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ANNEX A
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Does the Dalriada Doctor On Call service have implications for the Primary
Care Commissioning Pilot (PCCP)? [Mr Kelly]
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The two schemes share premises but do not affect each other: the PCCP is an
in-hours service whereas Dalriada Doctor On Call is an Out-of-Hours scheme.
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i. Is the Mental Health Pilot specific to the NHSS Board? Can you provide details
of the scheme? Are there problems with locum availability in your area? ii. The
Committee is about to conduct an inquiry into children's services, and it is recognised
that an insufficiency of specialist beds is creating a crisis this area: is this
a problem in your Board -for example, how many children need that service? How
serious is the lack of secure homes - for, example St Joseph's is now closing.
iii. Does the NHSS Board buy into specialist psychiatric services? iv.The Guardian
Ad Litem Agency quotes 194 days as the average waiting time for Care Orders, which
is alarming. How are social workers coping in your Board area? [Ms McWilliams]
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i. Locum availability is a global issue and a particular problem for rural
areas. The Co-ops help out with this. The Board is seeking funding along with
Home First Trust for a mental health pilot to plug a gap in the service. The pilot
would provide funding for a community psychiatric nurse to assist the emergency
Doctor and may help avoid inappropriate hospital admissions through a visit. The
Board will forward details of the pilot as soon as they are available.
ii. This September the Board will directly address the specific crisis in relation
to specialist beds with the provision of a home to accommodate six children with
behavioural problems. Although this is seen as an interim solution, it will be
for a minimum of three years and will help alleviate current staff pressures in
residential care homes, as well as meeting the Board's needs for specialist places.
The provision of secure accommodation for children is a widespread problem, which
the Board hopes to address in part by building a new home soon in the Mid Ulster
area.
iii. The Board has an arrangement for psychiatric trained staff to attend family
centres and for children who require a 24-hours service to be accommodated in
specialist children's homes.
iv. The Board targeted Children Order resources on increasing significantly
the number of social workers and qualified residential care staff, and staff appear
to be coping quite well. We will confirm the average waiting time for Court Orders
in writing.
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i. There are 47 children in five care homes in the NSS Board area. Is there
overcrowding? ii. How many social workers would the Board need to implement fully
its legal obligations under the Children Order? iii. You quoted the number of
children in your area as receiving care as 734, but your handout states that 593
are being "Looked After." Can you explain the difference in figures?
[Ms Ramsey]
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i. The homes are currently operating at maximum capacity, though they should
be functioning at only 80% to allow social workers to make appropriate choices
for placements. The Board will provide the Committee with detailed plans for its
residential care homes over the next three to five years.
ii. Under the Children Order, 53 extra social workers were funded. We will
confirm later the number of social workers believed necessary to meet the obligations
under the Order, and an assessment of the impact of court work on social workers.
iii. The discrepancy in the sets of figures is explained by the fact that "Looked
After" children do not include those in foster care or those at home on trial.
A further breakdown of figures will be forwarded to the Committee.
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How many additional staff would be needed to bring children's services up to
scratch? What plans are in place to tackle this winter's pressures on GPs? - the
main source of complaints was that last year there were insufficient home visits
by GPs. [Mr Berry]
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There remains a budgetary shortfall in community care and children's services,
where resources need to be increased.
We are already planning for the winter in conjunction with the other Boards
but many of the provisions will mirror last year's. The generous budget settlement
in March will also help put in place services to tackle pressures. For example,
last year slippage money allowed us to put various measures in place - a number
of places in the community to enable patients to be discharged from hospital,
50 additional beds, an increase in the numbers of nurses and social workers, overtime
for A and E and the Ambulance Service, and more vaccination programmes. Most of
the complaints about GPs failure to visit were satisfactorily resolved under the
NHS complaints procedure.
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How much does the Board's Out-of-Hours service cost and who pays for it? Are
there professional standards in relation to how far a patient can be expected
to travel to see a doctor and vice versa?[Mr Gallagher]
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The cost of the Dalriada service breaks down as follows: £344,000 provided
by the Development Fund; £1.3m charged to the GP practices; and a GP membership
fee that contributes £360,000.
It is a fact of life that rural GPs have to travel longer and this applies
to both In and Out of Hours services. There are no standards for length of journeys
- in parts of Northumberland GPs can travel over 50 miles. In recognition of the
problem, the Board has established four strategically placed "Lock Up"
centres across the Board area to minimize patient/doctor travel times. Doctors'
cars are equipped with phones so they can triage calls on route, and there is
sufficient staff at each centre so that care is not compromised.
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What is the average number of calls per night to the Board's four areas for
Out-of-Hours GP services? How can patients access the system - is there more than
one phone number? [Mr McFarland]
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The numbers of calls are variable but are in the region of 60 calls per night
before 12.00 p.m. (when three GPs are on call and standby) and 10 after 12.00
p.m. (when one GP and a standby are on call). About a quarter of these calls would
result in a home visit.
There is a single phone line to the call centre, which is well publicised.
Calls to surgery numbers will be either diverted or receive a recorded message.
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Does the panel think it would be a good idea to have a centrally managed system
to determine Senior Executives' pay? [Ms McWilliams]
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The sooner, the better. The Board has no discretion to deviate from the Department's
pay determination but the Trusts were given different freedoms.
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You say that you asked for an additional £8m to implement the Children Order.
How much did you receive?
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£5.1m
Health and Social Services Minutes 07 June
2000
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