Plans for a shake-up in how Northern Ireland's hospitals and health service should be run have been revealed by the health minister.

Bairbre de Brun said the proposals would bring about a more effective service - improving the treatment of life-threatening illnesses like cancer and heart disease.

A single regional authority would replace the four health boards and have responsibility for strategy and buying services.

Bairbre de Brun: Minister for Health

There will be nine acute hospitals - one of them a new hospital - which will be built in, or north of, Enniskillen in County Fermanagh.

To tackle the waiting lists problem, Lagan Valley in Lisburn, County Antrim, will become a specialist centre for non-emergency surgery.

Among the other recommedations are:

• A second specialist centre to be developed in a hospital in the west of Northern Ireland
• The Downe Hospital in Downpatrick, County Down, and the Tyrone County in Omagh will have "enhanced services"
• These services are likely to include out-patient clinics, day procedures and diagnostic tests
• Omagh would be in the frame for the development of a new unit to handle waiting list work
• The Downe Hospital would lose its maternity unit - but maintain 24 hour accident and emergency services

The minister also announced a fresh look at how to re-structure health service organisations

This is to be done in a co-ordinated way with a central review of all public administration.

However, the minister admitted she has not secured the funding necessary for her proposals.

Health boards

The report goes out to consultation until the end of September.

In 1996, Northern Ireland had 19 acute hospitals which had full accident and emergency units and the facilities to carry out life-saving surgery.

We are now a step closer to making decisions on acute hospital services

Colm Donaghy Southern Health Board

In the years since then, there have been a series of reports from the Department of Health and from the health boards, all recommending the number should be cut.

In that time four acute hospitals have closed - Ards, Banbridge, South Tyrone in Dungannon, which was supposedly a temporary measure, and the Route in Ballymoney which shut when the new Causeway hospital opened at Coleraine.

SDLP South Down MP Eddie McGrady said the proposals would "satisfy some of the needs and requirements of the people of this area".

However, he said they would "deny mothers and potential mothers continued direct access to an in-patient maternity service in Downpatrick".

"It is unsatisfactory that yet again such proposals will be put in the review pot," he said.

Comprehensive health

Colm Donaghy, acting chief executive of the Southern Health and Social Services Board, said years of chronic underfunding had contributed "to the serious problems we face today".

"We are now a step closer to making decisions on acute hospital services. It is essential that the uncertainty which has existed is brought to an end," he said.

The Eastern Health Board also welcomed the report and said it offered "the potential to further strengthen and modernise hospital services and management structures".

"The report... also acknowledges the important role of commissioning comprehensive health and social care services," it said.

Breedagh Hughes, secretary of the Royal College of Midwives in Northern Ireland, said it was pleased the review recommended the development of stand-alone midwife-led units.

Ulster Unionist health spokesman Robert Coulter said he believed patients were at last being given the priority they deserved.

Mr Coulter, a member of the assembly's health committee, said: "Decisions are being made for the benefit of patients and not for some kind of cosmetic change in administration."

He added: "The fact that the report says no local hospitals will be closed is important but the lack of accident and emergency services at many is a concern."