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MINUTES OF PROCEEDINGS OF THE HEALTH, SOCIAL SERVICES AND
PUBLIC SAFETY COMMITTEE 1. Chairman's Opening Remarks Present: Dr J Hendron (Chairman) Apologies: Ms P Armitage In Attendance: Mr G Martin (Committee Clerk) Dr Hendron took the Chair at 2:03 pm.
Private Session 1. Chairman's Opening Remarks The Chairman consulted with members on whether the Committee's deliberations on Primary Care (item 4) should be held in open or private session. Agreed: The Committee reached a majority decision to have its discussions on Primary Care in private session because of the potential sensitivities involved. Ms Ramsey requested that her dissension, on the grounds that the Assembly's business should be open and transparent as far as possible, be noted. 2. Minutes of the Last Meeting The minutes of the last meeting were agreed. 3. Matters Arising
Public Session 4. Adoption (Intercountry Aspects) Bill: Committee Stage Panel Members: Mr John Clarke
The Chairman welcomed the Departmental Officials to the meeting at 2:17 pm. The Committee's consideration of the Bill is recorded separately in verbatim minutes of evidence. Before proceeding to the detailed consideration of the Bill, the Chairman asked Mr Clarke to comment generally on whether its provisions would prevent the sale of children, given the recent controversy surrounding a British couple who had "adopted" two children from the US using the Internet. While advising that the Bill made provision for dealing with the bringing of children for adoption into the UK by stipulating that assessments be carried out by registered adoption agencies, Mr Clark expressed concern that the Bill may not cover all scenarios. The Department will keep the Committee updated on the current discussions with the Department of Health with a view to closing any loopholes in the legislative proposals. There followed a Clause by Clause consideration of the Bill, which is summarised below. Clause 1 - Further consideration was deferred pending Departmental clarification on the rationale behind the maximum three-month imprisonment term for contravention of Regulations under the Adoption (Intercountry Aspects) Bill (Clause 1), as against the six-month maximum term for contravention of Article 58ZA of the Adoption Order (Clause 12). Clauses 2 to 4 - Agreed. Clause 5 - The Committee will further consider this Clause following receipt of the Departmental definition of "habitually resides" for the purposes of the Bill. Clauses 6 and 7 - Agreed. Although Clause 7 was agreed, the Committee raised the apparent inequity that lay with HSS Trusts setting individual rates, which could vary widely, for their respective Adoption Services. Members were concerned that such an arbitrary arrangement should be regularised in order to have uniformity. The Officials pointed out that Trusts' respective charges for their Adoption Services were influenced by the volume of enquiries that they handled in relation to their Services. Agreed: The Chairman will write to the Minister to seek clarification on the Department's guidance to HSS Trusts on the setting of Adoption Service costs; and to request a common policy in this regard.
Clauses 8 to 11 - Agreed. Clause 12 - The Committee deferred further consideration on this Clause pending Departmental guidance and clarification on two points:
The Chairman thanked the Officials before adjourning the Committee's deliberations on the Bill until the meeting scheduled for 7 February. The meeting was suspended at 3:34 pm and resumed at 3:41 pm. Ms McWilliams joined the meeting at 3:40 pm.
Private Session 5. Primary Care The Chairman made an introductory declaration of his small link to the Grosvenor Road GP Fundholding Practice, where he holds three surgeries per week. He explained that he had no part in either the ownership or management of the practice and that he had no pecuniary interest in it. The Chairman referred members to the record of his meeting with the Minister and Senior Officials on 22 January in relation to the Committee's concerns surrounding the arrangements for the replacement of GP Fundholding and their timing. As no consensus had been reached at the meeting, the Chairman advised that he would be reporting back to the Committee on 24 January for its further consideration. The Committee deliberated at length on the implications of putting down an amendment to the HPSS Bill at the Further Consideration Stage in relation to the cessation of GP Fundholding. The Chairman reiterated that although he was firmly in favour of the ending of GP Fundholding, a system that he saw as inequitable, he wanted clear evidence of a viable alternative in place before its cessation. He voiced concern that any hiatus in Primary Care from 1 April would result in the loss of vital expertise from the sector. He believed that any option that would place responsibility in the hands of the HSS Boards would be a retrograde step and be at odds with the recommendation of a bottom-up approach in 'Fit For the Future: A New Approach', which envisaged budgetary powers resting with Primary Care Co-operatives. Rev R Coulter and Mr Berry both voiced dissatisfaction at any return to the arrangements that pre-dated GP Fundholding during any transitional period, which seemed to them to be the case in the absence of evidence otherwise from the Department. Mr McFarland suggested that the proposal to move to a new set of arrangements from 1 April was too fast and that it would inevitably lead to the loss of experienced staff in GP Fundholding practices to the sector. He agreed with the Chairman that Option 3 appeared to bolster the powers of the HSS Boards when previous consultations showed a clear preference for budgetary controls to be devolved to those delivering services at the coalface. He felt that now was an ideal opportunity for the Department to review its administrative systems to dovetail with the review of Primary Care. A year's delay in ending GP Fundholding would, he felt, provide sufficient time to plan for a smooth transition to the new arrangements. Ms McWilliams opined that the major concern lay with the implications for Primary Care in the interim until the new system bedded down, and the degree of uncertainty and anxiety in relation to how the new approach would be phased in. She made the point that the HSS Trusts had stated that the continuation of Fundholding beyond that point would cause them problems. She referred to the Committee's meeting with the Minister on 17 January when certain assurances had been given in relation to budgets, staffing and the retention of best innovative practices from pilot schemes under the preferred model. Ms McWilliams felt that the most important action would be for the Department to communicate its contingency plan by providing clarification and therefore reassurance on how it intended to make the transition to the new system of Primary Care. Mrs Robinson was concerned that if no amendment was put down, this could lead to a void in the delivery of Primary Care services. She referred to the Chairman's earlier point that representatives from the Royal Colleges of GPs and Nursing and the BMA NI were concerned about the apparent absence of an acceptable alternative before moving to any new system of Primary Care. Ms Ramsey referred to the record of the Chairman's meeting with the Minister, in which she had assured that there would be a phased run-down of GP fundholding over the six months from 1 April. She emphasised that the key issue was the commissioning of services. A small number of staff were involved and there were ongoing negotiations with the TUs to protect their interests. Moreover, those staff would still be needed to phase out the old system. Mr Kelly did not accept that the ending of GP Fundholding necessarily precluded the Committee from putting forward its preferred model of Primary Care. He made the point that previous research would be taken into account in whatever model of Primary Care provision was developed. He also referred to the Minister's statement that the HSS Boards would have to accept that change was inevitable and that there would not be a return to pre-fundholding arrangements. Ms Hanna emphasised the need for the right model of commissioning, which she was not convinced the Department could deliver on from 1 April, during the proposed transition period to the preferred Option. She was disappointed with the consultation document as she was hoping for more radical proposals. She was also concerned that any new arrangements should not cement the position of the HSS Boards. Mr Gallagher stated that the significant £5m overspend by GP Fundholding practices was disgraceful and that this should be reined in as soon as possible. He accepted that there were arguments for and against the putting down of an amendment in terms of implications for resources and patients. He felt that if an amendment were to be put down, it should defer the cessation of Fundholding for a minimum of six months and not a year.
Ms McWilliams left the meeting at 5:15 pm. Question put and agreed to: That an amendment to the HPSS Bill be made to specify a date before which GP Fundholding shall not be ended.
The Committee divided: Ayes: Mr Berry; Rev R Coulter; Mr Gallagher; Ms Hanna; Dr Hendron; Mr McFarland;
Mrs Robinson (7) Question put and agreed to: At the end of Clause 61 insert the following: "; but Section 39 shall not be brought into operation, by such an Order, before 1 April 2002."
The Committee divided: Ayes: Mr Berry; Rev R Coulter; Ms Hanna; Dr Hendron; Mr McFarland; Mrs Robinson
(6) The Chairman will put down a motion, on behalf of the Committee, on the agreed amendment for debate at the Further Consideration Stage of the HPSS Bill with the Business Office by the deadline on Thursday, 25 January. 6. Review of Legislative Process in the Assembly Agreed: Members agreed the draft response to the Committee on Procedures, which outlined the Committee's suggestions for changes to the Standing Orders. 7. Consultation Document - Inpatient Psychiatric Services Agreed: The Committee will defer consideration of the Department's regional review of inpatient psychiatric services for children and young people in NI until next week's meeting. 8. AOB
9. Date and Time of the Next Meeting The next Committee meeting will be at 2:00 pm on Wednesday, 31 January 2001 in Room 135, Parliament Buildings. The meeting ended at 5:40 pm. DR J HENDRON January 2001 |
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