ANNEX B

17. There was a public concern that decisions were being put on hold during the suspension period. The second 'Fit for the Future' document recommended having five Health and Social Services Partnerships as a future model for the delivery of primary care. Have any steps been taken to address the big issues in primary care? [The Chairman]

1. No decisions that would involve long-term implications were made during suspension, as it was felt these would be best left to local politicians. Minister de Brun will need to give a political steer to the matters raised in 'Fit for the Future'.

17. 'Children Matter' recommended that an extra 110 children's residential care places be provided over the next five years. Can you comment on the fact that only 16 more places in two centres have so far been created? How much of the additional £5m announced for children's services is to be allocated to residential care? [Ms Ramsey]

1. The voluntary sector, including the Holy Orders, moving out of this area of provision has contributed to a sudden gap in the services. For example, the closure of St. Joseph's in Middleton has meant the loss of 24 places. The need for the expansion of children's places is readily accepted and Departmental officials have recently met with four Boards' Chief Executives with a view to speeding up the process.

   We will respond in writing with the breakdown of the intended expenditure of the £5m.

17. Is there a battle royal gearing up with the consultants, judging from the recent NHS conference in London? [Mr McFarland]

1. There is determination to modernise the system and move forward in a way that encourages professionals to work together in partnership, offers the right incentives and achieves results. Clinical standards are very important and there has been recent public concern at the number of high profile cases. The General Medical Council which been recently coming under the spotlight recognizes the need for accountability and validation.

17. In relation to the question of acute hospital provision for the Western Board area, has the Dept. had sight of the report from Lancaster University and is it available to the Committee? Is the funding secure for the Sure Start programme due for rollout in September? [Mr Gallagher]

1. The Dept. has begun some initial work using the Hindle report in conjunction with the Western Board's recommendations to help inform the Minister's analysis of the optimum site for a new build hospital in that Board area, should that be her decision.

   Funding for the Sure Start programme is secured and it is on track for rollout.

17. What action is being taken to tackle the thorny issue of senior executives' pay? It seems a tragedy that St. Joseph's children's training centre, which is excellent, is to close; can anything be done to save it? [Mr Berry]

1. Minister Worthington wrote to the Trusts two years' ago warning them to exercise prudence in pay awards. The Minister has legal authority for the Boards' Chief Executives' pay, but this does not extend to Trusts, where the problems lie. The offending Trusts have been made aware of the Minister's displeasure and some have offered remedies, while others have still to respond. The Dept. will continue to follow this through.

   The reasons for the closure of the centre at St. Joseph's are complex but the Trustees who manage the facility feel they cannot continue, and they are reluctant to accept the offer of another team to take over the premises. Unfortunately, it seems therefore that the centre will have to close.

17. i. Can you explain why the HSS's superannuation costs are expected to rise by almost 55% this year - some £15m over predicted costs? ii. Do you agree that there ought to be a centrally managed system for determining Chief Executives pay? iii. There needs to be a link up between the Juvenile Justice System, HSSPS and Education in terms of a budget issue - for example, who picks up the tab when St. Joseph's closes? iv. Given that the £5m extra for children's services includes hospices, what will be left for remaining services? v. The recent educational sectoral meeting under North/South co-operation dealt with child protection and setting up a register for abuse cases. There is a clear need for linkage across Departments on these and other public health issues. vi. I was concerned that the recent NHS survey in GB did not extend to N. Ireland; how do we have input, as decisions may well affect our budget? vii. Why was there an ad in the paper for telecommunications equipment in advance of the decisions on the review of the Ambulance Service? viii. Can you give an assurance that the money allocated the Children Fund will be ringfenced? ix. The Minister told the Committee that she would be revisiting the whole area of maternity services. Are there any developments? [Ms McWilliams]

1. i. We will respond in writing to the question on superannuation.

   ii. It is critical to have a pay scheme that is fair, consistent and transparent. The Dept. is currently working on a system, based on a Scottish model, and details will be forwarded to the Committee as soon as possible. It is anticipated that it will involve linking levels of responsibility to grading.

   iii. It is quite correct to examine and develop the linkage between the Juvenile Justice System (which is a reserved matter) and other devolved parts of the government system. The question of what is appropriate treatment for young persons is a deprivation issue as well as a criminal one.

   iv. Written reply will be provided for the proposed spend of the additional £5m for children's services.

   v. Public health and child protection are clearly crosscutting issues; and while the lead should be with Health, connections should be made with the Education, Environment and Social Development Departments.

   vi. The fact that England carried out its own NHS survey is not entirely surprising in the light of the devolved administrations. The point is taken though about the potential impact on resources that the outcome from such a survey may have here. The Minister has made it clear that she and the Executive Committee will adopt policies that are the best for the local population.

   vii. There is no question that the appointment of consultants pre-empts the outcome of the Ambulance Review. The IT aspect needs resolving.

   viii. A written response will be provided in relation to the Children's Fund.

17. i. I presume the direct involvement of the Prime Minister in the discussions on the modernization of the health service is to be welcomed? ii. Does the Department have any plans to increase the number of Health Action Zones as part of the Public Health Strategy? iii. How is the recently allocated £5m for children's services to be spent? [The Chairman]

1. i. Yes. We are aware that the Dept. of Health and Children in the Republic of Ireland has similar problems and we are also involved in discussions with senior representatives from Dublin.

   ii. The two pilot HAZs are working well and it is envisaged that the Minister will decide to expand the scheme.

   iii. A written response will be provided

17. Is there a planned programme of expenditure across the Boards for capital equipment? - I have seen evidence of equipment that is almost 30 years old. Many people look to an island-orientated system of health service: is this being developed? [Mr Kelly]

1. There is an annual budget of about £50m for capital spends, divided into two groups: £25m to £30m on big schemes (equipment is included with new builds); and £20m to £22m allotted individually to Trusts for replacements. There is not enough money at present to cover all needs, so the Dept. encourages Trusts to use Private Finance Initiative to help fund costs, and many Trusts now use leasing schemes. The practice is probably variable among Trusts in terms of keeping track of capital resources.

17. Is the Department considering that the future of emergency services be based on a co-operative service with a co-ordinated communication system? [Mr McFarland]

1. This is very much tied in with the outcome of the Ambulance Review. A good degree of collaboration between the Ambulance and Fire Services would, though, be expected, as public safety is now the responsibility of one Department.

Health and Social Services Minutes 07 June 2000