Northern Ireland Assembly
Monday 23 October 2000
The Assembly met at 10.30 am (Mr Speaker in the Chair).
Members observed two minutes’ silence.
I have received notice from the Minister of the Environment that this Bill will be introduced on his behalf by the Minister of Enterprise, Trade and Investment.
The Minister of Enterprise, Trade and Investment (Sir Reg Empey): I beg leave to lay before the Assembly a Bill (NIA 7/00) to abolish the right to compensation in respect of certain planning decisions; and to amend article 121(1)(c)(iv) of the Planning (Northern Ireland) Order 1991.
Bill passed First Stage and ordered to be printed.
The Minister of Health, Social Services and Public Safety (Ms de Brún):
A Cheann Comhairle. Ar dtús báire, gabhaim mo leithscéal as bheith as láthair Dé Luain 16 Deireadh Fómhair. Tharla seo mar gheall ar mhíthuiscint faoi amanna, agus ní easurraim d’aonturas a bhí ann.
First, I wish to apologise for my absence from the Chamber when the Bill was called on Monday 16 October 2000. This was due to a misunderstanding about times, and no disrespect was intended.
Molaim go n-aontaítear leis an Dara Céim den Bhille um Shláinte agus Seirbhísí Sóisialta agus Pearsanta.
Pléann an Bille atáimid le breathnú inniu le réimse leathan de shaincheisteanna fíorthábhachtacha i Sláinte agus sna Seirbhísí Sóisialta agus Pearsanta. Tá ceithre Páirteanna ann — tugann Páirt 1 an Chomhairle um Chúram Sóisialta isteach, agus déanann Páirt 11 tuilleadh forála do aisghabháil na gcostas a leag na seirbhísí sláinte amach ar chóireáil taismeach timpistí bóthair ó chomhlachtaí árachais.
Tugann Páirt 111 leasuithe éagsúla isteach, lena n-áirítear aisghairm na reachtaíochta maidir le cisteshealbhaíocht liachleachtóirí, agus bearta le seachaint táillí seirbhísí sláinte a laghdú. Foráileann Páirt 1V do rialachán na gairme cogaisíochta agus ábhair ghineáralta eile. Leagfaidh mé sonraí gach ceann acu seo amach i ndiaidh a chéile.
Tá mé cinnte go mbeidh ceisteanna ag Teachtaí faoi pháirteanna éagsúla an Bhille, agus tá sé de rún agam plé leo seo i m’óráid chlabhsúir.
I beg to move
That the Second Stage of the Health and Personal Social Services Bill (NIA 3/00) be agreed.
The Bill we are to consider today deals with a wide range of very important issues in health and personal social services. It is in four parts, the first of which introduces the Social Care Council. Part II makes further provision for the recovery from insurance companies of the cost of Health Service treatment of road accident casualties. Part III introduces miscellaneous amendments, including the repeal of legislation relating to GP fundholding and measures to reduce the evasion of Health Service charges. Part IV provides for the regulation of the pharmacy profession and a number of general matters.
I shall set out the detail of each of these in turn. I am sure Members will have questions on the Bill’s various parts, and I propose to deal with these in my closing remarks.
(Madam Deputy Speaker [Ms Morrice] in the Chair)
Part I deals with the very important issue of training and the standards of conduct and practice expected of all social care workers. At present, there is no professional regulatory body dedicated to overseeing standards in the social care field. The Central Council for Education and Training in Social Work (CCETSW) regulates social work training by setting requirements, approving and monitoring courses and making awards. However, there is no such organisation in other fields to take a lead in driving up both standards of training and quality of care throughout the workforce.
I propose therefore to remedy that gap and set up a Social Care Council which will carry out those duties. It will promote high standards, both in the conduct and practice of social care workers and in their training. Strong support for such a council was expressed by an overwhelming number of respondents to the extensive consultation my Department carried out in the autumn of 1998.
Some 150,000 people receive social services of one form or another. These services are delivered by more than 30,000 social care workers, ranging from professional social workers to care assistants and home helps, and in a variety of settings, from nursing homes to clients’ own homes. Around 80% of the workforce have no qualifications relevant to their jobs. If we are to provide the highest possible standards of care, this is simply not good enough. Social care workers deal with many difficult and distressing human problems. I know that the vast majority carry out their duties diligently and conscientiously, but unfortunately that is not always the case. There have been instances in every part of these islands of unacceptable standards of conduct and of vulnerable people, including children in care, suffering harm and abuse.
The council will therefore have two key responsibilities: to register and regulate the workforce and draw up codes of practice for both social care workers and their employers; and to ensure that staff are properly trained and qualified to do their jobs. The functions of the CCETSW will be transferred to the new council, as will the functions of the training organisation for personal social services in Northern Ireland. This should ensure that education, training and qualifications are to a high standard, fit for their purpose and meet the needs of the social care workforce. The ultimate aim is to raise the quality of the services provided and put in place better safeguards for the protection of people being cared for.
The council will register the social care workforce, starting with qualified social workers. Other high priority groups will be registered from the start, including team leaders, all staff in residential childcare and the heads of residential homes.
Separate transitional parts of the register will be opened for other groups of social care workers within a timescale set by my Department, initially on the basis of having signed up to codes of conduct and practice. Time limits will be set both for achieving appropriate qualifications, such as NVQs, for each particular job and for subsequent transfer to the main register. The definition of "social care worker" will be very wide. It will include not only people working in residential homes, but also those involved in the provision of personal care in other settings, including day centres or a service user’s own home.
Registration will depend on an applicant’s being of good character, being physically and mentally fit for the particular job, and satisfying the training or educational requirements laid down by the Social Care Council for that part, or parts, of the register for which the applicant seeks registration. The council will have power to suspend, vary, or cancel registration if individuals are unfit to practise on the grounds of misconduct, bad practice, negligence, abuse or ill health. There will, of course, be an appeals procedure when registration is refused or cancelled in this way. Registration will make it possible for employers to check the suitability of potential employees and to keep unsuitable or undesirable people out of the social care workforce. Similar councils in Great Britain will also maintain registers, and there will be co-operation between all four councils.
The council will be an independent body but will carry out its functions in accordance with directions given to it by my Department, and it will be under the Department’s general guidance. It is not intended that the council should be a self-regulating body for the social care workforce, and it will therefore have a significant lay membership. Though not specified in the Bill itself, I plan to introduce regulations to allow for a total membership of 21 to 25, which will include the chairperson. The membership will be split into approximately one third laypersons, users and carers, one third registrants and one third other stakeholders such as employers, unions and professional associations. This will create a balanced membership so that the interests of one group do not predominate.
The Bill will also make it an offence for anyone to register as a social worker with intent to deceive. Further, it will allow the Department to make regulations to prohibit people from working in certain jobs unless they are listed in the appropriate part of the register.
My Department provides funding of almost £500,000 annually to the CCETSW, and this will be transferred to the new council. I intend that the maintenance of the register will be paid for by setting an appropriate registration fee, which should eventually raise at least £300,000. The council will also be able to charge for other services and publications. It must be recognised that the council’s role will be much wider than that of CCETSW, and some additional funding will be needed from within the existing budget of my Department.
Part II deals with the recovery of costs for hospital treatment for road accident casualties. It provides for the introduction of a new simplified procedure for the recovery from insurance companies of the costs of treatment, and it increases the maximum amount recoverable. While the Bill does not introduce any new charges, it does extend the current charge to include outpatient treatment. The provisions will not affect the amount of compensation paid to casualties.
Under the present law the charge for inpatient treatment, up to a maximum of £2,949 per case, is levied on insurance by a hospital when a road accident casualty makes a successful claim for compensation. The present system for collecting the charges is not efficient or effective. The proposed new provisions will help hospitals by easing the administrative burden on them, will simplify the system, which will help insurers, and will bring charges more into line with actual costs.
The provisions in part II will centralise recovery arrangements for the cost of hospital treatment by placing the responsibility for this on the Department for Social Development instead of on the hospitals. In practice the Social Security Agency’s Compensation Recovery Unit (CRU) will recover the charges.
The decision to use the CRU, which was taken following an option appraisal, makes good sense, because the new scheme will be similar to the benefit recovery scheme that the CRU has operated for 10 years. In line with the benefit recovery scheme, compensators, who are almost exclusively insurance companies, will be required to apply to the CRU for a certificate of Health Service charges for any case in which a road accident casualty claiming compensation has received hospital treatment. To help simplify the system and to stop hospitals from having to calculate charges in every case, a tariff of charges will be introduced. This means that the hospital, the insurer and the CRU, which will make the final calculation, will know from a few simple facts how much the charge will be. For the first time, the Health Service will be able to recover charges in cases where a driver who caused an accident is uninsured or untraceable and the casualty receives compensation from the Motor Insurers’ Bureau. The Bill brings the bureau into the scheme.
Finally, although difficult to predict, it is estimated that the scheme could bring in an extra £2·5 million per annum. Recovered moneys will be paid directly to trusts, so that hospitals that provide the care will benefit from the income. The CRU’s administration costs are estimated at about £150,000 per year, and those will be met by my Department. The effect on motor insurance premiums is not expected to be significant.
I now turn to part three of the Bill, which sets out a number of miscellaneous amendments. I am presently considering measures to replace GP fundholding. Pending decisions on those measures, as a first step, it is necessary to take powers to repeal the fundholding legislation, which can be given effect when I take the final decisions on the way forward for primary care.
The Bill introduces three new administrative measures concerning family health practitioners. First, technical changes will be made to the machinery for the remuneration of practitioners to clarify the statutory requirements for such remuneration.
Secondly, family health practitioners will be required to take out professional indemnity insurance. Most practitioners already hold such insurance, often through professional defence organisations, but this will be compulsory in future.
Thirdly, the Health and Personal Social Services (Northern Ireland) Order 1972 provides for the representation of family health services practitioners on local committees, which represent their interests in discussions with health and social services boards. The Bill aims to ensure that the practitioners themselves continue to be eligible to sit on local representative committees, but that, in addition, assistants or deputies will be allowed to represent them.
The Bill also contains measures aimed at reducing the evasion of Health Service charges by patients and fraud by family health practitioners. Health Service charges include prescription, dental and optical charges. Exemption from these charges is granted for a number of reasons, such as age, certain medical conditions, being in receipt of social security benefits or on a low income. There is evidence of considerable evasion of charges. It is estimated that during the last financial year, some £14 million was lost due to fraudulent exemption claims. The Bill introduces two deterrent measures. It creates a civil penalty for wrongful exemption from, or refund of, a Health Service charge, and it introduces a specific criminal offence for knowingly evading or fraudulently gaining a reduction in Health Service charges.
As I mentioned, the Bill also contains measures to deter fraud by family health practitioners. At present, a practitioner’s name may be removed from a board’s list if a tribunal, constituted under the Health and Personal Social Services (Northern Ireland) Order 1972, acting on representations, finds that the continued inclusion of that person’s name in a list is prejudicial to the efficiency of the service. These are normally referred to as efficiency cases.
The Bill expands the tribunal’s remit to hear representations that a practitioner’s name should be removed from a list on the grounds that he has caused detriment to any health scheme by securing — or trying to secure — for himself or another financial or other benefit to which he is not entitled.
Reciprocal arrangements with England, Scotland and Wales provide that the removal of a name from a list in any one of those jurisdictions would mean removal from, or non-inclusion in, a list in any of the others. The new provisions, therefore, include provision for any person aggrieved by a tribunal’s decision to appeal to the Court of Appeal, or — for example, where there is new evidence — to apply to the tribunal for a review of its decision.
The Bill will further provide for the disclosure of information obtained by the Commissioner of Complaints. During the course of investigating a complaint, the Commissioner may come across information suggesting that a person represents a danger to the health or safety of service users. The Bill clarifies the circumstances in which such information can be disclosed to, for instance, an employer. Such information must only be given to persons whom the Commissioner considers need to know in order to prevent a danger to service users. He must also inform the person involved that the information has been disclosed and to whom it has been disclosed.
The Bill also makes a number of provisions concerned with the Department’s power to direct trusts and with administrative changes in relation to their establishment and finances. For example, the Bill will enable the Department to set quality targets for treating service users and to determine the pay of trust chief executives and their senior staff.
Finally, part III makes provision for a number of miscellaneous matters. These include clarifying the legal basis for the exchange of information between the Registrar General’s Office and the Department; limiting the liability of officers of health and social services councils acting in the course of their duties; permitting pre-registration house officers to undertake training in general medical practice; requiring health and social services bodies to open their meetings to the public; and clarifying the existing law that the sale of the goodwill of medical practices is illegal.
I come now to part IV of the Bill. An important provision here will enable the Department by order to amend legislation regulating the profession of pharmaceutical chemist. The Bill contains provision for the Department, by order subject to affirmative resolution of the Assembly, to amend the Pharmacy (Northern Ireland) Order 1976. This would facilitate flexibility in the arrangements governing the profession here similar to the regime introduced by the Health Act 1999 in relation to the pharmacy and other professions in Britain.
Madam Deputy Speaker:
Given the number of Members who have put their names down to contribute, I ask that each Member limit his or her contribution to five minutes.
The Chairperson of the Health, Social Services and Public Safety Committee (Dr Hendron):
As Chairperson of the Health, Social Services and Public Safety Committee, I welcome the Bill. I know that Committee members are looking forward to considering it at Committee Stage. I will keep my comments brief because it is important that the Committee is given the opportunity to consider the Bill in detail.
As the Minister said, the Bill covers four broad areas. Part I provides for a body to regulate the social work profession and other social care workers. That will be welcomed by social workers as they have long recognised the need to regulate the social care workforce to protect patients, carers and the workforce itself. However, I suspect there may be a debate about the appointments procedure contained in schedule 1.
I understand that the aim of part II of the Bill is to simplify the system used to recover much needed cash for health and personal services from the compensation paid to the casualties of road traffic accidents.
Part III of the Bill covers a wide range of amendments to the law covering health and personal social services in Northern Ireland, including the repeal of the law which established GP fundholding. The Health, Social Services and Public Safety Committee is concerned that the lessons learned during GP fundholding are not forgotten, and it is looking forward to discussing with the Minister her proposals for a new primary care service.
The Committee has concerns, however, about the timing of the introduction of the changes. It is important that there is not a vacuum. Measures to introduce penalties for fraudulently evading prescription charges and changes to tighten the control exercised by the Department on the administrative and financial arrangements of trusts are also included. These are positive steps. Powers to regulate pharmaceutical chemists in Northern Ireland by subordinate legislation are covered in part IV. These will bring pharmacists into line with other health professionals, and that is welcomed.
Committee members will be looking in great detail at all the issues covered in the Bill, and we will return with amendments at Consideration Stage should they be considered necessary.
Rev Robert Coulter:
I also welcome the introduction of the Bill. It is not before time that it is being brought before the House. The Bill is to be commended as it is providing for a professional body for social workers. The time has come for social workers to be given the respect and recognition they deserve. I am glad that the council will be independent and not be self-regulating and that the training schemes envisaged will bring greatly needed equality to the workforce in the social care area.
As the Chairperson has already mentioned, there are some concerns about the appointments procedure, and that is an issue that the Committee will be looking at in depth.
One of the problems in Northern Ireland is what happens to patients after they leave hospital, and it is welcomed that this area of care is being looked at. I also welcome part II of the Bill, which deals with the recovery of costs after accidents; this measure should have been introduced long ago, and I support it fully.
I am glad that, under this Bill, the Department of Health, Social Services and Public Safety will have the power to direct trusts. Trusts will no longer be autonomous — they will be accountable to another body.
I support the regulations concerning pharmaceutical chemists. However, it is hoped that the Minister and the Department will ensure that the new council will not be just another centre for administration soaking up much of the badly needed funds for patient care. It is hoped that the council will be a well working, slim and efficient body. I welcome the Bill.
I welcome the opportunity to speak on the Bill, although it is no thanks to the Minister for Sinn Féin/IRA who arrived with it a week late and with very little apology. I listened very closely to what the Minister said and all that I heard in her apology was the word "misunderstanding" — it was her duty to be in the House at the proper time on that day.
However, from the outset it seems that the only the Department of Health, Social Services and Public Safety will gain anything from the Bill. Any reading of it confirms the view that if anything should be reviewed at present it is the Department itself.
There is a range of matters in the Bill that I still seek clarification on. Members have listened closely to what has been said about social workers, and it is to be welcomed that they are going to be properly registered. However, there are still major concerns and a great need for clarification on the registers.
Clause 3 (2) of the Bill says
"There shall be a separate part of the register for social workers and for each description of social care workers so specified."
Subsection (3) says
"The Department may by order provide for a specified part of the register to be closed, as from a date specified by the order, so that on or after that date no further persons can become registered in that part."
Clarification is needed on where social workers stand if they are not able to be properly registered.
Clause 9 should include the word "must". Clarification is also needed on the rules which will determine that, unless it is spelt out from the beginning, these bodies will conveniently dismiss those who ought to be consulted. The codes of practice need to be tightened up. The Bill states that the council shall do this and the council shall do that — the council should be held more responsible.
Clause 11 deals with qualifications gained outside Northern Ireland. There are currently many qualifications which ought to have equivalence but which the state does not recognise for fear that they will downgrade its imposed qualifications. I think of the anomaly with NVQs which are counted while other qualifications with historic standing in the world of business are dismissed, simply because they would downgrade NVQs. This equivalence should be spelt out in greater detail.
One very important matter is the status of this council as set out on page 39. The Bill proposes to replace the existing Central Council for Education and Training in Social Work (CCETSW). That is all right, but the status that will be given to the new council needs greater clarification. What was the reasoning behind this? It reads
"The Council shall not be regarded as the servant or agent of the Crown or as enjoying any status, immunity or privilege of the Crown; and the Council’s property shall not be regarded as property of, or property held on behalf of, the Crown."
I want a list of all other bodies, especially state bodies, that have the same status, and I want to see book, chapter and verse of such status elsewhere. Once again, the Department intends to be good to itself financially. The estimated cost of this council is £1·4 million. I trust that this will not just be more bureaucracy in Northern Ireland. The Assembly needs to think very carefully before going to the taxpayers and telling them that they will have something else to pay for.
Part II deals with the payment for hospital treatment of traffic casualties, and I broadly welcome the principle of recovery. But what concerns me is that the only people who will do the paying are the companies of those who have insurance.
There are two glaring weaknesses. First, those who drive without insurance and cause death and injury make no reparation to the hospital, but they still get treatment. That ought to have been dealt with in the Bill. As it stands, you are worse off if you have insurance. Secondly, there is the matter of those who are charged with careless or dangerous driving and who have injured themselves. There is no mention of their making reparations to the hospital for treatment. That is a major problem at present.
Clause 39 deals with the repeal of the law about fundholding practices. I welcome the initiative to end fundholding, but it is quite pathetic that we have no template or vision for its replacement. However, the fact that the Minister herself has no vision or strategy — she thinks only of reviews — explains why this is so.
Madam Deputy Speaker:
The time is up.
There should have been three separate Bills for this major discussion today.
Go raibh maith agat. I too welcome this Bill, one of the first Bills published by a local Minister who is accountable to the Assembly and, what is more important than that, is accountable to local people. This is a positive development as we can now scrutinise the Health Service. It is also positive as this is the first time in some years that we will have a structured say in shaping that Health Service.
On welcoming the proposed establishment of the Social Care Council I support the need to regulate the working practices and training of the people involved in this scheme. The Department and the Assembly need to recognise the hard work and commitment of social workers in delivering a quality service.
The proposed council will enhance and maintain the work of social workers, and I support that. However, some aspects of the council concern me. While I welcome the Department’s ensuring that its service users and lay-people are in the majority on the council, I have a problem with the Department’s appointing it.
I welcome the Minister’s statement that one third of the council will be made up of trade union representatives. However, a disciplinary procedure needs to be developed, not only with the delivery of a quality service in mind but with the inclusion of input from the unions.
The training remit needs to be strengthened and, more importantly, resourced. We are all aware of good legislation being put through here but with no resources or money following for it to be implemented. This cannot happen again. We need to take account of new pieces of legislation and the equality agenda.
Like my colleague on the Health Committee, Paul Berry, I welcome clause 11, enabling the council to recognise qualifications gained in European Economic Area (EEA) states as being equivalent to those gained in the North. There is a need for work practices to be developed in conjunction with bodies in the 26 counties to ensure quality of service and exchange of staff on an all-Ireland basis.
Sinn Féin is for free health care at the point of delivery. While, again, I understand the reasoning behind this part of the Bill, I remain to be convinced that this is the best way forward. The arguments put forward for supporting it are that this legislation will bring us into line with England, Scotland and Wales. We are a legislative body. This Assembly should decide its own way forward. Just because something happens elsewhere, does not necessarily mean that it is right.
Sinn Féin’s position on GP fundholding has been on the record many times. We have been against fundholding from its inception as we believe it created a two-tier system. It also promoted inequality in the Health Service. I welcome the closing of this chapter, but we need to learn lessons from fundholding in order to make the Health Service more accessible to all.
We have also been opposed to the setting up of unaccountable trusts. These facilitate the establishment of an internal market. I do not believe that trusts can plan and deliver services at the same time, and we are all aware of the recent report by the Audit Office on the amount of money paid out to chief executives. That report shows, and also makes me believe, that once again these are unaccountable quangos.
While we have been against the trusts, I welcome the provisions in this Bill that will give the Department power to direct trusts to provide services they should be providing at ground level and to set pay scales as advised by the Audit Office.
I welcome the new arrangements that will make trusts more open and accountable. On the issue of prescription charges, I agree that prescription fraud is high. However, we need to tackle institutional fraud in nursing homes and among GPs, chemists and dentists. Again, I welcome the provisions in the Bill.
I also welcome clause 51, which deals with the provision of information on births and deaths. We welcome this as a vital part of targeting resources and redressing inequalities in the Health Service. When the Bill goes to Committee Stage I would like more details on that provision.
Clause 54 provides for public access to meetings of health and social services bodies. At the moment, there is no statutory obligation for bodies to open their meetings to the public although I am aware that some do.
The Alliance Party welcomes many of the measures in this Bill. For too long we have left many aspects of our health care unregulated. The vulnerable and needy have been harmed by this dereliction of duty. We can only welcome the setting up of a register for social workers. These workers perform an important function, and we recognise that the vast majority approach their jobs with a professionalism and dedication that can only be admired.
Having a register that would reassure employing agencies about the qualifications of social workers will go far to maintain the high levels of service that we have come to expect from our social care staff. We are also pleased to see that the Government have finally recognised that GP fundholding has had its day. Since its inception, the Alliance Party has been greatly concerned about it — anything that complicates matters for our already overstressed and overstretched doctors and is of doubtful benefit to the patients ought to be abandoned.
It is laudable that we are setting out to recuperate more funds for our Health Service through a more comprehensive recovery of the cost of treating road accidents and by trying to cut down on fraud in the NHS, particularly in relation to prescription charges. I urge caution with the estimate of the moneys that will be regained. I hope that we can increase the amount recovered from road accidents — currently £0·5 million per annum — but I fear that insurance companies and individuals will not always want to co-operate. The collection of a few million pounds through that method will not ease the crises that our Health Service faces — the closing of wards, the cancellation of operations and the growth of waiting lists. We may want those who are responsible for road accidents to pay for the damage that they cause, but that would have, at most, only a symbolic effect and will do little to ease the financial strain faced by so many of our acute care providers.
Moves to tackle fraud are equally laudable, but I urge Members to think longer and more deeply about the problem. Perhaps one way to ease the cost of fraud would be to lower prescription charges; for some, they are too high already. People are hit with charges for a range of drugs. Faced with the costs, many are tempted to act fraudulently and fill out the back of the prescription form, thus claiming exemption. Perhaps lowering the costs would encourage more honesty. I am, however, convinced that people in the marginal sections of our society are confused by the many forms that they are required to fill in to receive benefits, including free prescriptions. We should be looking for ways to ease the cost of prescriptions, to ensure that those entitled to free prescriptions receive them and, finally, to tackle the fraud issue.
The Government have committed themselves to increasing the use of electronic forms and the use of IT generally in the administration of our health and other services. We should design software and hardware to aid the transfer of the necessary details onto the forms and ensure that people receive all their entitlements, and we should use the information to cut down fraud. We should not stop at the narrow provisions of the Bill but think about innovative ways to meet the needs of the population.
We support the Bill, which contains many worthwhile measures. However, it is just a first step towards creating the kind of health and social services that the people of Northern Ireland want, need and deserve.
I will not reiterate the questions that were raised at meetings of the Health, Social Services and Public Safety Committee. There were many, and the five-minute time limit does not allow me to go into detail. I will simply take up some of the points that the Minister raised in her speech, some of which we may not have been au fait with until now.
First, I would like to raise concern about the proposal that the old Central Council for Education and Training in Social Work (CCETSW) is to be stood down, as provided for in the Bill. If the Bill does not go through in the expected time, will there be a delay in the establishment of the Northern Ireland Social Care Council? If so, what will happen in the interim? Will there be transitional arrangements?
Secondly, this is the first time I have heard about the make-up of the council. Although I am pleased with the nature of the appointments, I share the concerns of Ms Ramsey. It is important that we have detail on that. All we knew was that there was to be a majority of users and lay people. It now seems that a third of the council is to be made up of lay people and users and another third made up of those registered, which is something I would like more detail on. How can this be the case if we are attempting to register under the new procedures?
The final third will be from employers, trade unions and professional associations — which one might consider to be users. I welcome the fact that trade unions will be in a position to put forward names. One of the best presentations to the inquiry into residential and secure units for children was made by the Northern Ireland Public Service Alliance (NIPSA), which covers social services and social workers in particular. Since NIPSA is familiar with the pay levels, the conditions, the stress and the work of social workers, it is important that it be represented on this council. It is significant that we are discussing this issue at a time when social workers have found it necessary to go on strike in the Foyle area, following similar concerns in the north and west of Belfast. These matters are extremely important.
I would like to have similar reassurance on the transitional arrangements for when GP fundholding ends. What will happen then?
The Bill says that there will be no adverse impact on co-operation or common action under North/South or East/West relations. That is something that the Bill does speak to. It talks about European Economic Area (EEA) states and qualifications outside Northern Ireland. We need to turn that around and ask whether Northern Ireland qualifications are recognised abroad. This is an issue about professional qualifications. In some cases, for those who do not follow the undergraduate route in Northern Ireland, fewer years are spent studying than in other countries.
The question then arises of whether our social care workers will be able to practise elsewhere. This is not just about whether people coming in can practise here. There is an adverse effect. Those wishing to work in the Republic, Scotland, England or Wales are having their qualifications questioned because of the number of years’ of equivalent practice.
This is the first time I have heard of hospitals producing charges or tariffs for the costs of operations. I am sure that that is the case, but is there a protocol that we could see? Is there further information on this? That is important.
The Minister says that prescription fraud now costs £14 million, although the explanatory note says £12 million. Have there been no savings from the introduction on the prescription charge which asks people to identify whether they are on benefits and, therefore, exempt from prescription charges?
On initial reading, I broadly welcome the Bill. I particularly welcome the setting up of the Social Care Council. It is notable that some 80% of social workers currently have no formal qualification. In recent years a small number of wayward social workers, particularly in Great Britain, have given the profession a bad name. I suspect that the new regulations, the recognition and the training will protect the profession and restore its good name.
In terms of GP fundholding, does the Minister plan to extend to Northern Ireland the proposals on contracts contained in Great Britain’s national plan? According to anecdotal evidence, certain GPs will never refuse to sign a sick note because they are paid according to the number of patients they have. If they refuse to sign the note, a patient will simply turn to another, willing GP. Likewise, few GPs will refuse to sign Disability Living Allowance forms. Such matters could, perhaps, be dealt with as part of this system.
I welcome the proposed widening of access to health trust meetings. At present, the public can attend a health board meeting but not a trust meeting. The new legislation will change this. I also welcome the thrust with which the appalling situation relating to trusts’ chief executives is being remedied. Earlier in the year, chief executives were leaving and paying themselves enormous sums of money. They were operating under contracts which allowed them to leave one job with large remuneration as compensation before taking a job elsewhere. That seems crazy. I look forward to examining this Bill in further detail in the Health Committee. Overall, I welcome it.
Perhaps a little learning is a dangerous thing, but I have some inside knowledge of the Health Service. I deeply regret that so much of the Bill should relate to bureaucracy and administration. The delivery of health care at the coalface is barely mentioned. Are the bureaucratic and administrative aspects of the Health Service our highest priority? The burning issue for people in the street — simple access to primary and secondary care — has been largely ignored. The Bill contains no plans to tackle the winter crisis, which is already upon us. Neither is there any mention of the fact that primary care, particularly community psychiatric care, is being bled dry.
It is easy to pay lip service to good things and to condemn sin. However, we are making no significant improvement to the Health Service.
Is that not an unfair list of criticisms to direct at this Bill? Many of us agree with those comments, but the same criticisms could be levelled at any piece of legislation, because one legal instrument will never be sufficient to cover every single problem in the system.
No matter which Bill is before us, we must prioritise carefully. The biggest priority is to ensure that there is adequate funding where people need it most — in primary care, where the most efficient and most cost-effective service can be delivered. In this Bill I detect an increase in bureaucracy, but I do not see the need to channel funds in this way.
I want to comment on the bungling that has been associated with the abandoning of fundholding. Fundholding was introduced by the Tories for all the wrong reasons. We can all jump up and down and be opposed to fundholding for all sorts of political or philosophical reasons. Many, including myself, were forced into the fundholding system in the hope that patients would get a better level of care.
We found — not for the reasons intended but almost by accident — that a by-product of fundholding was considerable benefit to patients. For the first time in the Health Service there was accountability, and that is saying something, because it had not been accountable for 50 years. Decisions were being made at the bedside or otherwise in the primary care setting. Choices could be offered to the patients, and small amounts at the edges — maybe 4% or 5% of the fundholding budget — were flexible and patients’ choices could be taken into account when meeting their needs. Perhaps most important of all, large monolithic extravagant hospitals were brought to account. If you want me to spell that out, I will. There were a number of benefits.
However, we have now got rid of fundholding — or have we? It is somewhere out there in limbo, and nobody knows what is happening. It is going, and it is not going. It has gone, yet it has not quite gone. Everybody is waiting for something to happen. There is no provision, financial or otherwise, for winding up fundholding.
Madam Deputy Speaker:
Time is up.
We are going to have commissioning, whatever that means. To me it means going back —
Madam Deputy Speaker:
Your time is up.
Thank you. It means going back ten years to the muddle and the confusion of throwing money at problems, rather than taking responsibility for them.
Madam Deputy Chairman:
Time is up.
We will have one big magic roundabout and no answers.
Many things in this Bill are agreeable, and we will be glad for them to happen, but we have concerns about some parts. It is good that the Minister has appeared before the Assembly today. Can one hope that, last week, she was addressing the bed shortage at the Ulster Hospital or, perhaps, the long waiting lists for appointments, or the long hours that nurses and doctors have to work in all the hospitals — especially in the Ulster Hospital — or the staff shortages that we have? Perhaps that is the reason she was not here last week.
I would like to address two issues. The first is in relation to the recovery of charges in connection with the treatment of road traffic casualties. Obviously there is a clear need to find a method for recovering the cost of treating injuries to these people, and the new arrangements are to be welcomed.
The explanatory and financial memorandum states that recovery will be centralised and that the savings to the Health Service could amount to £3 million, compared to the £500,000 at present. The memorandum states — on page 21 — that there will be slight increases in insurance premiums. Will the Minister confirm that in the Department’s dealings with insurance companies — and we hope that it has dealt with them — any insurance increase will be focused on those responsible for the accidents and thereby the injuries. We all know that the statistics very clearly indicate that the largest number of accidents and injuries are caused by the boy and girl racers who can buy a car with two years’ free insurance. It would be encouraging for those who have to tax and insure their cars, and who find that the premiums rise regularly, to be sure that any future insurance increases were not directed against those who, by and large, do not have a record of problems and accidents.
I also ask the Minister if the Health Service will be pursuing recovery for injuries from Republic of Ireland drivers who are involved in accidents in Northern Ireland. It would be a disgrace to find that such recovery could not be made from drivers in that jurisdiction. Has sufficient legislation been made to cover this eventuality?
I would also like to address part IV of the Bill, which has direct implications for the pharmaceutical chemist. I have made it my business to speak to some chemists, and they expressed specific concern that they could be forced to sell, on prescription, the "morning after pill", the PC4. Under this legislation, will chemists will be forced to make a moral decision? Some will neither stock, nor sell this pill.
Not enough research has been done on this, and chemists have a real concern that the pill will be taken off prescription and they will be asked to sell it over the counter. Will the Minister confirm that this will not happen? Not enough research has been done to determine if the effects of the pill could be detrimental.
Following hard on the abortion debate and the overwhelming vote against it, I urge the Department of Health to be cautious towards pharmaceutical chemists who will, generally, refuse to accept any directive or ruling from the Health Department. Will the Minister confirm her position on the PC4 pill?
Mr J Kelly:
Go raibh maith agat, a LeasCheann Comhairle. Along with other members of the Health Committee, I give this stage of the Bill a broad welcome.
If a little learning is a dangerous thing, Dr McDonnell is not in much danger, judging by his contribution. I am not sure whether he is happy or disappointed with fundholding, or if other issues which he raised were not in the domain of another Minister, rather than the one who is with us today.
I welcome in particular clause 2, which defines a social care worker. Clauses 3 to 7 detail the procedure for registering social workers, and that is an important matter. Clause 8, relating to registration and enforcement, is also significant. Clause 9, which defines the codes of practice, is to be commended and, despite some reservations that I have, clauses 10 to 13, which refer to a training function for social workers, are also to be welcomed.
As Mr McFarland said, we are particularly happy that clause 54 provides for "public access to meetings of certain bodies", as there is now no statutory requirement for health and social services bodies to open their meetings to the public. The Bill will make this a requirement, and we welcome that. We will also be looking at trust fund management and at how this Bill will make those responsible for trust funds accountable to the public in a way that they have not been before. We do not intend to allow the fat cats to get any fatter, and if they should happen to, they will have to be held accountable.
A LeasCheann Comhairle, at this stage we give a broad welcome to the Bill and look forward to further discussions on it.
Ms de Brún:
A LeasCheann Comhairle. Gabhaim buíochas leis na Teachtaí as ucht a suime sa díospóireacht ar an Bhille seo. Is ilghnéitheach iad forálacha an Bhille agus tugann siad isteach athruithe do na Seirbhísí Sláinte, Sóisialta agus Pearsanta.
Thóg Teachtaí ceisteanna agus luaigh siad pointí suimiúla. Féachfaidh mé le plé leo uilig. Madam Deputy Speaker, I thank Members for their interest in the debate on this Bill. The provisions are diverse and represent changes to health and personal social services. Members raised a number of questions and made interesting points, and I shall endeavour to deal with all of them.
We had questions about how the Social Care Council will be funded, about the appointments procedures and about representation on it.
I will move first to funding for the council. The cost of regulating the workforce will be met from annual fees paid by the registrants. A sliding scale of fees will take account of different pay scales and registration categories, and that is expected to bring in an annual income of at least £300,000 when all staff are on the register. At present, Government Departments fund the regulation of education and training through the provision of almost £500,000 to the Central Council for Education and Training in Social Work. These funds will be passed to the new council. It will also have the power to charge for other services. I do not see the new Social Care Council becoming a drain on resources and taking away from the value of health and social services. On the contrary, I see it adding value and improving quality in the health and social services field.
Ms McWilliams queried representation on the council. Decisions have not yet been made about the precise procedure for appointments. However, the selection process will be fully transparent, with all posts advertised and applications considered strictly on the basis of merit. Service users and lay members will make up a section of the council. One third will be drawn from registrants, and the others will come from employment, professional and education interests. Obviously, the registrants will be selected from people who will have been registered at that time. We can go into this point in further detail at a later date. In addition to advertising the posts, we will invite the representative bodies to nominate people who can bring the necessary skills and knowledge to the work of the council.
Mr Berry asked a question about the fact that the Department may, by order, provide for a specified part of the register to be closed, so that, on or after a given date, no further persons can become registered in that part. He asked why this power was necessary and what impact it would have if people could not get on to the register. It is not envisaged that the part being closed will at any time be a part to which people would be seeking access. The power will allow the council to take account, over time, of the changing patterns of service provision. In the future, it may well be that certain categories of the social care workforce will no longer exist. This may apply to those working in educational or criminal justice settings. Let me give a clear example of this. If we had established a register 25 years ago, we would almost certainly have had a section of the register dedicated to hospital almoners. Such a category would not be appropriate today.
I have dealt with most of the questions that have been raised about the council. Ms McWilliams also asked whether there would be a delay between the standing down of the Central Council for Education and Training in Social Work and the introduction of the new council. That will not be the case. The legislation provides for a shadow body until the council can be formally established. Members of the shadow body will also be selected through full appointment procedures. The shadow body will make the necessary preparations to facilitate a smooth transfer of responsibilities to the new body. This has been very clearly laid out, so there should be no hiatus or vacuum.
Ms Ramsey asked about the recognition of qualifications gained elsewhere. The Central Council for Education and Training in Social Work is working closely with the equivalent body in the South of Ireland to examine social work training and to facilitate opportunities for cross-border placements. Very clear guidelines are also in place which will ensure that people here can obtain qualifications which will allow them access to employment elsewhere.
Mr Berry also asked about the equivalence of qualifications. The National Training Organisation for Personal Social Services is working with employers to identify the skills required to deliver a quality service. The outcome of the consultation will dictate which qualifications are recognised. These will include the full range of qualifications and not just the NVQs and the professional qualifications that are recognised now.
At present, there is no agreed code of practice. Social care is so important to so many people that specific codes of conduct and practice are needed. We intend to introduce codes so that social care workers and their managers are clear about what is expected of them and to enable the public to see clearly the standards to which these staff must work. The four agencies who are working together on this, and who would have been previously represented, have commissioned a project to draw up draft codes of conduct and practice. This will be issued for consultation with the full range of stakeholders here. The Social Care Council will make the final codes widely available.
Finally, I note with satisfaction that several Members, including Rev Robert Coulter and Ms Ramsey, mentioned the dedication, commitment and hard work of social workers here. We ought to pay tribute to those working in the social care field. As Members have said, the imminent establishment of the Social Care Council has been widely welcomed by such people precisely because of their dedication and high standards.
I turn to the questions regarding the recovery of money following road traffic accidents. The Rev Robert Coulter said that the means to recover such money should have been introduced some time ago. The power to recover money from insurance companies has existed for some time under the Road Traffic Act. However, this new legislation will provide for a streamlined and less bureaucratic system, as well as an increase in the recoverable amounts to a level which more closely reflects cost. I am pleased that the Member has welcomed these new streamlining arrangements, which are indeed timely.
I have two points in response to Mr Berry’s question about whether it is only those with insurance who will pay. The impact on actual insurance premiums is not thought to be significant. An alteration of between £6 and £9 a year is being considered. It is the insurance companies which will be affected, and it will be for the insurance industry to determine how its customers are charged. The legislation will have an impact on those who cover insured drivers and on uninsured drivers. The introduction of the Motor Insurers Bureau into the scheme means that compensation will be paid in cases where a driver has no insurance.
Mr Shannon asked if the Department would recover compensation from drivers from the South. The Department has consulted fully with the insurance industry in developing the legislative proposals, but it will not recover compensation from drivers from the South.
I turn to the measures being taken to tackle the evasion of Health Service charges, prescription charges and fraud by National Health Service family practitioners.