there will be further talks, but I say to the Israeli Government that, even if there are further talks, lack of compliance with Security Council resolution 799 will result in their being conducted in such a frigid atmosphere as to make progress difficult. Therefore, I hope very much that Prime Minister Rabin will feel able to comply fully with that resolution.

The hon. Member for Linlithgow (Mr. Dalyell) mentioned Iraq. First, we must be clear about the fact that the Government of Iraq under Saddam Hussein have failed, in a number of very important respects, to comply with the resolutions of the Security Council or with their mandatory elements. For a start, he has not returned the Kuwaiti detainees. Secondly, he has not co- operated fully in the identification and destruction of his weapons of mass destruction. Thirdly, he is abusing his own population in a number of disgraceful and lamentable ways. This is non-compliance on a very large scale. The policy of Her Majesty's Government and of the Security Council is to hold to the sanctions until there has been full compliance. I understand the point made by the hon. Member for Linlithgow about the suffering in Iraq, but perhaps the hon. Gentleman does not present the full picture. I hope he will forgive me for reminding him of several elements. The sanctions regime now in place does not cover food, it does not cover medicines, nor does it cover those goods that are certified humanitarian.

The hon. Member for Linlithgow will come back and ask me about money. Here is my rejoinder. Security Council resolutions 706 and 712 enable Saddam Hussein to sell oil for the purposes of raising money for precisely the needs that the hon. Gentleman has identified. Saddam Hussein has chosen not to do it, and that is the problem which he and we face. For that reason I must tell the hon. Gentleman that the policy of adhering to sanctions until there has been full compliance will be maintained.

It being Ten o'clock the motion for the Adjournment of the House lapsed, without Question put.

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Hospitals (Armagh)

Motion made, and Question proposed, That this House do now adjourn.-- [Mr. Andrew Mitchell.]

10 pm

Mr. Seamus Mallon (Newry and Armagh) rose --

Rev. Martin Smyth (Belfast, South) : On a point of order, Madam Speaker. In tonight's Belfast Telegraph there is a comment concerning the decision of the electoral court in which there is this statement :

"If everyone guilty of electoral malpractice were to be disqualified, there might be quite a few vacancies declared". I seek your guidance on whether this should be referred to a committee or whether you can guide us as to what we should do about what I believe is a serious accusation. There are legal procedures, as people are aware, for malpractice, and they ought to follow them through.

Madam Speaker : May I suggest to the hon. Gentleman that he writes to me without delay and lets me have the evidence so that I may see it in full?

Mr. Mallon : I very much welcome the opportunity to raise this matter on the Adjournment. Almost by definition, Adjournment debates are parochial. They are confined to one's own constituency and, as of right, I think, they express concerns within our constituencies. But in this instance, while I want to deal with a localised issue in relation to two hospitals in Armagh that most hon. Members have never seen and never will-- although, Madam Speaker, I hope that at some time in your arduous duties you will find the opportunity to visit Northern Ireland and especially my constituency and these two hospitals, where you would be more than welcome- -there is a much wider and general point to be made. In relation to these two hospitals, the issue encapsulates one of the core tensions within the entire debate about health care provision.

There are three of those tensions. The first is quite simple, and it is the one that the debate centres on : the survival of the small, local, community hospital as against the large, centralised unit, based on the erroneous assumption that large equals better and more cost-effective. I believe that to be wrong and, in this specific case, I believe it to be very wrong. Not only that, but it is contrary to the Prime Minister's own charter, which we all received with great anticipation ; contrary to the Northern Ireland Office charter ; and contrary to the board charter that we received through the post only three days ago. That is the first false assumption underlying the type of approach that we anticipate in relation to these hospitals. The second core tension is that of quality of care as opposed to cost-effectiveness. As we progress through the debate, I hope to show that that is another erroneous assumption. The third crucial element, again relating to the citizens charter, is sensitivity to the needs of the community as opposed to bureaucratic requirements, bureaucratic requirements in this instance being those imposed by the Government and, in a very supine fashion, adopted by the boards. The boards have shown clearly that they evaluate and know the price of everything, but the value of nothing. The difficulty is that, once a decision is made on that basis, it is impossible to reverse.

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I believe that we have a valid case about the community hospital in Armagh and Mollinure hospital. Mollinure hospital was opened 18 months ago by Lord Arran, who described it as

"unique in Northern Ireland",

the first of its kind in Northern Ireland and

"among the best in Europe."

Would not it be a remarkable irony if, 18 or 24 months hence, the same Minister were to close the new purpose-built unit that he described in such glowing terms? The danger is that that may happen. No doubt the Minister will tell me that I am jumping to conclusions and that we are debating only options. No doubt he will have the booklet that has been issued by the board, "Making Choices", which presents six options, four of which contain the presumption of closure of the hospital that Lord Arran rightly praised so generously. Those options must be questioned. The debate will allow the Department of Health and Social Services to focus its attention on those choices.

Mr. David Trimble (Upper Bann) : I am sure that the hon. Gentleman will acknowledge that those four choices threaten not only his two hospitals but the hospitals in the constituency of the hon. Member for South Down (Mr. McGrady), two of the three hospitals in my constituency and perhaps one hospital in the constituency of my hon. Friend the Member for Fermanagh and South Tyrone (Mr. Maginnis). There is a wider dimension.

Mr. Mallon : I thank the hon. Gentleman. That is indeed why I tried to make the broader point that this is not just a parochial constituency matter. It affects Banbridge hospital, Lurgan hospital, Loane house and the whole caring service in the north of Ireland. "Making Choices" is cleverly written. Four of the options contain an underlying presumption in favour of the closure of the two hospitals that I have mentioned. I am not opposed to the development of three acute units at South Tyrone hospital, Craigavon and Daisy Hill in Newry, but they must not be developed at the expense of the smaller unit that caters for a vast area in our community and that is doing an immensely good job.

I referred to the praise that the Minister heaped on Mollinure. It is unique, because it is not just a geriatric hospital : it has a day care unit that allows elderly people to be assessed for perhaps two days a week and to return to their homes in the community to recuperate. That is crucial.

One of the main purposes of the Department is to get people back into the community. Mollinure hospital achieves that. Its assessment unit is unique, because it allows people to be assessed properly, not merely by one doctor but under the multi-disciplinary services it offers. Many people come in whose GPs have decided that they should be in continuous care, but this assessment allows them, after an examination and a period of rest, to go back into the community. The third crucial point concerns the respite that this allows for carers. How often is lip service paid to carers in our community? Carers are a crucial part of the whole health care service, and a growing part, with the cut that we are experiencing. If elderly people can go into this type of unit while carers enjoy a respite for one or two days, or for a holiday period of a week or two weeks, that caring service will improve substantially. That is what is under threat, and that is what I am concerned about.

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Armagh community hospital is a small, effective unit. It covers a vast rural hinterland, as well as the city of Armagh. It stretches to the border areas, upwards of 40 miles. For many people, it is their nearest point of contact, and this hospital serves the area exceptionally well. In the past year, it has served 38,000 patients out of a population in the region of 60,000. Not only that, but of that figure, 14,000 attended the casualty unit.

I have not doubt that we shall be told that the hospital is not cost- effective ; it is small, it is good, but we shall be told that its work should be done in one of the acute units, because it is not cost-effective. Lest that be given any credence, I will give two examples.

In 1992, the out-patient cost in Armagh community hospital was £9.22 per attendance. In one of the bigger hospital acute units, in the same unit of management--the South Tyrone hospital--the cost was £17.99. I cast no aspersions on the South Tyrone hospital, nor would I ever do so. I am simply making the point that, if we are to talk about costs, as I have no doubt the Minister will, we should bear that in mind.

My second point relates to the casualty element, and this applies only to staffing. The cost per attendance of those 14,000 people who attended casualty was £12 per head. I believe that that could not be equalled in any of the acute units, or probably in any of the other units available to us.

My next point is that the hospital serves a huge hinterland. The board has told us in its own little booklet--I view the booklet with more suspicion every time I read it :

"If service charges reduce accessibility, compelling reasons must be shown."

There is almost no such thing as public transport in that area ; it is almost totally rural. The only way for people to get to any hospital is by car, if they own one. If they do not own a car, they are dependent on the good will of their neighbours.

We are forgetting the basis of the charter again if changes are made and we bring health care to the people rather than people to the health care. I make that point in a very substantive way, because, when it comes to the health care of people, time means lives. The longer people have to travel, the further the distance, the greater the risk to them.

I make a last general point about the loss of jobs that will be involved. It might be said that one should not do that in this type of debate, in which we are talking about a health service issue, but it is crucial, because the people of whom I speak have given an enormous amount to the sick and elderly in the Armagh area. It is only right that I should refer to their position, because I do not want more jobs to leave Armagh. I do not want to see any more young people with expert ability to care for the disadvantaged having to leave the area to seek work.

In his last contribution to the United States Congress, Senator Hubert Humphrey made a comment that was apt to the situation to which I refer tonight and to many others :

"The moral test of government is how it treats those who are in the dawn of life--the children ; those who are in the twilight of life--the aged ; and those who are in the shadows of life--the sick, the needy and the handicapped."

We are dealing with all those categories. I urge the Minister to ensure that whatever decision is made meets the moral test laid down by Senator Humphrey.

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10.15 pm

The Parliamentary Under-Secretary of State for Northern Ireland (Mr. Jeremy Hanley) : I must at the outset congratulate the hon. Member for Newry and Armagh (Mr. Mallon) on his assiduousness in applying for the debate and his tenacity and perseverance in securing it.

There can be no doubt that the issues that he raises are of concern in his constituency, and he is right to raise them in the House. He will not be surprised when I tell him, in the time available to me, that there is still a considerable time left in which to consider the future of the two hospitals in question, and I am sure that he will take part, as will other hon. Members, in that process.

The hospitals in question, Mullinure geriatric hospital and Armagh community hospital, are two of the eight general and acute hospitals currently under review by the Southern health and social services board. In March of last year, following the publication of the Department of Health and Social Services regional strategy and its own area strategy, the Southern health and social services board decided that the time was opportune to review the provision of acute and general hospital services in its area.

A hospital planning liaison group was set up and immediately commissioned each unit of management providing those hospital services to undertake a review of current provision. From the reports received from the units concerned, the planning liaison group prepared a consultative paper, to which the hon. Gentleman referred, entitled "Making Choices". That was issued to a wide range of groups and individuals early in December 1992 inviting responses by 28 February 1993. I understand that, following complaints about the length of time allowed for consultation, the board agreed to extend the period to 31 March.

It is important that the status and purpose of "Making Choices" is fully understood. It reaches no conclusions about the overall pattern of hospital provisions, about the future role of any hospital in the area or about the size of any hospitals or specialties they might offer. The paper is intended to provide the background to a consultation process which will assist the health board, in the first instance, to reach a broad view about the future pattern of hospital care ; that process should be completed by about June this year. Thereafter, it will be necessary to undertake much more detailed planning to test and quantify any proposed changes before they can be implemented.

The objective of the present exercise is to reach that broad view on future services. It should be borne in mind that in the detailed planning of any changes, there will be a further opportunity for people in the community or hon. Members to examine the available data more critically. Where the closure of any facility is contemplated, there will be a further public consultation exercise.

As the hon. Gentleman said, "Making Cioices" presents us with six options describing possible patterns of future hospital services. The board has made it clear that they are not recommendations but subjects for discussion to stimulate debate on the future pattern of hospital care. It is easy to say that if an item is suggested as a subject for discussion we are somehow steering the public towards a particular course. That is not so--we hope that the people will take the six choices as an opportunity for general and genuine debate. As I said, "Making Choices" is not intended to come to a conclusion on the future of Mullinure or any other

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hospital. I shall concentrate on Mullinure because the hon. Gentleman made a particular point of saying that it has been opened recently. Although it was recently opened officially, it was planned some years ago, based on the best information available and in response to a pressing need to find suitable alternative accommodation for people who were housed in what I think the hon. Gentleman would agree were wholly unacceptable conditions at Tower Hill. The full impact of the community care policy had not become evident and was not anticipated at that stage. The extent of the growth in the private and voluntary sectors could not have been envisaged.

The capital cost of Mullinure was approximately £2.3 million. It is accepted that that is a considerable sum, but it is small in terms of the overall capital expenditure to bring hospital services into the next century, let alone the next millenium. More significant is the revenue cost, which was £1.85 million for Mullinure in 1991-92. The board will of course seek an alternative use for any buildings which might become redundant. The pattern of service provision has to change in the light of new developments, new treatment techniques and advances in medical science. Paragraph 7.33 of "Making choices" states that there might be other options for the development of geriatric hospital services. Although it is beneficial to have assessment and rehabilitation services on an acute hospital site, it does not apply to continuing care beds. A strong case can be made for their being as local as possible for the sake of convenience and to maintain links with the community. However, as I said, nothing has been decided.

We must consider the fact that we now have a different system of health care. We have come into the modern world. There is an increased emphasis on promoting health and preventing disease, in addition to providing care and treatment for those who need it. There is a continued development of acute hospital services to allow them to develop the role of providing specialised care. There are further shifts from institutional care to care at home or in the community, paralleled by a strengthening of the role of primary care. There is also improved targeting of health and social need to ensure that the most disadvantaged people in the community receive an adequate share of services. Changes in acute hospital services must be viewed in the context of improving the community's health and wellbeing alongside changes in other services, with the overall objective of making better use of existing resources.

The hon. Member for Newry and Armagh and the hon. Member for Upper Bann (Mr. Trimble) referred to the six options which have been tested against the board's core values for service provision. The core values are as follows : appropriateness, as services should meet the needs of individuals and the population as a whole ; equity, as there should be no administrative, social or geographical barrier to services and there should be a fair share of the services available to the whole population in accordance with need ; accessibility, because as far as possible services should be available locally, as the hon. Gentleman stressed ; acceptability, as services should satisfy the reasonable expectations of the population ; efficiency, as services should use resources to their best effect ; and lastly, effectiveness, as services should achieve the intended benefit. The board's options reflect the Department's strategy for the provision of acute hospital services, which has two

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main elements : the concentration of specialised services on a smaller number of sites, using markedly fewer beds overall, accompanied where necessary by supporting services locally ; and a substantial shift from in-patient to day and out-patient investigation and treatment. The strategy's aims reflect the public demand for increasingly sophisticated and technically advanced services which lead to more effective treatment, shorter stays in hospital and, more importantly, better results for patients. I have often said in the Chamber, and repeated during the 16 months that I was Minister responsible for health in Northern Ireland, that the health service in Northern Ireland should be to treat patients and that the social services in Northern Ireland should treat the clients as well as possible. We are not a furniture warehouse, or a job protection scheme, but we must consider the available facilities to make sure that there are sufficient beds for the necessary operations and sufficient people to provide that care.

Mr. Trimble : In his latter comments the Minister set out the criteria that the board has set for itself. He seemed to be concentrating more in its application concerning acute services. Does he appreciate that one has to give more weight to certain considerations when dealing with different aspects of medicine, and that in providing continuing care for the elderly particular emphasis should be placed on accessibility? The carers are usually also elderly and not particularly mobile ; consequently, there is a greater need for local provision. That adds weight to the argument of the hon. Member for Newry and Armagh about Mullinure and other hospitals which are providing continuing care for the elderly.

Mr. Hanley : The hon. Gentleman makes an important point. However, Northern Ireland is better suited than almost anywhere else in the United Kingdom to providing the right care, as we have health and social services boards which combine two aspects of provision within one area of responsibility. The boards are therefore able to plan both the acute services and the social services for the area : instead of what has happened in the past in other parts of the United Kingdom where the service has not always been matched, in Northern Ireland we can plan for the right balance.

Turning to the strategies for elderly people, the options to which the hon. Gentleman referred also reflect the Department's strategy for services for elderly people,

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which aim to increase the proportion of people aged 75 and over who are cared for in their own homes to 88 per cent. by 1997. It is a well established fact that the vast majority of elderly people prefer to be cared for in their own homes. Of course, people should not be cared for in their own homes if they are not suited to or do not want to be cared for in their own homes, but the basic principle that the vast majority want that, and that it is the best treatment for them, underpins the Government's community care policy.

The three major principles of that within the document "People First" were, first, to help elderly and other vulnerable people to lead as far as possible full and independent lives ; secondly, to respond flexibly and sensibly to the needs and wishes of invidual people and the relatives and friends who care for them ; thirdly, to concentrate professional skills and public resources on those who need them most.

I repeat what I said at the beginning of my speech. We are in a consultation exercise : absolutely nothing has been decided yet. General direction has been given because of the needs of people in Northern Ireland and the best use of resources. The hon. Gentleman said in an aside, "If it's not broke, don't fix it," but life does not stand still, and that also applies to medical treatment. If there are new ways of treating people better, if people can stay in hospital a shorter time, and if elderly people can be treated in their own homes in the way that they want, we should aim for that. We should be treating people as flexibly, professionally and in as modern a way as possible, making the best use of resources. I stress again, as I often have, that any money saved by the process, if there are savings to be made, will go straight back into patient care ; it is not a cost-cutting exercise. Hon. Members may treat that comment cynically, but it is an honest pledge that we shall put any money saved by these exercises into improved patient care in the areas where the money is saved.

I am grateful that the hon. Gentleman has raised the subject today. I hope that I have helped to stimulate more responses to the document than might have been forthcoming otherwise, and I hope that the hon. Gentleman will continue to make contributions to this particular procedure, and that ultimately we shall be able to serve the people of Northern Ireland better than in the past.

Question put and agreed to.

Adjourned accordingly at half-past Ten o'clock.

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