ANNEX A

17. There has been no clear information to date on how the recent £6m allocation to the Department as a result of the winter crisis was distributed. Can the Minister give an assurance that the extra resources for capital pressures are being allocated equitably and not simply targeted at Trusts which have overspends? [Mr Gallagher]

1. The extra resources granted to help meet winter pressures that were made available to the four Boards were based on the same needs-based formula on which annual allocations are made. Of the £52m capital spend for next year, the bulk will go on major projects such as Causeway, Altnagelvin and Craigavon with the remainder going on general/minor works based on proportionate overall spends.

17. Is it the case that some capital budgets are already in overspend and, if so, what are the implications? How does the Minister intend to fund the new build Maternity Hospital at the Royal? [Ms McWilliams]

1. Capital allocations have already been devoted to the projects under way at Causeway, Altnagelvin, Craigavon and the Royal. The Department manages these major capital programmes very closely, and monies are released in stages as the developers' bills come in. In terms of general allocations, while there are no overspends, there are enormous backlogs amounting to some £170m worth of smaller needs. The current capital investment levels are not able to keep pace with the level of inflation.

In terms of the proposed maternity new build, planning only begins this year, and there will not be any impact on the budget until later years. The Minister will also be looking to other areas where resources may become available.

17. In light of the cross-community support for the Jubilee site as the new site for the regional maternity hospital in the Committee, and the Assembly vote supporting a motion in favour of the City site, will the Minister reconsider her decision to select the Royal site?

The Department's document on budget proposals deals with Capital Expenditure at para. 7, but, surprisingly, no mention is made of the Ulster Hospital. Why is this so and if this year's priorities cannot be reviewed, can the Minister give an assurance that it will be included as a priority next year?

Board allocations are dealt with in paras. 9 and 10. As there is a history of underfunding of the EHSS Board (some £15m), how is this being addressed? I understand that the Department has not been in communication with the Boards in relation to their overall budget allocations: will this be addressed immediately?

Capitiation assistance was given in previous years: does the Minister intend to continue this into the next financial year? Are the current baselines for each of the Boards correct?

Inadequate money was given to fund the pay settlement for the current financial year, which meant that Boards had to defer service developments: has the Department learnt its lesson for next year?

Are existing resources being directed to the highest priorities? [Mrs Robinson]

1. In relation to the maternity decision, the Minister assures Mrs Robinson that she listened to all the points raised in the Assembly debate and appreciates the strength of feelings aroused by the decision. The Minister remains convinced, however, that she took the right decision taking account of all the factors. She has made personal visits to both sites, which are both excellent, and has been informed by the PAFT analysis, an economic appraisal, Departmental advice and the expertise of those who produced the Donaldson report. The final decision was based solely on what was deemed best and safest for mothers and babies.

Para. 7 of the document lists projects already committed to, but an assurance can be given that the Ulster Hospital is a very high priority and will have primary call on any moneys that may additionally become available. The Department is already in discussions with the Ulster Hospital's Board with regard to a strategic approach.

Allocations to Boards in terms of funding and capitation are based on a formula. The original formula was so controversial that it was overhauled in 1997 by a report recommending changes that were accepted by the four Boards, and the allocations were adjusted on that basis. The EHSS Board is now receiving its full capitation share, and there will be further fine-tuning of the system this September.

The Board's baselines reflect the 1997 recommendations, although the overall Departmental resources are not accepted as adequate.

The pay issue last year was very painful. The Department had set aside funds for the pay award based on what it had agreed with the Treasury. However, the Pay Review Board's report recommendations (which were considerably above that which was originally agreed) were subsequently accepted, with the result that the Boards had to fund the shortfall: the Treasury gave no extra funds. This year the Department can make provisions accordingly as it knows the Pay Review Bodies report in advance and can therefore factor in the recommendations from the start.

The Department is in communication with the four Boards and each has been sent a paper today on the proposed allocation funding for 2000/2001. The Boards views are fed into a working group, but the Department is happy to take up Mrs Robinson's concerns that the EHSS Board has not been consulted in relation to capitation funding.

The Department is convinced that resources are being directed to the highest priorities but accepts that, due to inescapable pressures, it is unable to do many things it would like to. The Minister wants the public made aware of the choices to be made.

17. Several Governments worldwide are suing tobacco companies for smoking-related diseases: does the Assembly have the power to seek to recover the health-related costs here over the last 25 years from tobacco companies? Health Action Zones (HAZs) are seen as potentially major contributors to the prevention and detection of diseases, therefore, can the Minister comment on their funding and profile? Given the Chief Medical Officer's report that states 500,000 lives here will be shortened by smoking, should health promotion in general not be awarded more resources than its present relatively small allocation? [Mr Kelly and Dr Hendron]

1. The NHS Confederation is examining the feasibility of taking action against tobacco firms, but there is the question of legislation, which the Minister is currently checking. Tobacco-related illnesses are a priority for the Minister, who wants to bring in legislation to ban related advertising. The Minister also attaches great importance to public health in general, and current spends will be maintained next year, with specific extra funding for vaccination programmes, flu jabs and healthy lifestyle programmes, for example.

The Minister fully supports the concept of HAZs. The action plans for the North/ West Belfast and Armagh/Dungannon zones have only just been endorsed and the Minister will want to evaluate their worth and contribution before considering setting up new ones. There is only £17m available after priority developments, and almost all is eaten up by commitments to cancer care (£9m); Childcare Strategy (£3); residential child care (£1.5m); and capacity pressures (£3). Therefore, while the Department would like to spend more on health promotion, funding is severely limited.

17. I would appreciate a more detailed version of the budget proposals giving breakdowns of spends under the five headings. I am concerned that so little is allotted to health promotion especially in view of the moneys for merit and distinction wards (£4.5m and post-grad. education (£25m). How does the NI spend on drugs (£235m) compare with the rest of the UK? [Ms Hanna]

1. A more detailed breakdown can be provided.

Merit Awards are designed to reward those with exceptional levels of skill- for example, in neurology and cardiology- and it would be difficult to negotiate these away. These are a means of retaining excellence in the service. The post-graduate funding is for the salaries of some 1200 junior doctors, and is administered by the Post-Graduate Council. Of course these doctors are all involved in health promotion activities, albeit not directly. The hospital system is a great resource to be capitalised on in order to get across the message and focus on behaviours and attitudes, with particular reference to smoking.

The NI spend on drugs is much higher than in GT Britain. For example, 13 prescriptions are dispensed per head here as compared with 12 for Wales, 11 for Scotland and 10 in England. The costs per head are £135 for NI, £110 for Wales, £109 for Scotland and £88 for England. The higher figures here can mostly be attributed to the higher morbidity levels and the exemption rates (94%). The Department wants to see additional sensible measures taken in prescribing and an action plan is in place.

Community Care was awarded £25m last year but the pay awards reduced the figure somewhat. An enhancement was made recently to restore the situation and the £25m has been re-instated.

17. Mr Blair recently admitted the NHS is underfunded: are any steps being taken to try to increase the budget? Annex 4 states that £3.5m is needed for children and residential care homes this year, but only £1.5m has been allocated: comment? Is the money for the Sure Start programme "additional"? [Ms Ramsey]

1. The Minister has made very public her view that there needs to be a long-term strategy for the health service and this will have resource implications. There needs to be a public debate about the needs of the service. The issue of the need for additional resources has been raised at the Executive, and indeed, some short-term help was granted towards the winter crisis.

The £1.5m allocated to children in residential care in the coming year's budget falls well short of what is needed. Although three new children's homes are proposed for this year, this only begins to tackle the problem- the report 'Children Matter' in 1998 recommended setting aside £20m for 20 homes. The Department hopes to accelerate building over a five-year period. The Department is putting extra resources into each of the Boards for the Sure Start programme.

17. According to the Donaldson report, the key factor in the decision to base maternity services at the Royal site was the proximity to the Royal Hospital for Sick Children, which seems a spurious argument: what other information was available to the Minister, that was not in the public domain, upon which her decision was based? [Mr McFarland]

1. The Minister reiterates that her decision was based on the fullest possible information including responses from consultants, community groups, health professionals and mothers, as well as information from a PAFT analysis and an economic appraisal. The final decision was informed by clinical arguments and it came down to the linkage with the on-site regional paediatric services and the A&E unit. The decision was very difficult and there were eminent doctors on both sides of the argument. It is important to make the point that Sir Kenneth Calman's small team of specialists who came down in favour of the Royal were totally independent and had no vested interest on the siting.

17. The Department's consultation paper on the budget lacks transparency and is not in-depth with the result that many questions are left unanswered: can the Minister comment? [Mrs Carson]

1. The Minister is more than happy to follow up on any queries that Members may have on the paper.

17. The maternity debate should focus on the many gynaecological-related problems as well as obstetrics and paediatrics. I am therefore concerned that the decision on the maternity unit could be the precursor to the splitting of gynaecological and obstetric services. The medical experts involved deserve a major input into any future decision affecting such services. [Ms McWilliams]

1. The Minister's decision on the regional maternity site does not necessarily mean a split in gynaecological services; the future configuration has not bee developed yet and there are a number of options. Discussions are being opened up with the City Hospital as to the future profile, and the Committee will be consulted before any decision is reached.

Health and Social Services Minutes 02 February 2000