Northern Ireland Assembly Flax Flower Logo



Health and Social Care Bill

10 January 2008

Letter from Joyce Cairns

Members present for all or part of the proceedings:
Mrs Michelle O’Neill (Deputy Chairperson)
Mr Alex Easton
Mrs Carmel Hanna
Mr John McCallister
Ms Carál Ní Chuilín
Ms Sue Ramsey

Ms Gail Anderson ) Department of Health Social Services and Public Safety
Ms Joyce Cairns )
Dr Norman Morrow ) Chief Pharmaceutical Officer for Northern Ireland

The Deputy Chairperson (Mrs O’Neill):
We now turn to the Health and Social Care Bill. Members will recall that officials from the Department briefed the Committee on the Bill on 18 October 2007. The Health and Social Care Bill is currently progressing through Westminster. The Bill contains provisions in respect of devolved matters that will require a legislative consent motion to be passed by the Assembly. The motion has been scheduled for debate on Monday 14 January 2008.

The Minister has written to the Committee to request its views. I refer members to their copies of the Minister’s letter and related documents. Members also have a copy of the Hansard report of our 18 October 2007 meeting. The main issue of relevance to the Committee is the regulation of pharmacists, and correspondence on that matter from the Pharmaceutical Society of Northern Ireland was tabled only today. Officials are in attendance to explain the provisions of the Bill and to answer members’ questions.

I welcome Joyce, Norman and Gail. I invite you to outline the provisions of the Bill.

Ms Joyce Cairns (Department of Health, Social Services and Public Safety):
Thank you. As you said, Chairperson, the legislative consent motion endorsing the extension to Northern Ireland of the provisions of the Health and Social Care Bill has been tabled for debate in the Assembly on Monday 14 January 2008. The Bill was introduced at Westminster on 15 November 2007, and it deals with several issues arising from the White Paper, ‘Trust, Assurance and Safety — The Regulation of Health Professionals in the 21 st Century’.

The provisions of the Bill affect the following devolved matters: the abolition of the National Biological Standards Board; the regulation of healthcare professions; the creation of a care quality commission, and the payment of a health-in-pregnancy grant. Most of those matters do not involve Northern Ireland to any great extent.

I shall briefly address the four sections that are covered by the Bill.

The National Biological Standards Board will be abolished. It was set up by the Biological Standards Act 1975, and is controlled by the Secretary of State for Health and, in Northern Ireland, by the Department of Health, Social Services and Public Safety. Therefore, Northern Ireland’s assent is required for its abolition.

The board operates the National Institute for Biological Standards and Control, which is a scientific body that ensures the quality of biological medicines. Northern Ireland partly funds that body through a contribution of around £325,000 per annum. Northern Ireland has been involved in neither the working of the board nor the running of the institute. The functions of the National Institute for Biological Standards and Control will transfer to the Health Protection Agency (HPA). That agency has a presence in Northern Ireland, in that it employs the staff at the Communicable Disease Surveillance Centre Northern Ireland, based at Belfast City Hospital. The Department funds that body. The funding of the National Biological Standards Board will transfer to the Health Protection Agency. Devolution issues arise because of the change to the status of those bodies. Because Northern Ireland has contributed funding, its agreement must be secured when the status of those bodies is changed and they transfer to the control of another body.

A number of issues impact on the regulation of healthcare professionals. The Bill provides for changes to apply across England, Scotland, Wales and Northern Ireland. Independent adjudication is the first of those issues. The Office of the Health Professions Adjudicator will be established, whose aim is to keep an even keel in the adjudication of fitness-to-practise cases and other matters. Enabling legislation will provide that councils of each healthcare regulatory body will have a majority of lay members. Therefore, an effort is being made to dissolve the impression that professionals manage professional issues. Instead, there will be more lay input to provide more clarity and transparency in the handling of cases.

Healthcare regulatory bodies will adopt the civil standard of proof in determining allegations of lack of fitness to practise.

Provision is made for the appointment by healthcare organisations of officers whose duty is to: safeguard patients by identifying and handling issues of poor performance by doctors; liaise with the General Medical Council; hear possible fitness-to-practise cases; and make recommendations on the relicensing of doctors. The detail of the duties of responsible officers will need to be worked up in the four countries that comprise the United Kingdom, as reform proceeds. The principle is contained in the Bill as it stands; detailed arrangements will not be decided until a later stage, and Northern Ireland will decide for itself what arrangements suit its system. In the same way, Scotland, England and Wales will consider what arrangements will work in their systems.

The Council for Healthcare Regulatory Excellence is an overarching regulatory body, charged with ensuring an even keel across regulatory bodies as to how cases are handled. The proposal is to have a smaller council with more board-like membership, independently appointed, rather than nominated by the regulators.

As the Committee is aware, pharmacy is a major issue since, potentially, there will be significant change in Northern Ireland. The pharmaceutical profession is not included in the wider regulatory reform of the health professions. At present, the Royal Pharmaceutical Society of Great Britain and the Pharmaceutical Society of Northern Ireland have regulatory and professional leadership functions. In GB, the General Pharmaceutical Council will be established to regulate the profession. The Bill will enable appropriate legislation to be made in Northern Ireland, should a similar decision be made here. Therefore, in GB, regulation and leadership will be separated; the decision for Northern Ireland has not yet been taken by the Minister, and it is the subject of correspondence.

The third area of the Health and Social Care Bill that I wish to highlight is the proposed creation of a care quality commission. That will be an England-only body, which is a new adult health and social care regulator. The legislative implications for Northern Ireland are limited to a single issue on powers for the new regulator to enter into arrangements with Northern Ireland Ministers, if, at some stage, that is their wish. We already have the Regulation and Quality Improvement Authority (RQIA), which is our single body with responsibility for that field. The Health and Social Care Bill will enable arrangements to be made if, in future, the bodies want to work together on a particular issue.

The fourth area, which is not so much a concern for the Department of Health, Social Services and Public Safety, but is contained in the Bill, is the health-in-pregnancy grant, which is to be introduced from April 2009. A single one-off payment of £190 will be made available to all mothers-to-be, regardless of their income, from the twenty-ninth week of pregnancy. The idea behind the payment is to support the costs of maintaining a healthy lifestyle. The entitlement is linked to the requirement to seek health advice from a health professional. It will be paid for from the consolidated fund and administered by HM Revenue and Customs. It is a distinct benefit, which does not form part of child benefit. HM Treasury wishes to make such grants an excepted matter, like child benefit, so there will be no additional cost to the Northern Ireland block grant. The money for the health-in-pregnancy grant will come from HM Treasury and will be administered by the Department for Social Development, not the Department of Health, Social Services and Public Safety.

Those are the main areas of the Health and Social Care Bill that are the concern of the devolved Administration. The potential for most change lies within the pharmaceutical field. That is a brief summary; we are happy to take questions.

Mr Easton:
How many responsible officers are needed in Northern Ireland?

Ms Cairns:
That is a moot point, and has yet to be resolved. No decision has yet been taken on whether there should be a responsible officer in each employing organisation, or simply at a regional level. The working group set up by the Department of Health, Social Services and Public Safety will have to provide the answer to that question. A decision will be made further down the road after the matter has been fully explored.

Mr Easton:
Do you have any ideas about the potential cost?

Ms Cairns:
Not at the moment.

Mr Easton:
The representative bodies of the pharmaceutical profession in Great Britain and Northern Ireland are to merge — is that correct?

Ms Cairns:
The Health and Social Care Bill provides the enabling power if the two bodies decide to merge. However, if they decide not to merge, it will not happen. There is no power in the Bill to force that to happen. Perhaps Dr Morrow could expand on that matter.

Dr Norman Morrow (Chief Pharmaceutical Officer for Northern Ireland):
The two societies will not merge. The work that was done previously on the regulation of all professions identified that there was a problem in the pharmaceutical domain, having both regulatory and professional self-advocacy functions. The question was whether the public interest could be defended while maintaining self-interest. Therefore, the idea of separating the regulatory role of the profession from its professional leadership or self-interest role came about. That separation has occurred in many other professions, such as nursing, the medical profession and the allied health professions. The Government took the view in its White Paper that those roles should be separated. That is a key event in respect of the public interest.

Allied to that is the issue of organising such a separation. The most helpful way of carrying that out would be to have a regulatory body, which would attend to the public interest, while the profession would establish its own arrangements for its leadership, advocacy and representation functions. The view is that there should be some form of professional college to do that.

Regulation is a matter for Government. That is where the ministerial decision is placed. The issue of the college is one that is for the profession. If one were do those things — considering the fact that there are two different societies — could we conceive of a regulatory body that covers the whole of the United Kingdom in a way that is similar to all of the other health professions? The pharmaceutical profession is the only profession where there are two separate bodies. The Minister has not made that decision. The legislation simply enables that to happen if he wishes.

Mr Easton:
Will the Minister come back to the Committee if he proposes to take that matter any further?

Dr N Morrow:
I think that that is what he said when he attended a previous meeting of the Committee.

The Deputy Chairperson:
Will the new pharmaceutical council cover Scotland and Wales?

Dr N Morrow:
Yes. Currently, the Royal Pharmaceutical Society of Great Britain covers England, Scotland and Wales. We also have the Pharmaceutical Society of Northern Ireland, which deals exclusively with Northern Ireland. There is also the Pharmaceutical Society of Ireland, which deals with the Republic of Ireland.

Mr Easton:
I welcome the health-in-pregnancy grant. It is good that it will not cost Northern Ireland any extra money. Do mothers receive the grant once they have applied for it, or do they have to demonstrate that they have examined their diet, etc? I am concerned that, perhaps, the grant may be open to abuse. Obviously, I would like to see that money being used for expectant mothers and their diet — and for that only — to ensure a good start for the child and for its future. What is being done to ensure that that money will be spent in that way?

Ms S Ramsey:
My point is on the same issue. We should be careful when we say that the grant could be open to abuse. I do not think that one can pretend that one is pregnant. That is why I mentioned 29 weeks. However, I accept your point about ensuring that they have a proper diet.

I thank the witnesses for their presentation. I am concerned about the issue of twins and multiple births. The Committee has received a letter from the Twins and Multiple Births Association. That association welcomes the introduction of the grant — which I also welcome. However, there is an issue about whether the grant will be a one-off payment because the woman is pregnant or whether there are additional payments if she has twins or a multiple birth. There are specific issues about ensuring that the mother is healthy and that the children are happy. I know that that issue is due to be raised next week.

The Committee and the Twins and Multiple Births Association have a concern about the timeline for the introduction of the legislation. That association wrote to Jane Kennedy, Financial Secretary to HM Treasury, to outline its concerns about that matter. I would like to know what the Department’s thinking is on that matter.

Ms Cairns:
It is for the Department for Social Development to address that matter — it will administer the fund. The expectant mother can receive the grant at the twenty-ninth week, on the basis that the expectant mother will register with a healthcare worker. That healthcare worker will work with the expectant mother in addressing her healthcare needs to ensure that she is healthy, that she is getting the right diet and is buying the right foods to ensure that.

Mr Easton:
That is done first?

Ms Cairns:
Yes. The link with the healthcare worker helps efforts to ensure that the expectant mother uses the grant in a way that will be helpful.

Currently, the grant has been set up to provide a grant for each pregnancy, and not for each child that is expected. Another school of thought concerns the avoidance of obesity in expectant mothers and young children. The healthcare professional, as part of his or her work, would need to work with the individual mother on her individual needs. If that mother is expecting twins or triplets, there may be particular dietary issues. There has to be the right diet for the individual person. Therefore, the grant is not increased because the mother is expecting more than one baby. That is the current position on the matter.

Ms S Ramsey:
I understand what Ms Cairns is saying. However, the briefing paper states that having multiple births is unique, in itself.

It states that for people who are expecting twins or multiple births:
“it is important for weight gain to be achieved as early as possible and consideration should be given to paying the grant at an earlier stage.”

The focus on additional babies, rather than only on pregnancy, must be taken on board.

The Deputy Chairperson:
There being no other questions, I thank the witnesses for coming. Are members content to support the principle of extending the relevant provisions of the Health and Social Care Bill to Northern Ireland?

Members indicated assent.

Ms Ní Chuilín:
I place one caveat on that. Sinn Féin is keen for as much legislation to be devolved here as possible, but there is a financial cost to the legislation. Our concern is that that cost should not come out of the health and social care budget. Although the Department for Social Development will be responsible for the pregnancy grant, it is the British Treasury’s responsibility to ensure that that money is transferred. Sinn Féin will make those points when the Health and Social Care Bill is debated in the Assembly on Monday 14 January.

The Deputy Chairperson:
That point has been noted and taken on board.

Mr Hugh Farren
Committee Clerk
Health, Social Services & Public Safety Committee
Northern Ireland Assembly
Room 412
Parliament Buildings
BT4 3XX January 2008



Dr Morrow, Gail Anderson and I met with the Health Committee on 10 January to provide briefing and answer any questions the Committee had in relation to the content of the above Bill.

During the briefing I advised the Committee that the Health in Pregnancy Grant would be payable from the 29 th week of pregnancy. This was the original proposal and formed part of the briefing provided by our colleagues in the Department of Social Development (DSD). However by the time the Bill was introduced at Westminster the date of payment of the Health in Pregnancy Grant has been brought forward to 25 weeks. While we sought input to the briefing and confirmation from DSD that the briefing was accurate we were not advised of any changes and as a consequence provided inaccurate briefing to the Committee. Fortunately the change in the process was noticed ahead of the debate on the Legislative Consent Motion and Minister correctly stated that the grant would be paid from 25 weeks.

I would like to ensure, for the record, this error in information is addressed. I would therefore ask that you advise the Health Committee of the change.

Thank you.

Yours sincerely

Deputy Director of Human Resources