Present:
Dr J Hendron (Chairman)
Rev R Coulter
Ms C Hanna
Mr A McFarland
Ms M McWilliams
Ms S Ramsey
Mrs I Robinson

In Attendance:
Mr G Martin (Committee Clerk)
Mr D Harkin (Assistant Clerk)
Ms K McFerran (Executive Support)

Dr Hendron took the Chair at 2:09 pm.

Private Session

i. The Chairman reported that Dr Maurice Hayes had been most impressed with the Committee's contributions at the recent informal meeting where he had updated members on the progress of the Acute Hospitals Review. Dr Hayes had emphasised that the views expressed would influence his forthcoming report.

ii. The Chairman reported briefly on the visit that he and the Clerk had made yesterday to Belvoir Park Hospital for an update on the state of cancer services there. Dr Russell Houston advised that should the Department agree to provide a new linear scanner, it will make a big difference when it eventually becomes available. There is, though, continuing concern among the staff about how the pressurised services can be sustained over the next few years until the new Regional Cancer Centre is opened. Consequently, the Committee's decision to have an inquiry into the delivery of cancer services in Northern Ireland is very much welcomed.

iii. The Chairman drew members' attention to a letter he had received from a local councillor regarding the plight of an 85-year-old woman who has been awaiting discharge into a nursing home from the Lagan Valley Hospital for five months because the Southern HSS Board does not have the funds to support the move.

Agreed: The Clerk will write to the Director of Social Services of each of the four HSS Boards to request a breakdown of the ages and illnesses of those patients currently awaiting discharge from hospital into nursing/residential care homes.

2. Minutes of the Last Meeting

The minutes of the last meeting were agreed.

3. Matters Arising

There were no matters arising.

4. Subordinate Legislation

i. Agreed: The Committee has no objections to the Department's proposals for the following two Statutory Rules: The Medical Act 1983 (Approved Medical Practices and Conditions of Residence) and General Medical Services (Amendment No.3) Regulations (Northern Ireland) 2001; and the General Medical Services (Miscellaneous Amendments) Regulations (Northern Ireland) 2001.

ii. Question put and agreed to:

That the Health, Social Services and Public Safety Committee has considered the following Statutory Rule:

No. 186 Restriction on Pithing Regulations (Northern Ireland) 2001

and, subject to the Examiner of Statutory Rules being satisfied as to its technical correctness, has no objections to the Rule.

iii. The Committee noted Statutory Instrument, Introduction of the Medicines (Products other than Veterinary Drugs) (General Sale List) Amendment Order 2001, which will take effect on a UK-wide basis from 1 June 2001.

Panel Members:
Dr Henrietta Campbell, Chief Medical Officer (CMO)
Dr Liz Mitchell, Senior Medical Officer
Dr Margaret Boyle, Senior Medical Officer

The Chairman welcomed the panel to the meeting at 2:30 pm, after which Dr Campbell briefly emphasised the importance of the 120-year tradition of the CMO's Annual Report, which sets out key public health issues in an independent way and provides valuable statistics that help inform future planning for health care provision. Dr Boyle's subsequent resume of the highlights of the Report, and the follow-up question-and-answer session, are summarised in Annex 1.

The Chairman thanked the panel for their work in producing such an excellent Report, and they left the meeting at 3:43 pm.

Private Session

6. AOB

i. Agreed: On a point of clarification, the Clerk will write to his counterpart on the Committee on Procedures about the rules for Members when speaking at the Consideration Stage of a Bill. Concern was raised at the suggestion that Members could speak only to amendments, which was not the Committee's interpretation of the wording of, and intention behind, Standing Order No. 34. The letter will be copied to the Clerk of the Committee Chairpersons' Liaison Group.

ii. The Clerk has issued the Committee with a draft list of organisations that will be invited to give written evidence in respect of the inquiry into the delivery of cancer services. Members wishing to add to the list should contact the Clerk.

iii. Agreed: The Clerk will write to the Dungannon Mencap Society to advise that, although the Committee is unable to accede to its request for a meeting at present, it will refer the highlighted need for a respite facility for the learning disabled in the area to the Minister.

iv. The Chairman has been invited to a tour of the new block at the RVH at 2:15 pm on Thursday, 24 May 2001. Committee members wishing to attend should contact the Clerk.

v. Members were reminded that the Final Consideration Stage of the Adoption (Intercountry Aspects) Bill will be on Monday, 21 May 2001.

7. Date and Time of the Next Meeting

The next meeting will be at 2:00 pm on Wednesday, 23 May 2001 in Room 135, Parliament Buildings.

DR J HENDRON
COMMITTEE CHAIRMAN
May 2001

9 May 2001 / Menu

ANNEX 1

Resume of the main points from the Chief Medical Officer's Annual Report 2000 by Dr Margaret Boyle:

• The statistics from the report show trends over time and are an important planning tool for future health services provision. For example, since 1985 there has been a fall of about 4500 in annual births. While death rates in children are falling, it is still concerning that 20 children died last year as a result of accidents.

• While there has been a gradual reduction in mortality rates from heart disease and cancer over the last decade, it is concerning that Northern Ireland remains near the top of the league in Europe for related death rates. Worryingly, there has been an increase in female mortality rates from lung cancer, a trend that looks set to continue given the high numbers of young female smokers. There are 3000 deaths per annum here due to smoking.

• Lifestyle factors greatly influence the population's long-term health. A lot of work needs to be done to influence positively the health outcomes of children by reducing risk factors such as smoking, alcohol and drug abuse, low levels of exercise, and dietary habits.

• The environment is intimately linked to health in terms of housing, air and water quality, food safety and the effect of mobile phones.

• Planned changes in the delivery of primary care will mean an increasing number of patients being treated in this environment. The introduction of a number of primary care commissioning pilots is producing results in terms of support to cardiac patients, for example.

• There are continuing strains on the acute hospital services with the numbers of patients being treated, winter pressures, a reduction in acute beds and a decline in nursing staff. Northern Ireland has the longest waiting lists in the UK. The CMO therefore believes that, in order to maximise the quality of patient care, better use must be made of the highly skilled workforce and modern technology, and there should be improved co-ordination across the health care sectors.

• There needs to be greater effort in relation to the promotion of social inclusion for everyone.

Summary of Question-and-Answer Session

Q. The Report has rightly highlighted smoking as a major preventative cause of death and ill health in Northern Ireland, but I am concerned that resources allocated to tackling this problem do not seem to be filtering down to the Trusts and making an impact. Are there figures available on resources directed to smoking cessation and prevention, and their impact? [Mr McFarland]

A. We would like to see more resources invested in preventive measures, which would be a long-term health investment. We wish the awful statistic of 3000 smoking-related deaths per year here could exercise the minds of the entire population. Commitment needs to be given across all Departments, as this is clearly a cross-cutting issue. It is important to bear in mind, though, that it could be 15 to 20 years before we see the results of such measures. We understand also the competing pressures for limited resources, when currently some people are waiting 18 months here for a heart by-pass operation.

We can provide the Committee with detail on the resources allocated for smoking prevention and cessation, but stress that they are never enough. There is evidence, though, that nicotine replacement therapy is beginning to work. There are also planning problems for those delivering preventive programmes insofar as they often do not know until in-year how much resources they are to be allocated.

Q. I am aware of the financial constraints, but would it not be possible for the Department to send a powerful message to young people of the inherent dangers of smoking by way of a hard-hitting television advertisement? Will the move in Europe to mark one-third of a packet of cigarettes in black with a direct warning be introduced here? [The Chairman and Rev R Coulter]

A. There is actually a video, which has been evaluated in Australia and the US, that sends an extremely strong message about smoking, and which has had an impact on young smokers. We are contemplating stepping beyond what we have ever done before on health promotion and sending such a message in a Northern Ireland context. A Committee on Tobacco Control has been set up under the Ministerial Group on Public Health. Under EC Directives, Northern Ireland will comply with the legislative requirements in relation to cigarette packaging.

Q. How can we develop a more centralised computer system in order to gain a clearer picture on, for example, heart disease or diabetes? There had been some controversy following the recent report that linked MMR vaccines with autism and bowel disease, despite the fact that the Medical Research Council and the World Health Organisation did not share this view. Are we getting the message across to people of the importance of immunisation? To what do you attribute the decline in the numbers of spina-bifida and hydrocephalus births over the last 10 years? I was concerned that the report does not reflect the potential years of female life lost to homicides, as it does for men: why has that statistic disappeared? Finally, we need to get out a strong message about the rapidly increasing elderly population, which will create tremendous pressures on the health sector. We will have 10,000 people aged 90 or more by the year 2005. [Ms McWilliams]

A. In terms of the immunisation question we need to strengthen the relationship between health professionals and parents. GPs are regarded by parents as a trusted source, so we try to support them. A new question-and-answer pack has been devised for health professionals, and we have updated a parent leaflet on the MMR vaccine.

The welcome reductions in the numbers of spina-bifida births over the last 25 years are attributable to improvements in mothers' diets, particularly the contribution of folic acid prior to pregnancy and in the first 12 weeks of pregnancy. We have run a number of high profile campaigns on the benefits of folic acid, which, incidentally, is contained in the flour of the USA.

We fully accept the critical need for an effective information strategy so that GPs can make referrals to hospitals and obtain lab reports on-line, thereby cutting down on interface time. A problem on the horizon could lie with the continuing need to ensure data protection. The question of what information can be stored, shared and how it can be used, is a massive one, requiring dialogue with, and the consent of, the public.

Q. The number of children who die in road accidents is alarming, and there is a clear need for more traffic-calming measures. What input does the Department have in relation to the Regional Transport Strategy, and who will take the lead? What can be done to stop the gap between rich and poor widening, which leads to further health inequalities? What measures are being taken to address the problem of suicides among young men, particularly in the rural sector? What is the Department's view of the water inspectorate? [Ms Ramsey]

A. The strategy is to promote public health so that adults and parents can see the danger signs before young people spiral down into depression. Quite often the signs are seen too late or not at all and the young person never reaches the door of the health professional. Armagh and Dungannon HSS Trust have established a rural support helpline providing counselling.

The Ministerial Working Group involves a cross-Departmental approach to public health issues. To this end, the Regional Transport Strategy is undergoing a health impact assessment, with that Department taking the lead, the subject matter being outside the direct remit of HSSPS.

We have absolute confidence in the water inspector, with whom we liaise very closely and have a good, open and frank working relationship.

The gap between rich and poor in GB has been widening over the last 20 years, as it has in Northern Ireland, and this why Investing for Health is anti-poverty led, with the aim of targeting resources at the least well off. On a macro level, the issue of the need for socio-economic re-engineering is a matter for Government policy.

Q. I agree that there are huge challenges to be addressed in mental health, including the problem of teenage suicides, which is very complex. Sometimes the parents have no warning whatsoever that anything is wrong before the tragedy occurs. With regard to smoking, heavy deterrents must be put in place to reduce the problem, which is costing so much both in human and financial terms. Initiatives such as Healthy Living Centres and Healthy Cities are excellent and should be built on. It is depressing to note that we are still near the top of the European League in terms of mortality rates from heart disease and cancer. We must work proactively to reduce these figures. What does the panel see as the broader relationships within the new proposed primary care arrangements? We need a strategy to deal with long-term chronic illness, which might be covered by future CMOs' reports. There seems to be a range of new drugs that can help sufferers of, for example, rheumatoid arthritis. [Ms Hanna]

A. The simple message for the public in terms of helping to reduce heart disease incidence is to include plenty of fruit and vegetables in diets and take more physical exercise. The message is beginning to get through, but the highest incidence rates are among the most disadvantaged.

Primary care is central to helping change the public's habits, so we need to nurture and value those health care professionals who are delivering on the front line. More resources must be targeted at this Cinderella Service.

A balance needs to be struck between the cost of new drugs and what they save the Health Service. While some new (leukaemia) drugs can buy patients years of life, they are hugely expensive. And with technological advances, more and more new drugs will come on the market, throwing up increasingly difficult choices for our health care system; something will have to give.

Q. I commend the report for its comprehensiveness but am surprised that it does not include figures for the uptake of breast screening and prostate cancer screening. [Mrs Robinson]

A. Figures on breast screening appear on alternate years but I take your point that we need to keep the public aware of this issue and will commit to publishing the figures in future. Prostate cancer screening remains a difficult issue in terms of the potential risk of impotence and incontinence, and more research is needed before the test could be advocated.

Q. Is anything being done to discipline government agencies that are guilty of pollution? Has the Department any influence on planning applications for high-density housing estates? Is there a health risk associated with loud music? [Rev R Coulter]

A. Sound is an issue, as overexposure to loud music can lead to ringing in the ears. There is legislation in respect of loudness of disco music that is enforceable by environmental health officers. We can provide the Committee with more details on the legislation if it wishes.

9 May 2001 / Menu / 23 May 2001