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Northern Ireland Assembly

Monday 15 January 2001 (continued)

Teachers: Occupational Health Care


Mr Ford

asked the Minister of Education to outline the availability of occupational health care for teachers; and if he will make a statement.

(AQO 551/00)

Mr M McGuinness:

The provision of employee access to occupational healthcare is an important element of the employer's role. Within the teaching profession, the employing authorities in all school sectors recognise that staff may require occasional support in resolving health and welfare matters that may impact on their working lives. Such authorities have been making their own arrangements to provide support and referral to specialist services.

A working group, chaired by the director of the Northern Ireland Civil Service Occupational Health Service, has been commissioned to take forward an in-depth analysis of the issues surrounding teacher welfare. I look forward to the results of that work and to the recommendations the group may make in this area.

Mr Ford:

The Minister shares the concerns of other Members and myself regarding the increasing pressures on teachers and lecturers, which can lead to difficulties such as long-term sickness and early retirement. How long is it likely to be before the Minister receives the recommendations of the review group? Can he assure me that when the review work is complete we will have an occupational health service for all teachers and lecturers which is both comprehensible and accessible to all those who require it?

Mr M McGuinness:

I cannot say for certain when that report will be finished. As this is an issue of serious concern to many teachers, the unions and the Department of Education, it is crucial that the work be completed as soon as possible. We are very concerned to ensure that teachers are supported in a fashion that takes account of the pressures and stresses that they are undoubtedly under.

As regards the research, the tenders will go out later this month. Although it will take some time, we are keen to press forward with all speed.

Mr ONeill:

The Minister said that he has every faith in the teaching profession to meet his targets for the inclusion of yet another piece of administration. That is very nice. However, when will he do something about the intolerable pressures and administrative workloads being placed on the entire teaching profession? For headmasters, in particular, administration represents the highest wastage of any single element in the profession. The Minister needs to do something to allow classroom teachers to teach rather than become administrators.

Mr M McGuinness:

I share the concerns of many regarding the pressures and stresses within the teaching profession. My Department has been at pains for considerable time to appreciate the difficulties many teachers face in terms of the perceived bureaucracy that has come into the system in recent times.

There are ongoing discussions between my Department and the teachers' unions. It is incumbent on our Administration to ensure that when these issues are raised, we are moving in partnership with the teachers and their unions to address and, I hope, to resolve many of the difficulties that teachers face in trying circumstances.

Sale of School Playing Fields


Mr McCarthy

asked the Minister of Education to give his assessment of the sale of school playing fields; and if he will make a statement.

(AQO 549/00)

Mr M McGuinness:

The agreement of my Department is required to the sale of any school playing fields. Such agreement would not be given if my Department considered that the facilities were required to enable the school to carry out its curriculum responsibilities. At present, I am not aware of any formal proposals with the Department for the disposal of school playing fields.

Mr McCarthy:

In this era of excessive greed on the part of some developers and the large sums of money being offered for land, does the Minister agree that school playing fields ought to be one of the last areas to be sold for development, bearing in mind the ongoing need for all schools to provide good, healthy outdoor facilities for the coming generation?

Mr M McGuinness:

Normally the Department would agree to the disposal of playing fields only where a school had closed or where the playing fields were considered to be surplus to requirements. It is certainly of concern to us. I know that there was some discussion in the media about the situation at Wellington College. It is important that people understand that in the case of the private finance initiative (PFI) scheme for Wellington College, while part of the playing fields was transferred to the PFI contractor, new and improved replacement physical education facilities will be provided for the school as part of the contract.

Ms McWilliams:

Can the Minister confirm that, in a recent planning appeal concerning the PFI scheme on the Wellington College grounds, the Department of the Environment stated that a community impact survey should have been carried out before the Department of Education agreed that those - or any other - playing fields were surplus to requirements? Can he confirm that those community impact surveys have not been carried out?

Mr M McGuinness:

I was certainly very interested in the publicity that surrounded the situation at Wellington College. Monica McWilliams made a valid point in relation to the contribution that the local community can make to this type of development. The Department will give very serious consideration to ensuring that, in the future, there is community participation.

Local Management of Schools


Mr Kennedy

asked the Minister of Education to detail how he proposes to take forward the review of the local management of schools formulae.

(AQO 543/00)

Mr M McGuinness:

I wonder where Question 7 went.

A consultation paper containing proposals for a common funding formula will be published early this year and will allow for consultation with schools and other education interests until May, after which the necessary legislative and administrative arrangements will be put in place with a view to implementation by April 2002.

Mr Kennedy:

Will the Minister ensure that any proposals take account not only of post-primary education changes but also of changes to the educational administration set-up?

Mr M McGuinness:

We will give serious consideration to all of that, and take all of the points made by Danny Kennedy into account at that time.


Health, Social Services and Public Safety

New Maternity Hospital


Ms McWilliams

asked the Minister of Health, Social Services and Public Safety to detail the progress that has been made in the provision of the new-build maternity hospital which underpinned the recent consultation on maternity services and to confirm that it is being processed in a timely and effective manner.

(AQO 538/00)

3.00 pm

The Minister for Health, Social Services and Public Safety (Ms de Brún):

Thosaigh Iontaobhas an Ghrúpa Ríoga Ospidéal ag obair ar chás gnó d'ospidéal máithreachais nua ar shuíomh an Ospidéil Ríoga goirid i ndiaidh mo chinnidh in Eanáir 2000. Bhí sé ar intinn ag an iontaobhas a chreatchás gnó a sheoladh chuig an Roinn faoi dheireadh mhí Eanáir 2001, ach, i ndiaidh breithiúnas na cúirte mo chinneadh a chur ar leataobh, cuireadh an obair ar fionraí.

Tá mé ag déanamh machnaimh go fóill ar an ghníomhnú is gá a dhéanamh mar gheall ar bhreitiúnas na cúirte.

The Royal Group of Hospitals Trust began work on a business case for a new maternity hospital on the Royal site shortly after my decision in January 2000. The trust had intended to bring forward its outline business case to the Department by the end of January 2001, but, following the court's ruling to set aside my decision, work on it has been suspended. I am still considering what action needs to be taken in light of the court's ruling.

Ms McWilliams:

I am concerned that a deadline has not been given for any new maternity hospital. Will the Minister confirm that last month, as a result of the merger between the Jubilee and the Royal Maternity hospitals, on at least three occasions the regional neonatal unit for the whole of Northern Ireland had to be closed to admissions? Will the Minister also confirm that there is serious overcrowding on the Royal Maternity site? There has been a deterioration in hygiene standards, and at least 40 midwives have left the service since the merger of the Jubilee and the Royal Maternity hospitals. Is the Minister as concerned as I am that conditions for the delivery of babies in the Belfast area are now reminiscent of those at the turn of the last century?

Ms de Brún:

With reference to the deadline, I am as concerned as any about problems arising from the uncertainty over many years about the location of a new maternity hospital. It has an adverse effect on the morale of the medical and nursing staff involved, and it also has the potential to cause concern to future mothers. I am anxious to make a decision on the way forward as soon as possible. The Member will recognise that when an issue ends up in court those plans will inevitably fall behind schedule, and everyone has to live with that. I have not yet decided how to respond to the court's decision, but whatever the way forward, my Department and I remain committed to providing maternity services of the highest quality.

In relation to the specific references to the maternity services at present, I am confident that the Royal Group of Hospitals is able to maintain, provide and sustain maternity services for the population. If the Minister wishes to write to me with specifics, I will reply to her.

Ms McWilliams:

I am not a Minister yet.

Ms de Brún:

Sorry: I meant to say "the Member".

Mr McGrady:

With reference to the issue of consultation on maternity services, is the Minister aware of the crisis in the Downpatrick Maternity Hospital, which was threatened by closure, presumably by the unlilateral action of anaesthetists? Will she ensure that the plan that has been evolved by the Eastern Health Board and the Down Lisburn Trust as of last Friday, for ratification tomorrow, receives her support and particularly her financial support? Will she ensure that there are further discussions regarding the Downpatrick Maternity Hospital to ensure that its in-patients services continue until the Hayes review reports and that all the resources and the services for the mothers in that area be sustained?

Ms de Brún:

I am happy to assure the Member that it remains my intention to maintain current services at the Downe Hospital pending the outcome of the Hayes review. I have asked the Down Lisburn Trust and the Eastern Board to do everything possible to maintain maternity services at the Downe Hospital until that time. The Department will continue in discussions with them, and we will monitor the situation.

Ms Ramsey:

Go raibh maith agat. There was widespread media speculation that, on the issue of consultation, the Minister took only two days to consider the matter. Was that the case?

Ms de Brún:

In spite of the fact that the consultation period had ended before I became Minister, I made a point of visiting both the Royal Maternity and Jubilee Hospitals and met many of the leading players on both sides. I was closely involved in the decision-making process for many weeks before that and was already well briefed on the important issues. Therefore I can assure the Member that that was not the case.

Shortage of Care Workers (South Antrim)


Mr J Wilson

asked the Minister of Health, Social Services and Public Safety if she is aware of the shortage of care workers in the South Antrim constituency, and to detail how she intends to address the problem.

(AQO 531/00)

Ms de Brún:

Tuigtear domh go bhfuil sé ag éirí níos deacra i rith an ama ag Iontaobhas Pobail Homefirst, atá freagrach as soláthar sláinte phobail agus seirbhísí sóisialta i gceantar Aontroma Theas, go leor oibrithe a earcú dá sheirbhísí cúraim bhaile. Tuigim fosta go bhfuil fadhbanna den chineál céanna ag cuid de na soláthraithe cúraim bhaile neamhspleácha, agus de réir cosúlachta tá na fadhbanna seo ann mar gheall ar fhás fostaitheoirí nua in earnáil an mhiondíola agus in earnáil an ríomhthráchta atá ábalta téarmaí agus coinníollacha fostaíochta níos tarraingtí a thairiscint.

Le cur ar a chumas dul san iomaíocht sa mhargadh fostaíochta deacair seo, tá Iontaobhas Homefirst i ndiaidh tabhairt faoi athbhreithniú a dhéanamah ar a sholáthar cúraim bhaile, lena n-áirítear socruithe, agus téarmaí agus coinníollacha fostaíochta na foirne cúraim bhaile

I understand that the Homefirst Community Trust, which is responsible for the provision of community health and social services in the south Antrim area, is experiencing increasing difficulty in recruiting sufficient staff for its home care services. I also understand that similar problems are being experienced by some independent home care providers. The difficulties appear to result from the growth of new employers in the retail and e-commerce service sectors, who are able to offer more attractive terms and conditions of employment.

To enable it to compete in this difficult employment market, the Homefirst Community Trust has embarked on a review of its home care provision, including the arrangements, terms and conditions for the employment of home care staff. Where there are specific problems in relation to the availability of care workers, the trust makes every effort to resolve these or to provide alternative arrangements for care that are acceptable to the individuals and families concerned.

Mr J Wilson:

I am thankful to the Minister, particularly for the part of her answer where she admitted that all is not well in my constituency with regard to care workers. Does the Minister agree that stability is the key issue with regard to home care? In order to achieve this, continuity of personnel and consistency of time are vital, as it is infinitely preferable for a family or individual to have care provided by the same person or persons, in order that a degree of trust and efficiency can be established. Will the Minister assure me that measures are being taken to address the problem of lack of availability of care workers in the late evening and early morning to provide care in accordance with patients' needs? Disabled patients are being put to bed as early as 6.30 pm and remain in bed until 9.30 am, or later, the following day.

Ms de Brún:

I have already outlined the measures that the trust is taking. I absolutely agree with the Member on the question of stability. The best situation is when there is continuity of the care worker that the person is familiar with. That is the situation that I expect the trusts to be trying to achieve, where possible, within the resources available to them, and under the conditions that they are faced with.

Residential and Nursing Homes


Ms Armitage

asked the Minister of Health, Social Services and Public Safety what steps she is taking to ensure that the reduction of independent sector residential and nursing home providers in Great Britain is not repeated in Northern Ireland.

(AQO 532/00)

Ms de Brún:

Tá ról tábhachtach le himirt ag an earnáil neamhspleách i gcóiríocht chónaithe agus tí altranais a sholáthar anseo agus leanfaidh mo Roinn agus na boird agus iontaobhais sláinte agus seirbhísí sóisialta de bheith ag obair i bpáirtíocht leis an earnáil neamhspleách le seirbhísí fóirsteanacha a chur ar fáil.

Anuraidh rinne meitheal oibre feidhmeannach ó mo Roinn agus ó na boird sláinte agus seirbhísí sóisialta measúnú ar an mhaoiniú do thithe cónaithe agus altranais de chuid na hearnála neamhspleáiche. Mhol an grúpa sin a lán beart ar aontaigh an tAire faoi Rialú Díreach ag an am sin, George Howarth, le linn don Tionól bheith ar fionraí, leo, agus ar iarradh ar na boird sláinte agus seirbhísí sóisialta iad a chur i bhfeidhm i Mí na Bealtaine na bliana seo chuaigh thart.

The independent sector has an important role to play in the provision of residential and nursing home accommodation here. My Department and the health and social services boards and trusts will continue to work in partnership with the independent sector to provide appropriate services. Last year a working group of officials from my Department and the health and social services boards carried out a review of funding for residential and nursing homes in the independent sector. That group made a number of recommendations for action, which were approved by the former direct rule Health Minister, George Howarth, during suspension and which health and social services boards were asked to implement last May.

It was recommended that fees paid to independent sector providers of nursing and residential care beds should not be tied to the income support rate but should be reviewed annually in the light of prevailing circumstances and priorities. It was also recommended that boards and trusts consider waiting lists for places in nursing and residential care homes and that, where appropriate, more places be purchased in independent sector care homes to raise occupancy levels. It was further recommended that boards and trusts consider whether block contracts could be offered to homes to give providers a more secure income stream, and that boards and trusts consider setting fee structures to encourage and reward quality. Boards and trusts are now working to implement those recommendations.

Ms Armitage:

It is interesting to learn that you have a number of ongoing commitments. I am concerned that by the time you have all those goals in place, those homes will already have closed. You are aware of the problem of keeping patients in hospitals, where the cost of accommodating someone is two or three times greater than the cost of accommodating him in a nursing home. I am always informed that these two budgets must never be mixed. Will the Minister comment on this? At present, we do not have enough homes for children. It is very possible that elderly people will be affected by similar problems. I do not want to see that happen.

We both know - it is obvious when one looks around the Chamber - that people are living longer and they will continue to do so. I was not looking at anyone in particular. I am sure that you will agree that we must make plans now, rather than wait until it is too late.

I thank you for your answer, but perhaps you could follow it up by stating when the reviews will take place. It is to be hoped that by the time they do take place the homes will not have closed, and we will not have left it too late, as in the past.

Mr Deputy Speaker:

Before calling the Minister to respond, I remind Members to address their remarks through the Chair.

Ms Armitage:

I was just trying to be friendly.

Ms de Brún:

I thank the Member for her friendly start to the new year.

I pointed out that a working group of officials had carried out a review, and that the recommendations were approved last year during suspension by the former Health Minister, George Howarth. The boards and trusts are now working to implement the recommendations of that review.

In response to the question about how budgets are used, I point to the way in which planning to cope with winter pressures was taken forward to make best use of the available resources and the integrated nature of our service. I have made it clear that I expect the health and social services boards and trusts to look at every available option for dealing with winter pressures. In that instance, the boards' plans for addressing waiting lists included the use of beds in nursing homes to facilitate the discharge from hospitals of patients who required a limited period of recuperative care before returning home.

Obviously, the details of contracting arrangements between boards and trusts and independent providers is a matter for local decision. There is nothing to prevent boards and trusts from providing this overview of their services, where it is possible. Ms Armitage expressed concerns about trends which she had noted in England. While I am aware that there have been some bed losses in the independent sector here, the most recent figures available show that, although the number of nursing home beds has been reduced by 320, the number of residential care beds has increased by 277. Boards and trusts are working on the specific recommendations of the review, which was endorsed by George Howarth last year.

3.15 pm

Ms Hanna:

Can the Minister tell me what consideration has been given to the need for increased resources for the elderly - specifically to bridge the gap between discharge from hospital and return to the community when they need rehabilitation and extra care? Currently, we do not have such resources. I am sure the Minister is aware that for those who are fortunate enough to get a place in a nursing or residential home, the rehabilitation element is often minimal.

Ms de Brún:

As with other areas of community care, this is a subject to which my Department has been giving some thought. I have made it clear in recent statements that there has been some difficulty with a large number and a wide range of services. There have been years of underfunding, and we are now trying to rectify that, but it cannot all be done in one year. However, this is an area to which we are giving specific consideration, and I am well aware of the particular concerns that the Member has raised. In looking at the allocations which we can make, we will take those points on board.

Mr McCarthy:

The recommendations of the recent Royal Commission on the provision of residential and nursing care for senior citizens were adopted by the Government just last week. Can the Minister assure the House that these will be introduced in full in Northern Ireland?

Ms de Brún:

I appreciate the concerns raised by both Mr McCarthy and Ms Hanna. When considering my response to the report of the Royal Commission on long-term care, I will be looking at ways in which we can help to meet the needs and reduce the uncertainty and distress of older people. That matter is still under consideration.

Hospital Trusts:
Finance (Specific Projects)


Mr Ford

asked the Minister of Health, Social Services and Public Safety to outline the steps she is taking to ensure that money given to hospital trusts for specific projects is being spent on the projects for which it was intended.

(AQO 547/00)

Ms de Brún:

Éilíonn mo Roinn tuairiscí ar chaiteachas míosúil na bpríomhthionscadal forbartha otharlainne uilig. Ina theanta sin, cuirtear grúpaí monatóireachta tionscadail, faoi chathaoirleacht stiúrthóra sa Roinn agus le príomhfheidhmeannaigh ón iontaobhas iomchuí agus ón bhord sláinte agus seirbhísí sóisialta atá ag coimisiúnú an tionscadail ag freastal orthu, ar bun do gach scéim le dul chun cinn agus le caiteachas a choinneáil faoi athbhreithniú.

Caithfidh tuairiscí ráithiúla ar dhul chun cinn agus ar chaiteachas i gcoinne an chostais aontaithe agus an chláir ama a sheoladh chuig an Roinn mar a tharlaíonn de ghnáth i gcás tionscadal caipitil uilig eile ina bfhuil an costas os cionn £250,000.

Dearbhaíonn na bearta seo domh go bhfuil na hacmhainní caipitil a ceadaíodh do scéimeanna ar leith á n-úsáid mar is ceart.

My Department requires monthly expenditure reports for all major hospital development projects. In addition, project monitoring groups chaired at director level in the Department and attended by the chief executives of the relevant trust and commissioning health and social services board are set up for each scheme to keep progress and expenditure under review. Quarterly reports on progress and expenditure against the agreed costs and timetable for a project are required to be sent to the Department in the case of all capital projects where the cost is above £250,000. I am satisfied that these measures provide me with the necessary assurances that capital resources approved for specific schemes are being properly used.

Mr Ford:

I thank the Minister for that response, in so far as it related to capital projects. I also remind her of my concern, which she has supported in the past, that acute hospital services tend to be regarded as sacred cows with the result that, at times of financial pressures, childcare and mental health and community care all lose out. The Minister has agreed that there is a problem with that. For example, I refer to the answer she gave to Patricia Lewsley recently on the issue of money diverted from mental health to acute services in Down Lisburn Trust. When recurrent expenditure is being considered, is it not necessary to ensure that we put in place the same checks which exist for capital expenditure?

Ms de Brún:

The checks to be put in place will need to be somewhat different. There are a number of ways in which I ensure that moneys are actually spent on targeted areas. One way is to have specific allocations ring-fenced to particular areas. This method has been used in the past, but there are difficulties, particularly when the number of areas to which ring-fencing is applied is increased. Another way is to approve boards' annual spending plans, which will have to identify how any additional resources allocated to them next year are to be applied. Finally, throughout the year we monitor the actual use of resources through the use of the accountability process.

As happened with pay awards in 1999, issues sometimes arise which mean that we have to re-examine initial spending plans if other areas of spending come in significantly higher than was planned for. It is essential that we have enough flexibility to deal with such matters, if and when they arise. Discretion is needed to allow hospital trusts to respond to local pressures on the ground. But, as I have outlined, there are methods I intend to use to indicate the strength of our determination that money allocated to specific areas of the services should in fact be spent on those areas. I will pursue this issue throughout 2001.

Mr Hussey:

Part of my question has already been answered, and I am glad that the supplementary from Mr Ford highlighted the position on revenue expenditure and more specifically the deflection of revenue expenditure from an intended target that a particular hospital trust had made a bid for. How far are hospital trusts allowed to deviate before a board will say that enough is enough or before the Department will say that enough is enough?

Ms de Brún:

It is not so much a question of how far they will deviate as whether or not a coherent reason is given for the deviation and if there is a rationale behind the proposed decision or any plan for future rectification. For example, in the case of the question put by Ms Lewsley, the board explained why, when faced with a particular problem, it had to divert funds. The board has put forward a coherent plan for returning those funds. We must ensure that it is understood that the plans, priorities and reasons put forward for funding are those to which people should adhere where at all possible.

Where there is difficulty, and a decision is made to deviate, there should be a coherent explanation and plans put in place to ensure that a specific area of service does not suffer and, particularly, does not continue to suffer.

Mr Dallat:

Does the Minister agree that the present powers of the Comptroller and Auditor General are inadequate for the scrutiny of health trust accounts, and will she support demands by the Public Accounts Committee and the Audit Committee that the powers of the Comptroller and Auditor General be extended to ensure that the money she allocates for specific projects is in fact spent on those projects?

Ms de Brún:

The powers of the Comptroller and Auditor General are not specifically within my remit, and at this point I do not wish to make a comment on them.

District/Community Nurses:
Mileage Allowances


Rev Robert Coulter

asked the Minister of Health, Social Services and Public Safety to detail the discussions she has had with the Secretary of State for Health regarding payments on mileage allowances for district/ community nurses.

(AQO 541/00)

Ms de Brún:

Mar a mhínigh mé don Teachta i mo litir den 20 Nollaig, ní gá domh cainteanna a bheith agam leis an Státrúnaí Sláinte. Cuireadh na méaduithe ar shocraigh sé orthu ón 1 Iúil 2000 don fhoireann sa SNS i bhfeidhm ar fhoireann SSSP ón dáta céanna.

As I explained to the Member in my letter of 20 December 2000, it is not necessary for me to have discussions with the Secretary of State for Health. The increases agreed by him, from 1 July 2000 for staff in the National Health Service, have been applied to all health and personal social services staff from the same date.

Rev Robert Coulter:

I thank the Minister for her reply. I am sure she is aware that mileage allowances for community nurses in rural areas of England and Wales were increased with effect from 1 July 2000. Given that many community nurses in Northern Ireland work in rural environments, and given the increases in the cost of motor fuel in recent years, will she indicate when allowances were last increased in Northern Ireland?

Ms de Brún:

As I have said, the allowances agreed by the Whitley Council automatically apply to staff who remain on centrally agreed terms and conditions here. Any time that there has been a change it has automatically been applied here also. Under the Health and Personal Social Services (Northern Ireland) Order 1972 (Amendment) Order (Northern Ireland) 1999, trusts are free to set their own terms and conditions of service for staff employed on trust contracts. Those terms and conditions may include mileage allowances, annual leave entitlements, or payments that differ from those agreed centrally by the Whitley Council or the National Joint Council. Where trusts have exercised their right to determine their mileage rates for staff, like all terms and conditions, those are agreed with staff organisations locally. I hope that that answers the Member's question.


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