The Northern Ireland Assembly

ANNEX B

People must have confidence in primary care service, especially with regard to the arrangements for out-of-hours GP co-operatives: is the Board satisfied with the service being provided by these centres, and what is their cost? [Mr Gallagher]

The rationale behind the Co-ops lay in the difficulty in recruiting GPs in rural communities. While the Board has the biggest proportion of single GP practices in NI, this creates maintenance problems in terms of cover. Last year in addition to the Health Service's central funding of £291,000 for the four co-ops in the area, the Board directed a further £70,000 of its own funds. The Board has invested time in measuring patient satisfaction with the Co-ops in conjunction with the Western HSS Council, and the ratings currently stand at between 80% and 90%.

Does the Board accept that the Health Service has lost its way somewhat in the delivery of primary care -for example, on Boxing Day one person spent three hours trying to get through to the call centre in Craigavon? [Mr McFarland]

The Board is about advocating for patients while trying to strike a balance by providing realistic cover. The call centre was overwhelmed over the four Christmas Holidays when there were no surgeries - some 1800 calls were taken. The Board is developing effective complaint mechanisms. Digital technology is an important issue - for example, GPs using short-wave radios as opposed to mobile phones is a possible solution to solving signal problems in mountainous areas.

The rise in the number of suicides among young men is alarming: did you refer to a link between this and the crisis in farming? What is your mental health budget? [Ms Ramsey]

We spend proportionately more on mental health than any other N Ireland HSS Board - £22m. The annual suicide figures in the Board area have risen from 15 in 1996 to 29 in 1998. The Board has commissioned Dr Foster from South Tyrone Hospital to carry out research in this field. Suicides are often related to impulsive behaviour, but alcohol misuse increases the risks substantially. Sensationalist press and media coverage can lead to copycat behaviour. The high number of parasuicides is a serious drain on resources.

In relation to Community Care, children's mental health is a major issue: what is the Board's view on this? [C Hanna]

The Board is concerned about the mental health of adolescents, and by targeting extra resources it has managed to halve its mental health waiting lists. It has the highest proportion of children of all the Boards, with corresponding demands on related resources; indeed, it has already overspends in two Trusts. Lack of suitable accommodation is a huge problem especially for some "besieged" housing estates.

There is now also a shortage of specialist fostering expertise in dealing with problem children. The Heather Project on adult survivors of child sex abuse showed that the mental health service is often seen as insensitive and inappropriate and the Board is currently working with survivors to improve practice in this area. By developing protocols and guidelines with a multi-disciplined approach, including greater use of psychologists and specially trained nurses, the Board has increased the opportunity for patients and clients to be seen appropriately. This has led to a reduction in the waiting list to see the psychiatrist for the high priority cases.

How useful have you found your meetings with the WHSS Council? When you talk about a model service appropriate to NI, what do you mean? You propose a radical scrutiny of medicine prescribing: please expand. [Ms McWilliams]

Although it would be wrong to describe our meetings with the Health Council as "comfortable", they are constructive and productive. The Area Health Council is a tremendous resource in terms of taking up the health challenge and providing practical criticism; and a Board member will always attend its meetings to answer questions. This relationship is also positive in that the public can see the Board being tested and scrutinised properly.

The Board was never happy with the concept of the internal market and the fragmentation of the Health Service. It sees the need to go back to original values with an accountable system in which the public can have confidence. It wants a common Health Improvement Plan which would include all the Trusts, Agencies and Councils and by which every party is bound -for example, in the development of a cancer strategy.

The Board wants to see rational but not necessarily cheap prescribing-for example, more could be spent on medication for asthma and hypertension. It also wants to see better compliance by patients in following courses of medication. The Board has developed a joint strategy with GPs, community pharmacists and the WHSS Council, which is well accepted locally.

How did the Board fare in terms of bed management during the recent crisis?[Mrs Robinson]

The crisis was not confined to the Belfast area. There was also intense pressure in the Western Board area necessitating the cancellation of some elective treatment. We commend Altnagelvin hospital staff for their management of the crisis, which they alleviated by instigating a 'step down bed' system at the beginning of the emergency. The appointment of a discharge co-ordinator to eliminate 'bed blocking', where possible, was a major step forward with private Nursing Homes accepting 60 patients who were discharged early. Some elective surgery was also carried out in Sligo to avoid waiting list problems in the long term.
Vaccinating health professionals against influenza may be a long-term solution.

The WHSS Board has the smallest population of all four Boards but appears to have the same bureaucracy and levels of management as the others: comment? [Mrs Carson]

When HSS Trusts were formed in the Western Board area, we established
Westcare which supplies personnel, estates, IT support services to both the Trusts and the Board thus allowing us to reduce administrative staff levels and direct more of our resources to patient care. The Board has a cost ceiling representing 1.9% of its total spend of £260m, which it views as good value for money.

You have said that you planned ahead and contracted out services, is this an increasing trend and what is your view of it? [Ms McWilliams]

The Western Board would prefer to commission all patient care from providers in Northern Ireland, but, unfortunately, in some services, especially cardiac care and orthopaedics, the waiting lists are so long that it took the decision to offer patients the opportunity to have their operations outside Northern Ireland. This is more expensive than purchasing these services inside the province but in these instances we feel that the cost is justified. We currently purchase some care from hospitals in ROI and anticipate that this will increase.

Do you feel that a strategic plan for the whole of Northern Ireland would assist you in planning for the future? [Mrs Carson]

We await the Minister's decision on the siting of the new hospital in the West of the province, which we expect to be made in the context of the needs of the whole of the Province. We agree that the number of Boards and Trusts should be reviewed but are concerned that, if a centralised administration were to be sited in the Belfast area, the wider area of Northern Ireland would lose out.