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MINUTES OF PROCEEDINGS OF
THE HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY COMMITTEE
IN ROOM 135, PARLIAMENT BUILDINGS
AT 2:00 PM ON WEDNESDAY, 21 FEBRUARY 2001
1. Chairman's Opening Remarks
2. Minutes of the Last Meeting
3. Matters Arising
4. Briefing by UUJ Consultants on 'Building the Way Forward in Primary
Care'
5. AOB
6. Date and Time of Next Meeting
Present: Dr J Hendron (Chairman)
Mr P Berry
Rev R Coulter
Mr T Gallagher (Deputy Chairman)
Ms C Hanna
Mr J Kelly
Mr A McFarland
Ms M McWilliams
Ms S Ramsey
Mrs I Robinson
Apologies: Ms P Armitage
In Attendance: Mr G Martin (Committee Clerk)
Mr D Harkin (Assistant Clerk)
Mrs V Artt (Executive Support)
Mrs K McFerran (Administrative Support)
Dr Hendron took the Chair at 2:10 pm.
Private Session
1. Chairman's Opening Remarks
The Chairman noted the Committee's productive visit to Bangor Community Hospital
and its meeting with representatives of the Alzheimer's Society (NI).
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2. Minutes of the Last Meeting
The minutes of the last meeting were agreed.
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3. Matters Arising
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Members noted the Department's positive response to its request for feedback
on whether there was any perception that the Committee was interfering in matters
or raising issues inappropriately.
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Agreed: The Clerk will write to the Department to request a briefing
note in relation to the co-ordination of decision-making on drug therapies.
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Agreed: The Chairman will write to the Minister to ask for her views
on the key conclusions from the UNISON report 'Communities in Crisis'. The report
highlights the serious need for transitional funding within the community and
voluntary sector as core programmes, whose outcomes have clear positive implications
for public health, run out.
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Public Session
4. Briefing by UUJ Consultants on ' Building the Way Forward
in Primary Care'
Panel members: Prof. Hugh McKenna
Prof. Brenda Poulton
Prof. Dorothy Whittington
The Chairman welcomed the panel to the meeting at 2:30 pm, after which Prof.
McKenna gave a briefing on the main points arising out of the group's study of
the consultation document 'Building the Way Forward in Primary Care'. These are
summarized as follows:
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The document's emphasis on tackling health and social inequalities and making
the best use of available evidence to underpin Primary Care (PC) management, commissioning
and practice is welcome.
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The future delivery of PC services must be inextricably linked with housing,
education, the environment, and collaboration with community groups and other
sectors. The document does not point up the importance of the multi-agency approach.
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There is no long-term strategic vision for PC within the document.
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Account must be taken of the pivotal relationship between PC and acute care.
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The paper has to be viewed against the backdrop of NI's worst profile in Europe
for heart disease, teenage pregnancy and general deprivation. Also, no mention
is made of NI's lower health funding per capita than GB.
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PC must be viewed in its widest sense, including social as well as medical
care.
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Collaboration and partnership between PC groups and HSS Boards and Trusts can
exploit opportunities for targeting health and social need. The Boards hold most
of the expertise in health and social needs assessment, strategy setting, investment
planning, service level agreements and monitoring.
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While many positive initiatives flowed from the Total Purchasing Pilots, PC
Commissioning Pilots and GP Fundholding schemes, the level of services commissioned
was limited. Given overspends in some 50 Fundholding practices, there appears
to be a lack of expertise among GPs at present in commissioning.
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Missing throughout the document is a clear view of how the public and service
users can be involved in actively planning and evaluating PC services.
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Effort must be made to eliminate the multiple lines of management and accountability
systems in health and social care, and move to a situation where all practitioners
are employed within the one organization. Accountability arrangements need to
be rigorous and systematic.
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There is a lack of guidance in the document for the process of moving from
Model 3 to 4, with no timeframe identified. One consideration would be for a combined
Model of 3 and 4, where PC Practices could take on an expanded role when ready.
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It would have been preferable for the paper to state that all health care professionals
will have equal status, not merely that they should feel equal.
Leaders in Clinical Governance must be decided on equity and ability to do the
job effectively.
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There needs to be greater co-operation between health and social care professionals,
as called for in the paper. UUJ research shows that social workers do not identify
themselves as part of PC.
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The development of Multiskilling is crucial. Nurses are taking on a greater
share of patient care including diagnosing, prescribing and health promotion.
The experience of nurse-led Personal Medical Services pilots in England is instructive.
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Timely and equitable access to all levels of care must be a main criterion
in designing an overall system of health and social care.
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Although the paper calls for research to underpin evidence-based practice in
PC, it should be noted that, to date, the R&D Office has not ring-fenced research
funds for PC.
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In terms of Clinical Governance, it would be a welcome development if the reconfiguration
of services were to lead to the establishment of clear structures for service
and performance frameworks.
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If gains from any new PC arrangements are threatened down the line as a result
of restructuring of local government and related services, there will be a backlash
from health and social care professionals and local communities.
This was followed by a question-and-answer session, which is summarized
in Annex A. The Chairman thanked the panel, and they
left the meeting at 3:40 pm.
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The meeting was suspended at 3:41 pm and resumed at 3:45 pm.
Private Session
5. AOB
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Agreed: The Clerk will proceed with outline arrangements for the Committee
to visit to a Primary Care project and a NHS Direct team in London, preceded by
a visit to both a local urban and rural Primary Care pilot project.
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Agreed: In response to a letter from Dr McClelland of Belfast City
Hospital (BCH) requesting a meeting to discuss the outcome of the judicial review
prompting the forthcoming consultation on the future of regional maternity services,
the Clerk will arrange for the BCH and the Royal Maternity Hospital to give their
respective views on the matter to the Committee at separate lunchtime briefing
sessions.
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Agreed: The Committee was content with the Clerk's draft programme
for a lunch-time event on Men's Health Issues in the Long Gallery in May 2001,
with the proviso of an additional balanced urban/rural community input, including,
if possible, representation from a young men's peer education project.
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Agreed: The Committee will take up the offer of a presentation by BT
on public sector projects. The Clerk will arrange a suitable future date.
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Agreed: The Committee will take up the offer of a presentation by PA
Consulting on work it has undertaken in the Republic of Ireland on the working
hours of junior doctors. The Clerk will arrange a suitable future date.
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Agreed: Following a letter to the Committee seeking its support in drawing
to the Minister's attention the plight of haemophilia sufferers in NI, the Clerk
will initially invite a local representative(s) from the UK Haemophilia Society
to a give lunchtime briefing session on the major issues, including from a European
perspective.
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Ms McWilliams drew members' attention to an Assembly debate scheduled for Tuesday,
27 February on the Royal Commission on the Long-Term Care of the Elderly. To facilitate
the most wide-ranging discussion, and to avoid repetition in the debate, the Clerk
will advise members in advance of the main issues in the Chairman's speech.
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6. Date and Time of Next Meeting
The next Committee meeting will be at 2:00 pm on Wednesday, 28 February 2001
in Room 135, Parliament Buildings.
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The meeting ended at 4:20 pm.
Dr J HENDRON
COMMITTEE CHAIRMAN
February 2001
14 February 2001 / Menu
/ 28 February 2001
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