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ANNEX A

Is the m£90 increase next year for the Hospital, Community Health and Personnel Social Services & Health Service Trusts announced today by the Minister for Finance actually "additional" money?

Approx. m£60 of the total will be used to fund next year's pay award (based on an average 3.5% rise). There is discretion as to how the m£30 balance will be spent, but the bulk may be used to cover certain commitments entered into by the previous Administration. These include m£5 for the Sure Start initiative, m£9 for vaccination programmes and m£4 for the Ambulance Service.

Q. How long has Northern Ireland been top of the table in terms of Europe's Poor Health

Indicators and what has the Dept. been doing to address this problem? Deprivation is not a one-community issue. And as there is deep concern about the links between poverty and ill health issue, what can be done to address inequality? How can we better educate the public on the big killers of heart disease and cancer?

Northern Ireland has suffered the worst health in Western Europe throughout the last

Century (basically since records began) in terms of TB and infant mortality rates. Since 1986 we have had the worst record in Europe for heart disease, though improvements are being made with the help of programmes such as 'Change of Heart'.

The Department is signed up to health promotion but our society must be geared up for significant social and environmental re-engineering. This area is directly linked to the (in)equality issue. There also needs to be a hard drive against, for example, tobacco.

Q. There was serious public disquiet at the removal of cancer services from Belvoir to the

City Hospital in view of the excellent reputation that Belvoir had enjoyed. How was this

decision justified?

The special atmosphere that Belvoir created for its patients is something that is fully

recognised by the Department and it has sought to replicate this in the new facilities at

the City Hospital. The aim is to make people feel catered for, while getting the very best

treatment for them. The Department was persuaded to move the service by the many

clinicians and nurses who argued that, in order to optimise the use of technology, intensive

radio and chemotherapy treatment needed to be carried out at an acute site which has the

necessary backup facilities. The present arrangements also benefit those patients and their families who can now attend patient-friendly units in their local hospitals in Antrim, Craigavon and Altnagelvin for low level cancer treatment.

Q. What can be done to tackle the shortage of occupational therapists and

the consequential lengthy waiting lists for housing assessments? Could some thought be given to training people simply to carry out specific assessments?

Decisions to tackle ever increasing demands are inevitably money driven and the situation

is one of constantly playing catch-up. Two-thirds of all occupational assessments are for

heating assessments, and a fundamental review of how Housing Executive(HE)

adaptations are made is due shortly. The Dept. is working with the HE on service level agreements in respect of things that can be done which do not require an occupational therapy assessment. There may be some merit in training individuals to carry out basic assessments and so relieve some pressure, but there is concern within the profession about how this would be supervised. Work is ongoing in this area.

Q. There is frustration that some hospitals' standards have been allowed to slip below those that the Royal Colleges set so stringently. No account seems to be taken of the prevailing circumstances such as socio-economic factors. Are other European countries subjected to similar standards?

A. The Royal Colleges are purists and have a charter to provide benchmarks against which to judge standards regardless of individual circumstances. They visit hospitals regularly and draw up proposals on training. All European countries have similar clinical standards, however, while they do not have the same high proportion of small hospitals as here, they have twice as many consultants per capita. The Department's 'Putting It Right' document looks at ways of decentralising health provision to make it more accessible.

Q. The Social Services Activity statistics in relation to children are very worrying. There is concern that the Boards and Trusts are not implementing the Children's Order. Is this area underfunded? What are the officials' views?

A.. This has become an increasingly difficult problem in recent years especially since the Holy Orders began to close their children's homes. The additional burden on the system means that m£30 will be needed over the next three years to provide for the replacement of large institutions with smaller humanitarian staff-intensive ones. To date m£26 has been devoted to implementing the Children's Order, which is a superb piece of legislation. And while m£7 has been spent this year, demand is rising on every front. Not enough resources are being devoted to this area so funds must be used as effectively as possible, and balances continually have to be struck.

Q. What is being done to encourage more nurses to join the profession?

A. The Department is very conscious of the importance of nursing and wants to recognise this through the education system. Other measures to attract trainees are increases in the junior pay scales and the development of a better career structure with the new concept of nursing consultants.

Q. In relation to the Patients Charter there is concern about the ability of the Health Service's staff to meet adequately the increasing demands placed upon it. Would the amalgamation of Trusts bring about significant savings to plough back into the system?

A. The demographic rise in the number of the elderly here clearly points to an inevitable increase on demand for resources in the future. In terms of amalgamation of Trusts, it is estimated that £400,000 would be saved per Trust per annum.

Health and Social Services Minutes 15 December 1999