ANNEX B

17. Will you follow up your presentation with a paper? [Ms McWilliams]

1. Yes.

17. What do you think are the implications from a Trust point of view of the review of public bodies, the possible removal of Boards and an increase in the centralisation of services within the Department? [Mr McFarland]

1. Local ownership of services allows for local participation by both staff and clients/patients, and is good for staff morale. We do not believe that a large centralised organisation will provide this. It is difficult to manage an organisation that is in a state of flux, and we therefore need clarity on the changes to be made not only on the future of the Boards but on the number and type of Trusts and local commissioning arrangements proposed. Whatever form of re-organisation is decided upon, we want to avoid a two-stage change. We agree that combined Trusts allow for an easier-to-manage service and believe it is vital to retain our integrated health and social services system, which is a unique arrangement within the UK.

17. We understand that the HPSS is under resourced and that in some areas the relationship between good health practices and resourcing varies. How do we reduce bureaucracy and keep good practice? [Mrs Hanna]

1. We hope that the decision on infrastructures will be made soon and that the Department will review its own internal structures as part of the review. Governance protocols also need to be developed to ensure that leaders of primary care-commissioning groups are accountable. The system established must be appropriate to N Ireland. A properly resourced primary care service, which provides 90% of care, with 'hospital at home' schemes and appropriate care management costs much less in the long run.

17. We understand that the Department sets target for Trusts. Is the Confederation able to respond when Trusts are not meeting these targets, and, if not, could it undertake this function? [Ms McWilliams]

1. The Confederation does not undertake a monitoring role, which is a function of the Department and Boards. In England the National Centre for Clinical Excellence (NICE) is developing National Service Frameworks, which will set standards for various programmes of care, and will monitor Trusts' performance against these standards. N Ireland has yet to decide how it will participate in these frameworks.

17. In your initial presentation you mentioned five areas of practice which the Boards say should be improved on. I understand that the Trusts are doing their best within their resources to do this, although not all attach the same level of importance to each area. Does the Confederation have a role in overseeing this and in encouraging Trusts to share good practices? For example, North and West Belfast Trust is involved in one of the Health Action Zones, should Down Lisburn Trust not also be involved as they border each other? [Ms Ramsey]

1. The Confederation always encourages the sharing of good practice, organising conferences, policy fora etc., although the formal monitoring and dissemination role belongs to the Department. We also feed into the Policy Committees Confederation at a national level. There are good examples of Trusts sharing services such as the mental health programme, and, where appropriate, clinical services such as addiction services, and adoption services, which are managed on a geographical basis of need.

The Western Board has established five locality groups of GPs who decide on the services required for their area. 'One stop shops' are also being established in several areas where patients/clients can see a range of health professionals. Healthy Living Centres are also being developed to encourage community development in deprived areas. Two Health Action Zones are being piloted in conjunction with these and if successful we hope that they will be rolled out.

17. I understand that all Trusts face deficits this year. What formula is used to allocate funds and do you agree that it is fair? Is there any way to keep in check Trusts which have large deficits and to ensure that such overspends are not compensated for by funding being taken from other Trusts? [Mr Gallagher]

1. The formula for all providers is based on the population in the area and calculated on need. We feel that capitation funding is not properly weighted as it is geared primarily towards those over sixty-five and not towards children who also require considerable resources. There is an issue for a deprivation-weighting factor. Increased funding is also required to carry out the government's TSN policy. It is the responsibility of Boards to take into account local circumstances and need when allocating resources as well as balancing their budget. The reality of Trust deficits is the they reflect the current demands on their emergency services as opposed to slack management. A recent Confederation survey showed that overall Trusts were in deficit by £20m in November 1999. This will mean making service cuts resulting in patients not receiving all the care required.

17. The most vulnerable suffer when there are cutbacks, although I know that some Trusts have directed extra resources to children's services including the care of those attending special schools. [Mrs Robinson]

1. Under the auspices of the recent equality legislation, individuals and organisations can advocate for patients/clients to ensure that needs are being addressed equitably in all areas.

17. What effect will Section 75 of the Equality Act have on Trusts? [Ms McWilliams]

1. Boards and trusts are working together on the equality agenda with the CSA and the Equality Commission to make best use of specialist staff and so limit the extra funding required. The question of who holds final responsibility for equality of care is still to be resolved.

Health and Social Services Minutes 02 February 2000