ANNEX A

17. Can the Minister reassure the Committee that urgent attention is being given to the very serious situation in relation to waiting times for fracture surgery? The recently highlighted death of Mrs Daly five days after being admitted for surgery has brought home the extent of the crisis. More assurances are needed on funding for this area across Northern Ireland. [The Chairman and Mr Berry]

18. The Minister expressed her condolences with the family of the late Mrs Daly and stated that she had requested a detailed report on the matter.

It was emphasized that the utmost attention was being given to this area, which the Department is monitoring. Musgrave Park Hospital has been called upon to support the RVH in carrying out fracture operations. From 1998/99 two additional consultants have been recruited and funding has been made available for two additional posts, which the Trusts have had no success in filling despite regular advertisements in the press and medical journals. A training programme for orthopaedic surgeons is also in place in Northern Ireland. It is also acknowledged that there is a shortage of appropriately trained nurses.

The average number of patients waiting each day for a fracture operation is 45, well within the upper limit of 60 that Prof. Marsh agreed with the previous Minister.

17. I am very concerned at the fact that the Departmental bid in respect of mental health services remains static year on year at £21m, in effect, providing no increase. [Ms McWilliams]

18. The recurring figure of £21m bid for mental health services for each of the next three years would represent an additional investment over and above the baseline figure.

17. In 1998 the Boards had to fund a higher than expected pay rise for nurses from within their budgets and this affected the community care services. Can an assurance be given that the cost of any pay award this year will not impact on front line services? Will the bid for Ambulance Services fully meet the necessary replacement costs of the fleet? [Mr Gallagher]

18. There are specific difficulties with pay awards, particularly if they are higher than anticipated, and the timing of settlements continues to cause problems; it is not an exact science. However, the Modernisation of Pay Arrangements should facilitate planning. Every effort will be made to protect basic services.

The bids in respect of the Ambulance Service make provision for both an immediate capital injection (which would be partly used to replace ageing vehicles) and a longer-term developmental strategy.

17. Can the Minister give an assurance that the proposals for cancer services will be put in place as soon as possible? [Mr Kelly]

18. The Minister shares the concerns about cancer and is absolutely determined to ensure that cancer services in Northern Ireland rank among the best in the world. The bids are required to provide for the regional centre at the City Hospital, four cancer units and 200 extra staff, including cancer nurses. The resources will be immediately targeted at the proposals.

17. Is the scale of the bid -£274m -at all realistic, as I understand that the overall sum available for all Departments this year is £40m? Is this not unduly heightening the public's expectations? Is it correct to say that there was a Departmental underspend of £10m last year that had to be returned to the centre? There had been talk previously of the possibility of co-locating emergency service control services to maximize efficiency: why then is £12m being bid for upgrading the Ambulance Service communication system? [Mr McFarland]

18. The bid is far from an ethereal wish list; it is simply recognition of the urgent needs to address priorities right across the health sector.

It is a common and indeed sensible financial practice to have carryovers from one financial year to the next if an expected expense is delayed and not required to be met in the current year; all Departments have the same prudent arrangements.

Work is ongoing on the recommendations in the Ambulance Service report. To bring together emergency services, sharing stations, for example, would involve major capital spend.

17. The question of Children Services comes up time and again, and there is deep concern that allocations for these services have been often raided in the past to meet other needs. Will you give an assurance, Minister, that future resources will be ring-fenced? [Ms Ramsey]

18. The Department has got a very clear message about the Committee's concerns in relation to Children Services, and it is currently looking closely at a number of options for maximizing the accountability process in order to ensure resources are targeted specifically at the services for which they are intended.

17. In order to be able to evaluate properly the bids, it would have been helpful for the Committee to have had a breakdown under each of the headings and also to be able to make comparisons with previous years' figures. How does the Minister propose to tackle the waiting lists problem? Will she consider the ring-fencing funding of Community Care services? How can efficiencies be made within the system? [Ms Hanna]

18. The Minister shares the member's concerns about community care services and has asked for this area to be included in the Boards' reviews of winter pressures. As stated already, the Minister will examine seriously the concept of ring-fencing.

The introduction of new technology will help to reduce costs in the long term and Trusts are expected to co-operate fully to optimize efficiency. Public Finance arrangements will also be considered where appropriate. Preventative health measures and the possible savings to be made are bound up in the public health strategy.

17. The Minister's paper detailing her bids does not explain how the bids will be distributed across the Boards and Trusts. Will the Minister's plans not pre-empt the recommendations of the Acute Hospital Review Group? Does the Minister have any thoughts on the reorganization of Boards and Trusts? [Ms Armitage]

18. Consideration is currently being given to the Primary Care proposals and the Executive Committee is reviewing Public Administration. Unfortunately any further information on the reorganization of Boards and Trusts cannot be shared at present.

Allocations to Boards and Trusts will be made in terms of the capitation formula, which is currently under review. An initial consultation exercise with local councillors being consulted on allocations for specific areas is already underway. The Department plans to discuss the proposals with the Committee once the initial exercise is completed.

The Department will discuss its proposals for the allocation of funding once the Executive Committee has made a decision.

17. Can the Minister give an assurance that funds earmarked for developmental work will not be swallowed up through deficit recovery by Trusts? [Mr Gallagher]

18. Clear guidance has been issued to the Trusts in relation to deficits, but it is also important to recognize that deficits are not only about mismanagement; but they are mostly caused by Trusts responding to the care services required by their population. Small-scale provisions can be built into baselines to cover unexpected additional services. However, where a Trust's bid incorporates a deficit recovery sum amounting to more than 0.5% of its overall bid, the Department demands that it submit a recovery plan.

17. One could almost despair as to where to begin with so many priorities, but it is important that we attempt to understand the serious pressures experienced right across the board. Given the constraints, will the Minister have to rely on Private Sector Finance to maintain services in the acute sector?

18. The Minister would prefer to meet the Department's needs within the budget but, in reality, recognizes that she may be obliged to look elsewhere.

17. How is the Department assessing quality and efficiency of care here? [Ms Hanna]

18. Clinical audit is already well-developed and is expanding into multi-professional audit, a powerful tool in the review of results in respect of care of individual patients. In addition guidelines on clinical governance are being developed. Community Trusts are working closely together with regard to quality of care. There are proposals to introduce legislation to impose a duty of quality on the Trusts' Chief Executives. A new Social Care Council will also be introduced in legislation planned for the autumn.

17. Have rules been introduced to stop Trusts' Chief Executives awarding themselves excessive pay increases? [Mr A McFarland]

18. The previous Conservative Government introduced the concept of the internal market and enshrined in the legislation was the freedom for Trust Boards to decide the Chief Executives pay. This remains the position. However, one of the intentions of the forthcoming HPSS Bill is to take the power to decide on these pay awards back within the control of the Department. The Department also plans to develop a Job Evaluation based pay system that gives responsibilities a weighting. The Scottish system is being investigated in this regard and the establishment of a pilot scheme is under consideration.

17. In view of the establishment of the HPSS Research and Development Office, how much funding has been given and what actual research has been done on the future of primary care services? [The Chairman]

18. The Minister will respond to the Committee in writing on this point.

Health and Social Services Minutes 27 September 2000