ANNEX A

17. What implications are there for the Public Service Agreement (PSA) targets in terms of the legislative decision to extend the period for GP Fundholding? Will the Regional Strategy 1997-2002 document be replaced now by Priorities for Action? What is the position in relation to HSS Trusts incurring penalty points in relation to junior doctors working in excess of the hours agreed under the new contracts? Will the PSA targets in relation to the recruitment of nurses alleviate the crisis in nursing? [Ms McWilliams]

1. The legislative decision will have financial implications for the HSS Boards that will have to be urgently addressed. It will also intensify the uncertainty facing fundholding practices, many of which are already disorganized, and impact on frontline services. It will impede the new arrangements for Primary Care by tying up resources, and this will necessitate taking money from elsewhere or bidding for more resources from the Executive. Inevitably, current overspends within GP fundholding practices will increase.

The Regional Strategy 1997-2002 provides a long-term perspective. It needs to be developed in light of the rollout programme for the immediate future. The Priorities for Action, which will be published shortly, give a short-term and realistic perspective on what can be achieved; it will not replace the Regional Strategy.

In relation to the junior hospital doctors, there have been varying degrees of compliance with the new deal but the figure has slipped back from 80% to 70% over the last five years. The Department has, though, spent £3.3m in supporting the new deal by adding 109 medical posts but this has not been enough. The new contracts have led to increased overtime payments, which have given some cause for concern, but the Department is working towards the goal of 100% compliance. The baseline figures allow for £3.4m for junior doctors' overtime.

Extra resources have also been directed towards professional training to meet the targets for nursing and other health professions. However, it is recognised that the amount of resources available will not always fully match the needs.

17. What resources have been set aside for the maintenance and replacement of old equipment at Belvoir Park Hospital, given the lengthening waiting lists? I am concerned that some of the equipment is almost defunct. What Capital investment is needed for the RVH, the Causeway Hospital and the redevelopment of the Ulster Hospital? [Mrs Robinson]

1. We will provide written details in relation to the question on equipment at Belvoir Park Hospital. However, services will be maintained at Belvoir while the Cancer Centre is developed at the City Hospital but expenditure will have to be kept to a minimum. Belfast City Trust has raised similar concerns with MLAs in relation to this issue, and the Department is working with them to explore ways to overcome the problems.

Considerable work has been done on the needs of the Ulster Hospital, and an extensive Business Plan has been drawn up. It is accepted that something much wider is needed than was originally anticipated and the latest submission is currently being examined.

17. How much extra funding has been devoted to Cancer Services in the Budget? The Budget Final Determination shows £6m, whereas the Summary of Service Developments shows an additional £3m for Cancer Services. How much did the recent court case taken by the Department against the First Minister cost? [Mr Berry]

1. Given that NI has the highest death rates from cancer in Western Europe for both male and females, additionality is certainly needed for Cancer Services. An additional £3m is made available next year to continue the development of Cancer Units and help with the recruitment and retention of specialist nursing staff.

The bill for the court case has not been presented yet but it is safe to say that it would not materially affect the Health Budget.

17. The Budget Proposals paper refers to the need for 56 additional residential childcare places. How does this fit with the 453 places estimated as needed in 'Implementing Children Matter', given that there were 338 places as at 1 August 2000? Last year, out of 31,000 Fire Service call-outs, only 18,000 were to actual fires. Is there scope for a target in relation to bogus call-outs? [Ms Ramsey]

1. It is frequently young people who make bogus calls, and we would therefore appeal to elected representatives to use their influence to appeal to our youth to desist from this behaviour. This vital service must be used most efficiently.

It is estimated that there is a current shortfall of 100 to 110 children's residential childcare places. There is a clear focus now on how to repair that and the Children Matter TaskForce will be reporting very shortly. While the Programme for Government provides for 12 additional places, we hope to have an extra 40 places by the end of this year and a further 30 by the end of the following year. We should be close on target by the end of 2003/04. The crash programme involves identifying sites and applying for planning permission. The big issue is having trained staff in place.

17. I note that the Public Service Agreement in relation to the Fire Service aims for a reduction in sickness levels from 13% to 10%. Given that some 75% of the Fire Service budget is spent on wages, is the Department satisfied that this is an acceptable level of sickness; it seems very high notwithstanding the high fitness levels needed for the physical demands of the job? I note that the Economic Policy Unit of DFP is to examine budget expenditure within the Health Department. When is it expected to report? [Mr McFarland]

A. The fact is that the Minister has asked the Economic Policy Unit to look at the level of need and demands within the Health Service with a view to strategic planning over the next few years. We need to examine how resources are spent, HSS Trusts' deficits, and ask the Executive to consider those needs.

In terms of the Fire Service, the particular conditions, and sometimes horrific scenes, that firefighters face must be considered. They are expected to be available on a 24-hour basis, and getting the required commitment levels means providing commensurate salaries, which are negotiated UK-wide. However, the Local Government Auditor Inspector has spoken to Departmental Officials already and highlighted a number of areas to be addressed in terms of efficiency savings, for example, the civilianization of some roles.

17. Mr Hamilton spoke here previously on finances and said that the Department was putting in place a mechanism to track expenditure. This should have been in place before. In order for us to argue persuasively for extra resources for the Health Service, we must be able to assure ourselves that existing allocations are being spent effectively and efficiently. [Mr McFarland]

1. The Department does have very specific mechanisms for tracking expenditure right through the system. Considerable documentation has been sent to the Committee to show how and where resources are spent. Thirty-five bodies produce accounts, which are monitored monthly. We appeal for understanding of the particular political framework within which we have been working for some time: the Department - HSS Boards - HSS Trusts. The consequences of long-term underfunding must also be borne in mind.

17. We appreciate that the Health Service is considerably underfunded, which is why we are trying to get the complete picture. We welcome the £3m for extra nurses but we need to be creative. What are the cost implications for the implementation of the new Primary Care arrangements? [Ms Hanna]

1. There will be cost implications in the setting up of the new Primary Care Groups but the fact that GP Fundholding will not be ending will cost some £2.5m in administration that could otherwise be saved.

17. I would appreciate more details on the estimated costs of the Primary Care proposals; the implications of GP Fundholding continuing for another year; and the costs associated with the transition period and where the money will be spent.[Ms Hanna]

1. We will make a written response.

17. What is meant by the reference in the PSA Family Health Service targets by "improving standards of service in the FHS"? How can this be measured and quantified and what baseline will be used? Is there a timescale for the Modernization of Imaging technology? [Rev R Coulter]

1. Pages 23 to 25 of the Priorities for Action set out the targets in relation to Family Health Services. In terms of the Modernization of Imaging, we are starting with the big issues and assessing requirements before developing timescales.

17. The RVH and BCH were prepared to work together in relation to the purchase of Positron Emission Tomography. Could this very valuable technology be secured urgently? [The Chairman]

1. We want to see the benefits from modern technology, and PET will be considered in this context. This is an area for the North-South Ministerial Council, and a joint health technology group will be examining the issues. The Department is aware that charitable funds have been raised to support PET but it is also important to bear in mind the ongoing revenue and staffing costs. The main priority for the Minister is the expansion of MRI to support the work of the Cancer Units.

17. What controls will there be on GP Fundholding practices, HSS Boards and Trusts in the transition period to the new Primary Care system to counteract budget overspends and deficits? [Mr Kelly]

1. Unfortunately, overspends and deficits may rise in the next year as GP Fundholding schemes find it increasingly difficult to cope. In such overspend cases the HSS Boards have to pay the deficit, which has damaging consequences. There are controls in relation to GP Fundholding practices insofar as legislation provides for the expulsion ultimately from the scheme of those that overspend. The HSS Trusts must put in place specific recovery plans for deficit situations.

17. If 45 out of the 145 Fundholding practices left are expected to be in overspend situations, they can be taken back into the system and the remainder, which presumably are working well, can move seamlessly into the new Primary Care arrangements. [Mr McFarland]

1. It is not accurate to say that the system is working well; in fact, it is falling apart. There is a rising trend of practices leaving the fundholding system. The internal market produced inequities, and it needs to end. Staff in the Fundholding practices are faced with continuing uncertainty, which creates problems.

17. Where are services for the rural community catered for in the Budget proposals and Priorities for Action? The sizeable Final Determination of £3m extra for Primary Care goes to the HSS Boards, and that concerns me. They have ignored local opinion in the past. The Department should be more involved in monitoring the Boards' usage of resources. Will the Budget for 20 extra Occupational Therapists provide for fully trained staff immediately? What percentage of the additional resources did the Health Promotion Agency receive? What is the Department's plan to reduce single mother pregnancies by 10%? [ Mr Gallagher]

1. The Executive has requested that all Departments take on board the impact on rurality in their Budget allocation and Priorities for Action. New TSN places emphasis on accessibility, for example, in terms of planning services and the Ambulance Service. A raft of issues are to be addressed in the forward strategy, for example, there has been concern in relation to the GPs Out-of-Hours Service, with some doctors covering very wide areas. The Capitation Formula and Health Action Zones also take account of rurality where appropriate.

Local Medical Committees will meet with the Boards to address issues in relation to Primary Care and expenditure of the additionality. The total extra money for front-line Primary Care services will be £4.5m, and the Department engages with the HSS Boards and Trust to discuss their priorities and pressures. Allocations are then made with specific tags, though there is some flexibility so that Boards can advise the Department if pressures change with a view to redirecting resources. It is intended that there will be increasing direction from the Department to the HSS Boards.

The Health Promotion Agency was given an inflation rise to the baseline figure. However, an additional £1.5m has been allocated to Health from the Public Health Strategy to encourage the development of a number of initiatives.

The Budget provides for a minimum of 20 fully trained Occupational Therapists, not training places. The Department is working with the Housing Executive to review occupational therapy assessments for home adaptations, and it is hoped that this will lead to a 20% reduction in waiting lists. An advance copy of their report will be provided.

17. I welcome the hands-on approach that devolved Government brings, as this gives the Department an opportunity to examine hospital consultants' contracts and whether they are providing value for money. Where are we in relation to this issue? [Mr McFarland]

1. The development of hospital services has included the question of consultants' contracts, and the Department is in ongoing discussions with the Royal Colleges. The matter has also been raised with the Acute Hospitals Review Group. However, the National Management Side reports extremely slow progress to date on the negotiations at UK level, with no signs of any agreement emerging. The Department feeds in to this process and wants to see greater flexibility on the deployment of consultants, including geographical coverage.

17. Are there any current PFI initiatives to offset capital costs? [Mrs Robinson]

1. The first step is always to establish the Business Case, which needs to be carefully constructed and examined by the Department and DFP. There is no presumption that either public or private finance is best. PFI was used in the Renal Unit at the City Hospital. Some £25m worth of current capital schemes are similarly funded, with a further £50m being considered. The long-term price tag of PFI must be borne in mind, though, as there are clearly in-built revenue costs.

17. Could the work of the plethora of bodies involved in health promotion be co-ordinated under one umbrella organisation? Can the Committee help to advance the arguments made by NICON in relation to the historical under-investment in Northern Ireland's Health Services? [The Chairman]

1. The HPSS spent £40m last year on Health Promotion, and this remains an absolute priority for the Executive. (We have the highest coronary heart death rates in Europe.) As this is a cross-Departmental matter, a Ministerial Group on Public Health has been established. The 'Investing for Health' public health strategy document is currently out for consultation, and we would be happy to discuss this with the Committee at a future date.

17. Do all Departments contribute to the Health Promotion Budget? [Ms Ramsey]

1. Although Health Promotion comes under the Department's remit, the Ministerial Group was set up because of the understanding that public health is a cross-cutting issue requiring a cross-sectoral approach. Each Department will take responsibility for their own input and work with the community and business sectors.

The Department would clearly welcome any contribution by the Committee to advance the argument for increased funding for health, given the history of under-resourcing outlined by NICON.

17. Has the Department thought of making a pre-emptive strike in relation to the argument for extra funding by carrying out an examination of its administrative structures and ensuring that it is fully efficient? That would help advance its argument. [Mr McFarland]

1. The Department has examined ways of making efficiency savings. Last year £190m worth of savings were made, which went back to the centre. In England those savings would have been allowed to remain in the NHS. We are in the early stages of administrative review and all Departments have submitted lists of their remits. Discussions have commenced regarding the number of HSS Trusts and Boards, and what the review should entail to find the best structures. As a member of the Executive, the Minister cannot pre-empt the final outcome. There needs to be integration between the various Departments to get a uniform approach.

The Department has been looking at making savings in administration over a number of years. Indeed, £7m has been saved over the last four years. Although management costs are £90m, the rationalization of HSS Trusts and Boards would not save that sum. Economies of scale would amount to estimated savings of between £5m and a maximum of £10m. In spite of NI's more complex system of Health Care, the proportion of administration costs spent on management, 4.5%, is below the UK average.

It should also be noted that some community nurses have been complaining of a lack of administrative support. In other words, there are two sides to the argument on administration.