As part of a series of interviews with NI Executive ministers, Monika Unsworth talks to the Health Minister, Ms Bairbre de Brún, charged with steering an under-funded Northern health service out of crisis
Everybody knew Bairbre de Brún was handed a poisoned chalice when she accepted the health portfolio in December 1999, but few could have anticipated the scale of the crisis she would be facing.
In its latest report published last week, the Northern Ireland Confederation for Health and Social Services, whose members include more than 95 per cent of all health trusts and boards in the North, said that without an extra £100 million sterling investment each year over the next 10 years, the health service would not even be able to deliver an "acceptable level" of provision.
According to the report, Northern Ireland has the longest hospital waiting lists in the UK, with fewer acute hospital beds on average per population, the lowest per capita spend on public health services, the highest incidence of heart disease and the lowest survival rates for a number of cancers in Europe.
So where do you start as the Minister of Health, Social Services and Public Safety? Ms de Brún says she is in no doubt about what needs to be done. "I certainly wouldn't wish to put a specific figure on the amount needed at this time. But there is no doubt that the legacy of under-funding over a prolonged period in the 1980s and '90s by the British Conservative government has left us with a situation where the money was not only not in the system but there wasn't the investment in training, in beds, in staff, in hospital equipment and in the community.
"There is no way round the fact that without considerable extra resources and a recognition of the damage done by previous funding decisions, we will not be able to make progress."
The former schoolteacher says she had "all of the first 10 minutes" to get to grips with the many complex issues of her portfolio. "There simply wasn't any choice. Within weeks there was a major decision to be taken surrounding the future of maternity services on the basis of consultation that had been carried out before I ever took office.
"There were a number of other very important issues pending that needed to be taken forward with fairly great speed. I also took office at the beginning of December at a time of great pressure on health and social services due to a very severe winter. So within weeks I was grappling with very major issues."
Nevertheless she has found the challenge "truly rewarding", Ms de Brún hastens to add. "Yes, I do feel I have achieved something in the two years since I took office. There have been some immediate, specific actions.
"We now have 33 more intensive care and high-dependency beds, more residential childcare places, 100 extra nurses in training a year, 100 more ambulances on the road, extra community care provision with 1,000 new care packages in the coming year alone.
"I am also establishing new local health and social care groups which will bring together local health professionals with local people making decisions about local services. I am putting an end to the last vestiges of the internal market and ensuring closer co-operation in terms of the competition and competitiveness that was there before. There is also the Acute Hospitals Review that will set the hospital and health agenda for years to come."
The quietly spoken Sinn Féin MLA seems to attract more hostility from political opponents both inside and out of the Assembly chamber than even her party colleague, Minister of Education Martin McGuinness. What has she found to be the main cause for irritation - her gender or her political views?
"For some it's the fact that I am a woman in a position of power, for some it's a question of political beliefs, for some it is the fact that I am an Irish speaker. For some people the question of cultural practice seems to impact on their view of another person's ability or integrity.
"But I must say that I have found throughout society and throughout all my visits to local services that people from all political backgrounds see beyond that or in some cases don't see that at all and treat me as the Minister and I find that very rewarding and fulfilling and a privilege to work with people who are carrying out such vital work in our society."
After a little hesitation she adds: "But yes, some of the very personalised attacks are hurtful."
Last year, the two Sinn Féin ministers were banned from attending North-South Ministerial Council meetings by the First Minister, Mr David Trimble. While officials in both departments did their best to continue cross-Border projects, Ms de Brún feels that some of the "impetus that comes from a strategic ministerial overview" was lost during that time.
However, much fruitful cross-Border co-operation is going on, she insists, in such areas as food safety, cancer research, joint health promotion and the pooling of resources for equipment and training.
Having repeatedly highlighted social deprivation as one of the main causes for ill health in the North, Ms de Brún has found herself working closely with other Executive ministers on the issue.
She finds it "somewhat frustrating" that her two DUP colleagues, Minister of Social Development Nigel Dodds and Minister of Regional Development Peter Robinson, still refuse to sit on the Executive or deal with her directly. However, she is heartened by the fact that DUP MLAs have been working closely with the other parties on a committee level.
While there will continue to be "stumbling blocks", Ms de Brún says she is hopeful that the Assembly will be able to continue its work without further suspensions. Does the decommissioning issue not remain one such stumbling block? The Sinn Féin Minister flinches slightly before deflecting the question.
"I knew I would not get to the end of an interview without somebody plucking the word out of nowhere.
"I think there have been many stumbling blocks placed in the past in the way of the institutions, in the working of some of the commissions, in the work of the human rights and the equality agenda, in the right of people regardless of what community they live in to have the same experience of peace and the new beginning we all want to see.
"I wouldn't like any stumbling blocks placed in the path of all our people on the island of Ireland in the future."