Q.(Mrs Robinson) Is there any indication that the Eastern Health and Social Services Board (EHSSB) will receive retrospective resources to redress the underfunding dating back to the 1990s as a result of the old capitation formula?

A.While the EHSSB is in no way defeatist and will use every avenue to pursue this issue, there is no indication that money will be forthcoming.

Q.(Ms Ramsey) Is the EHSSB satisfied that it is carrying out satisfactorily its statutory obligations in relation to the Children's (NI) Order? (Ms Ramsey)

A.We recognise children's residential care as a particular problem. With the withdrawal of many independent providers in recent years, there is not longer adequate residential care provision. The EHSSB will require an additional £12m investment over the next 5 years to redress the shortfall. A working group, which produced the report 'Children Matter' was established by the EHSSB to examine the areas of deficiency; North and West Belfast are accepted as having particular problems and consequently North and West Belfast HSS Trust was allocated an extra £600,000. A working plan will shortly be produced with a view to increasing overall childcare provision; in the next few weeks an 8-bed facility will open on the Antrim Road as a first step.

Q.(Mrs Carson) You mentioned the £5m budget deficit EHSSB incurred last year through overspends: what action can you take to change that? Can you comment on funding for Community Care especially with increasing numbers of the elderly?

A.The EHSSB has a deficit strategy in place. It feels that focusing on tackling fraud could yield significant benefits. (Fraud costs and estimated £5m per year.) A more streamlined structure could also free up some of the substantial resources that are currently tied up in administration. There is potential for savings in prescribing levels as Northern Ireland's average (£144 per capita) is much higher than that of GB (£99). Further investment in information technology could also reap dividends.

Q.(Mrs Armitage) Is everyone who wishes to live in a residential able to do so or is it cheaper for the elderly to stay in hospital?

A.The EHSSB views Care in the Community as very important, acknowledging that many elderly people would choose to continue to live at home. The rule on Community Care expenditure on an individual is that it should not exceed that which would otherwise be spent on their residing in domicillary residential care. The fact that there are some 200 cases needing care each year in addition to the existing backlog has obvious spending implications.

Q.(Ms McWilliams) The issue of funding is a concern. GP fundholders overspent by £6m last year: can you impose penalties, for example? What seems to be the problem in relation to Section 75 of the Northern Ireland Act in relation to the Children Order; are there not enough places in residential care for children with challenging behaviour? Does the EHSSB have additionally to cover the costs of in-patients who normally reside outside the EHSSB area but who are being cared for within its area? With so many holes in the system, how can you plan a strategic vision?

A.The EHSSB is obliged to pick up the bill for GP Fundholders' overspends. Last year 44 out of 75 overspent, creating a liability of £1m - £1.5m, which the EHSSB will try to recover from their next year's budget. Conversely, other GPs managed a total saving of £6m. The Board had a £5m overspend this year due to the medical negligence bill, an unfair share in relation to its legal liabilities. This money has to be found from patients' services. The EHSSB must also fund A&E cases in their area regardless of patients place of residence.

The EHSSB regards equity as essential and wants to meet the spirit of the equality legislation without being bogged down in bureaucracy; a streamlined system is required.

Q.(Mr Berry) Has the EHSSB recommended the RMH to the Department as the preferred maternity site?

A.In the circumstances, the EHSSB would support an interim move to the RMH but would be happy with either site in the long term.

Q.(Mrs Carson) Why can the Board not be fully prepared for seasonal demands on its resources if funding and contingency allowances are known well in advance? Are there ongoing discussions among the Health and Social Services Boards to save money by taking a more holistic approach to services?

A.Much thought has been given to the future of the Boards. Now changes in the structures are within the power of the Assembly. The Boards do work together on common areas - for example, on training and Community Care analysis. There is a strong sense, though, that there would not be local dimension with a regional body with the result that some may feel disenfranchised. However, if a demonstrably more efficient way was to be devised, we would support it wholeheartedly.

The Board unfortunately does not know details of its budget until inescapably late in the year, and this obviously affects planning. We did hold meeting with the Minister very early last year to point up concerns and to warn of the very problems that materialised in the past few weeks. Unfortunately the resources allocated last year did not match our well-articulated demands.

Q.(Mr Kelly, Ms Ramsey) There is a 6-month waiting list of Housing Executive (HE) tenants awaiting occupational therapy assessments for home adaptations: could HE staff be trained specifically to carry out assessments for minor adaptations?

A.The fact that occupational therapy is an open access service places very heavy demands on it and the Board agrees that this area needs a root-and-branch review. For example, do we need a professional's opinion on whether someone needs a handrail? Handing back decisions on minor adaptations has not really worked in the past, as there are still lengthy waiting lists. When an occupational assessment is made, the decision then has to be approved by a welfare officer in the HE. What is perhaps needed is a set of strict guidelines on eligibility for services.

Q.(Mrs Robinson) There has been a shortage of resources spent on mental health, which seems to be the Cinderella service. A 20-bed unit at the Ulster Hospital could be opened at a cost of £2.5m with money that the Board is owed from previous underfunding: comment?

A.We welcome the Committee's interest in mental health especially that of adolescents, which has never enjoyed a well developed service and is a serious problem. The Boards are now undertaking a regional review of the service at the request of the Chief Medical Officer. We welcome all support on the capitation issue.