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MINUTES OF PROCEEDINGS OF THE HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY COMMITTEE AT 2:00 PM ON WEDNESDAY, 26 JUNE 2002 IN ROOM 135, PARLIAMENT BUILDINGS Present: Apologies: In Attendance: Dr Hendron took the Chair at 2:05 pm. Private Session 1. Chairman's Opening Remarks i. Agreed: The Chairman will send a letter of sympathy, on behalf of the Committee, to its former colleague, Mr Alan McFarland, on the passing away of his father yesterday. ii. The Chairman drew members' attention to a paper by Research Services that categorised the applicants for the post of special adviser to the Child Protection Inquiry, on the basis of their responses. Agreed: The Committee was content with the proposal to shortlist for interview those experts falling into the highest category. The Clerk will convene a Committee interview panel over the next few days to select the preferred candidate. iii The Chairman reported briefly on the conference he had attended at Island Hall in Lisburn that was reporting on the 'Families Project', a partnership project between a learning disability charity, United Response Northern Ireland, and Downe/Lisburn HSS Trust. The project provides support and services for children and young people with a learning disability, and is being financed by the Department initially for three years. The Chairman was highly impressed with the initiative and expressed his hope that longer-term funding would be secured to allow it to be extended across the four Board areas. iv. The Chairman advised that the General Practitioners' Committee of the BMA (NI) was meeting today to discuss concerns in relation to the establishment of the Local Health and Social Care Groups, and that the Committee could return to this matter when more detail was available. Some members raised concern that low morale among GPs was leading to more referrals to the already over-stretched acute hospitals, with the resultant "trolley waits" and pressure on doctors and nurses. v. The Chairman reported briefly on the informal Committee meeting on Monday, 24 June 2002 with Belfast Door Project. Its mission is to work with the statutory and voluntary sector in establishing a multi-agency youth building, to help marginalised young people from across the Greater Belfast area and beyond in accessing a wide range of services. A briefing paper on the work of the Project has been issued to members. Public Session 2. Minutes of Proceedings of the Last Meeting The minutes of the meeting of Wednesday, 19 June 2002 were agreed. 3. Matters Arising The Clerk will report on the arrangements for the announcement of key Departmental policy statements by the Executive and Minister, for consideration at next week's meeting. [2.25 pm] 4. Subordinate Legislation i. Feeding Stuffs (Amendment) Regulations (Northern Ireland) 2002 Agreed: That the Health, Social Services and Public Safety Committee is content with the Department's proposal for Feeding Stuffs (Amendment) Regulations (Northern Ireland) 2002 ii. Animal By-Products (Identification) (Amendment) Regulations (Northern Ireland) 2002 Agreed: That the Health, Social Services and Public Safety Committee is content with the Department's proposal for Animal By-Products (Identification) (Amendment) Regulations (Northern Ireland) 2002. iii. Statutory Rule No. 206/02 - Pharmaceutical Society of Northern Ireland (General) (Amendment) Regulations (Northern Ireland) 2002 The Clerk advised that further information was being sought in relation to members' concerns about the level of the fee increase for students, which would be tabled for consideration at next week's meeting. iv. Statutory Rule No. 217/02 - Meat (Hazard Analysis and Critical Control Point) Regulations (Northern Ireland) 2002 Question put and agreed to: That the Health, Social Services and Public Safety Committee has considered Statutory Rule No. 217/02 - Meat (Hazard Analysis and Critical Control Point) Regulations (Northern Ireland) 2002 and, subject to the Examiner of Statutory Rules being satisfied as to its technical effectiveness, has no objection to the Rule. v. Statutory Rule No. 221/02 - Optical Charges and Payments (Amendment No.2) Regulations 2002 Question put and agreed to: That the Health, Social Services and Public Safety Committee has considered Statutory Rule No. 221/02 - Optical Charges and Payments (Amendment No.2) Regulations 2002 and, subject to the Examiner of Statutory Rules being satisfied as to its technical effectiveness, has no objection to the Rule. vi. Statutory Rule No. 226/02 - Food and Animal Feedingstuffs (Products of Animal Origin from China) (Emergency Control) Regulations (Northern Ireland) 2002 Question put and agreed to: That the Health, Social Services and Public Safety Committee has considered Statutory Rule No. 226/02 - Food and Animal Feedingstuffs (Products of Animal Origin from China) (Emergency Control) Regulations (Northern Ireland) 2002 and, subject to the Examiner of Statutory Rules being satisfied as to its technical effectiveness, has no objection to the Rule. [2.35 pm] 5. Executive Position Report 2003/04 Departmental Officials: Resources Officials briefed the Committee on the Department's position with regard to the Executive Position Report. They set the various Departments' substantial bids in the context of the limited resources available and the statement by the Finance Minister that the significant additional resources from the Chancellor's SR 2002 statement should be devoted to the Health Service. Mr Hill emphasized that even if all the Chancellor's additional resources were devoted to health, the Department would still be significantly short of being able to maintain existing services. Indeed, if the Executive were to devote to health the entire £125m Room to Manoeuvre funds currently available, it would only allow movement on a few of the Department's developmental bids. The Department's bids are designed to fill gaps in critical services. The fixed Block Grant allocation for Northern Ireland will be decided after the Chancellor finalises the Spending Review for England on 11 July. Mr Hill emphasized the critical importance of the Committee's input in order to influence the Executive's draft Programme for Government and Budget in September 2002. The Report records the position in relation both to the resource constraints imposed by the Barnett Formula and the Needs and Effectiveness Evaluation, which has been conducted in collaboration with DFP and OFMDFM. The Department is confident that the evaluation will clearly show, through the range of comparisons made, the local HPSS match favourably with GB in providing value-for-money services. In terms of needs, they are significantly greater, with an estimated minima underfunding of £190m rising to what the Department estimates could be as high as £350m. The £190m is the product of a detailed Relative Need Assessment as of 2000/01, which evaluated the key determinants of health by deprivation in comparison with England. The gap has increased since then, because the Barnett Formula has meant that Northern Ireland has not matched England's increased expenditure on health. If the Executive is to recognize the plight of the Health Service, the Department argues that the temptation to add more priorities to the top three already identified must be resisted. Moreover, the skewing of priorities must be towards health at the expense of other departments. The Department is of the view that there is no room for further priorities, in addition to those of health, education and transport identified last year by the Executive. If the chronic problems facing the Health Service are to be faced, the Department feels that the priorities should be further refined to place health as the most pressing need. The Wanless Report highlighted the growth in technology and the ability to do more as the single most serious issue facing the Health Sector in terms of financial pressures over the next 20 years. This is reflected in the substantial increase in the final cost of the Cancer Centre from the initial estimate, to take account of advances in modern technology. Substantial additional capital is being sought to improve the provision of the Ambulance Service A&E and Critical Care Transportation services, to support the proposed new configuration of acute hospital services. The Officials pointed to the detailed analysis in relation to the bids and the measures taken to control and manage expenditure in the health and social services, including the extensive savings being sought, as being a sound basis for the Department's bids. Family and Childcare Services feature as a priority in the Department's bids, as there is a clear recognition to build up capacity in this sector, particularly with regard to the development of Sure Start, services for children with learning and physical disabilities, and residential child care provision. Staffing shortages are recognized as a problem across the Health Service, and the Department has been giving increasing attention to this issue through its workforce plan. At present, some £600,000 per year is being devoted to the recruitment and training of additional social workers. Expenditure on childcare services per annum has increased from £57m in 1995/96 to £70m in 1999/2000, to rise further to some £98m in 2003/04. However, much more work needs to be done in this field. The Department fully recognizes the need to relieve the extreme pressures faced by social work field workers and the need to provide better support to foster carers, who give sterling service in looking after some 1,500 children. One of the key elements of the announcement on the loans package was the Executive's proposal to establish a strategic authority to examine the totality of capital needs across all Departments. In the context of the PPP Report, 'Financing the Future,' the Department is considering a mixed approach to tackling infrastructure deficit and is open to exploring every route. There will be a high challenge for PPP proposals to demonstrate better value for money than public sector procurement in the Health Service, as there is generally little scope for financing costs to be offset by greater efficiencies, or through Health Service facilities lending themselves to third party income. Also, clinical staff would not be included in a PPP transfer. PFI best lends itself well to the maintenance and upgrading of Health Service equipment, which have regular replacement cycles. In terms of demonstrating value for money, a recent analysis by the NICON report showed that Health Service management costs are less in Northern Ireland than in GB. In overall terms, the costs are broadly comparable. A specific section in the Needs and Effectiveness Report addresses this issue. There is potential for limited financial savings by amalgamation of local Health Service structures, but the real gain will be in improving the effectiveness of the service. The Executive has begun the Review of Public Administration and the Department is currently seeking responses to its consultation document on the Review of Health Service Structures. The Department recognizes the need for significant changes to improve efficiencies, which are reflected in a range of strategies, as well as the structure of the bids. For example, in order to tackle the problem of waiting lists there needs to be increased capacity in primary care and the community sector. In constructing the bids, the Minister has attempted to skew priorities towards the community, where there has been neglect. Programme for Government There must be a clear outcome from all areas of expenditure that demonstrates value for money. The linkage between resources and outcomes has been an enhanced feature of the Programme for Government. The question for the Committee is what are the key social, economic and environmental issues. Are the current five priorities all still relevant and is the concept of Service Delivery Agreement working? The new focus on quality of public services is welcome. The Department fully supports the four areas identified of investing in infrastructure, improved service delivery, tackling social exclusion, and partnership. This must be linked closely with the rating policy and the question of generating additional resources. For example, it would not be feasible to try to squeeze from the existing resources the funding required to improve water and sewerage services. The Department recognizes that additional resources alone are not enough to bring about the necessary improvements in service delivery. It is also a question of how, why and where need is met. Some £195m in efficiency savings has been achieved by the Department over the last 10 years, and a further £12m is being found in the current year. There is significantly more to be achieved and the Department will shortly be publishing an ICT strategy. Initiatives generated under Executive Programme Funds in relation to GPs have significant potential to improve delivery to the patient. Social exclusion is very important because of the direct links between deprivation and health. This highlights the importance of partnership across the Departments as demonstrated in the Investing for Health initiative. Equality, New TSN and health go hand in hand. The health action zones have proved very successful and have been given due importance by senior staff in other agencies. Officials recognize that more work could be done under Executive Programme bidding strategies in relation to inter-departmental partnerships. The Department believed that the priorities are entirely relevant and should not be changed. A clear monitoring and challenge role will work well in improving service delivery. Agreed: That the Committee's response to the Executive Position Report should be considered at its next meeting. [3.15 pm] 6. Strategy for Carers - Departmental Briefing Departmental Officials: The Officials gave a brief presentation on the Strategy for Carers document, which was issued in April 2002 and contains proposals for practical measures that will make a real difference to the estimated 250,000 carers in Northern Ireland. The Officials summarised the series of recommendations designed to improve the services to carers in relation to health, social services education, training and employment. Work to implement the recommendations of the strategy will be taken forward by an inter-departmental group, recognising the contribution that other Departments make in supporting carers. The recommendations are summarised under the following three headings: Information and Training
Support Services
Employment
Young Carers
Co-ordinating Support for Carers
Agreed: The Committee will evaluate the effectiveness of the Strategy in due course once the implementation of the recommendations has had time to bed in. [3.35 pm] 7. Children (Leaving Care) Bill (NIA 5/01) - Draft Report The Committee deliberated. Draft Report on the Children (Leaving Care) Bill (NIA 5/01), proposed by the Chairman, brought up and read. Ordered: That the draft Report be read a second time, paragraph by paragraph. Paragraphs 1 to 28 read and agreed to. Resolved: That the Report be the Fourth Report of the Committee to the Assembly. That the Report should include written and oral evidence from the list of witnesses in Annex A. Ordered: That the Report be printed. [3.50 pm] 8. AOB i. Agreed: The Committee will host an informal lunchtime meeting with the Association of Nursing Students (ANS), Northern Ireland in the Autumn Session. ii. Agreed: The Clerk will arrange an informal Committee briefing by the manager of the Alzheimer's Society, on the report and recommendations of a survey of 130 carers across Northern Ireland. iii. The Chairman advised members that he intended to meet informally with a member of the UK Lyphmoedema Support Network in the coming week to discuss issues in relation to local services for patients. Members will be invited to attend. iv. The Clerk advised members of the possible clash of next week's meeting with the Assembly's Plenary Business, when the Second Stage of the Children and Vulnerable Adults Bill and the Further Stage of the HPSS Bill will be debated. The Clerk will review the situation and advise the Committee accordingly. He will confirm the arrangements followed by the Business Committee for minimizing the risk of members' overlapping commitments. v. The Clerk advised members of the forthcoming meeting with Mr Richard Congdon, Chief Executive of the CESDI (Confidential Enquiry into Stillbirths and Deaths in Infancy) in Castle Buildings at 10.00 am on Thursday, 04 July 2002. Dr Maureen Scott, CESDI Regional Co-ordinator, and Dr Henrietta Campbell, Chief Medical officer, will attend the meeting. vi. The Clerk advised members that the management of the South Tyrone Hospital had indicated that the rescheduled visit by the Committee could be facilitated on Thursday, 04 July 2002. Members will be contacted to confirm their availability to attend. 9. Date and Time of the Next Meeting The next meeting will be at 2:00 pm on Wednesday, 03 July 2002 in Room 135, Parliament Buildings. The meeting ended at 4.00 pm. DR J HENDRON June 2002 ANNEX A ORAL EVIDENCE Barnardo's First Key North & West Belfast HSS Trust Children's Law Centre Department of Health, Social Services and Public Safety LIST OF WRITTEN SUBMISSIONS 1. Southern Health & Social Services Board |
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