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MINUTES OF PROCEEDINGS OF THE Present: Dr J Hendron (Chairman) Apologies: Mrs A Courtney In Attendance: Mr P Hughes (Committee Clerk)
Dr Hendron took the Chair at 2:07 pm.
Private Session
i. The Chairman reported on the positive meeting that he had with the Minister on Monday last in relation to the Committee's proposal for a taskforce on the problems affecting acute hospital services. The Minister undertook to respond in writing to the Chairman on the matter. The Clerk will issue members with a note of the meeting. ii. The Chairman advised members that they would receive a report on his meeting yesterday with the Causeway Pharmacy Locality Group in relation to the new Primary Care arrangements. The Group's main concern related to the proposed make-up of its particular Local Health and Social Care Group, which included only one pharmacist out of a total of 18 representatives.
The minutes of the meeting of Wednesday, 13 February 2002 were agreed.
There were no matters arising.
[2:15 pm]
Public Session The Chairman referred to a number of letters that he had recently received highlighting serious concerns about the Department's arrangements for the new primary care system post-April 2002. These included correspondence from the General Practitioners' Committee of the BMA (NI), the Royal College of Nursing (NI), and the Royal College of Midwives (NI). On the foot of these concerns the Chairman tabled for discussion a motion for the Floor of the Assembly that would give Members an opportunity to debate the incoming arrangements for primary care. There followed a discussion about the best way for the Committee to proceed on the issue. Some members felt that it would be best to seek a meeting with the Minister first to discuss the concerns of professionals in the field. Other felt that the urgency was such that a motion should be put down immediately for debate in the Assembly. The Committee proceeded first to a vote on Ms McWilliams's proposed amendment to the Chairman's motion, which was as follows: "That the Assembly calls on the Minister of Health, Social Services and Public Safety to take action to allay the current concerns of the professions and staff working in the Health and Social Services about the arrangements for Local Health and Social Care Groups." [Ms McWilliams]
Question put and negatived.
The Committee divided: Ayes 1; Noes 6. Ayes: Ms McWilliams Noes: Dr Hendron, Mr Berry, Rev R Coulter, Mr Kelly, Ms Ramsey, Mrs Robinson The Chairman then moved the following motion: "That the Assembly expresses its grave concern about the future of primary care services in Northern Ireland and calls on the Minister of Health, Social Services and Public Safety to take prompt action to allay the serious concerns of the professions and staff working in Health and Social Services about the arrangements for Local Health and Social Care Groups." [Chairperson, Committee for Health, Social Services and Public Safety]
Question put and agreed to.
The Committee divided: Ayes 4; Noes 3. Ayes: Dr Hendron, Mr Berry, Rev R Coulter, Mrs Robinson Noes: Mr Kelly, Ms McWilliams, Ms Ramsey Agreed: The Clerk will invite the following sets of witnesses to next week's meeting to speak to the main issues of concern in relation to the new primary care arrangements:
[3:05 pm]
[3:10 pm] Mr McFarland joined the meeting at 3:13 pm.
The Clerk briefed the Committee on a paper that he had tabled for discussion containing revised proposals for amendments that addressed the concerns raised by Barnardo's and Carers Northern Ireland, assisted by the Children's Law Centre. Members also considered a letter from the Department advising that its policy is that young carers under 16 should be seen as children first and carers second, and that they should not be expected to carry levels of caring responsibility that could adversely affect their education and development. Their needs should be covered under the Children (Northern Ireland) Order. The guidance on implementation will explicitly make these points. This same policy applies in England, Scotland and Wales. The Committee deliberated. Agreed: The following three motions proposing amendments to the Bill were agreed:
Motion 1 That the Committee recommend to the Assembly that Clause 1 be amended as follows: in Clause 1, page 1, line 4 insert- "( ) It shall be the duty of an authority to disseminate information widely regarding the right of carers to an assessment of the carer's ability to provide and to continue to provide care for the person cared for; ( ) an authority shall take such steps as are reasonably practicable to ensure that carers within the authority's area receive the information relevant to them." [Chairperson, Committee for Health, Social Services and Public Safety] The effect of the above amendment would be to place a duty on Boards or Trusts to be proactive in providing information on carers' assessments and to take reasonable steps to ensure that carers receive the information. It acknowledges concerns made about raising awareness of assessments and recognizes the practical limitations faced by Trusts in being able to seek out all carers in their areas.
Motion 2 That the Committee recommend to the Assembly that Clause 1 be amended as follows: in Clause 1, page 1, line 11 insert- "( ) Where a carer aged 17 or under has requested an assessment under subsection (1) the authority shall carry out an assessment that complies with Article 18 of the Children Order and provide services in accordance with that assessment." [Chairperson, Committee for Health, Social Services and Public Safety] The effect of the above amendment would be to require Boards or Trusts to carry out an assessment under the Bill for carers aged 17 and under that would comply with the Children Order.
Motion 3 That the Committee recommend to the Assembly that Clause 2 be amended as follows: in Clause 2, page 2, line 20, insert- "( ) After Schedule 2, Part 7 of the Children Order there shall be inserted- 'Services for children defined as carers 7.A Every authority shall provide services designed to give children defined as carers under section 8 of the Personal Social Services (Amendment) Act (Northern Ireland) 2001 the opportunity to live lives which are as normal as possible.'" This proposed amendment would introduce a new subsection to Clause 2 that would amend Schedule 2 of the Children Order. It is designed to place a duty on Boards and Trusts to give children and young persons defined as carers under the Bill the opportunity to live lives that are as normal as possible. The Clerk advised members that the Department was considering putting down an amendment in relation to the Short Title, which may address the Committee's concerns on the matter. In such an event, the Committee could decide whether or not to withdraw its proposed amendment to the Short Title. The proceedings relating to this item of business are recorded separately in verbatim minutes of evidence.
[3:40 pm]
Dr Janice Thompson, Assembly Researcher, spoke briefly to a briefing paper that she had prepared for the Committee on the MMR vaccine. Departmental Officials: Dr Henrietta Campbell, Chief Medical Officer Dr Campbell explained that, while she and her colleagues in the Department fully understood the anxiety of parents in relation to the MMR vaccine, there was a wealth of evidence to support its safety. She also pointed out that Dr Wakefield, whose research had sparked the controversy, has admitted that it does not establish a link between autism and MMR. The research has been reviewed by the US Institute of Medicine and other expert bodies, none of which has found any evidence to link autism with immunization. Dr Campbell advised that the single vaccines leave vulnerable children unprotected and have the effect of reducing the uptake rates, which is liable to increase the number of congenital abnormalities. This method also requires six separate injections, which can cause mild side effects. There is no scientific evidence to support separate vaccines. The role of the Chief Medical Officer and her staff is to facilitate the health professionals in getting across the message to the public that MMR has a long established safety record and that it is vitally important to sustain the high immunization uptake rates in Northern Ireland. Dr Campbell advised that the two surveillance units in Belfast and Dublin work closely in terms of immunization policies, which is important given the population movements on the island. Dr Doherty explained that a recent survey of all health care professionals involved in immunization in Northern Ireland showed that they all supported MMR. The Department has taken a number of recent steps to address public concerns about the vaccine including the following:
In response to a member's question about why parental choice was not seen as the preferred option, Dr Campbell explained that it would be morally wrong to use publicly funded resources in a way that did not promote the safest immunization process. The Department's business is to protect the entire population, and it has a duty of care to recommend the best vaccine. As Chair of the UK Committee on Screening, Dr Campbell emphasized the importance of ensuring the public are given the fullest information and up-to-date evidence on autism, and of the need to find out the reasons for the condition. Dr Campbell undertook to send the Committee full details of the work undertaken by the Medical Research Council on the subject and to provide up-to-date epidemiological evidence, including any local statistics, that discount any link between MMR and autism.
The meeting was suspended from 4:40 pm to 4:44 pm. [4:45 pm]
Departmental Officials: Mr Don Hill Departmental Officials were questioned on the Implementation of the Strategic Review of the Ambulance Service. In response to a query about the proposed number of additional response points (11) against the original proposal for 20 extra sites, Mr Hill advised that there would be a pragmatic approach to the numbers required, which would be continually reviewed. The current figures were the outcome of detailed analysis of distances and populations. He emphasized that the Hayes Report viewed the Ambulance Service as an integral part of the health care system and any changes must be reflected in the eventual overall hospital distribution. The proposed changes in the consultation paper took account of similar reviews in GB and envisage an operational separation of A&E Ambulance Service and Patient Care Service. The determinant for locating ambulances other than at stations is based on a complex mathematical model, but the figures will be continually reviewed. The identification of response sites will be based on the length of time for an ambulance to reach a patient, as opposed to how far to take them to hospital. Mr Hill acknowledged that there was a considerable funding implication for the implementation of the strategic review - an estimated £43.8m in respect of phases 1 and 2 over the next five years. The Department proposed a prioritized funding approach, with the key being a commissioning group, incorporating the Ambulance Service and the four HSS Boards as a single entity, to determine Trusts' funding allocations. This is intended to simplify the commissioning process by adopting a regional approach. The Department was very concerned at the rising number of attacks on ambulance personnel, and the Consultation Paper made references to this problem. A meeting is to be arranged with the Chief Executive of the Belfast Education and Library Board, with a view to promoting a positive picture of the Ambulance Service that will discourage young people from making such mindless attacks. The Medical Priority Dispatch System, which is to be piloted in the Eastern HSS Board area in March 2002, will be rolled out across Northern Ireland depending on funding. It will require a degree of confidence in the training by the users.
[5:20 pm]
The Committee considered a paper from the Department providing an overview of the latest position regarding the D&E virus affecting local hospitals. Members were satisfied with the figures, which showed that, as of 19 February 2002, only Antrim Area Hospital remains affected by the virus, with 2 new beds out of commission.
Agreed: i. The Committee agreed to end its request for weekly updates in view of the improvement in the position. ii. The Clerk will write to the Department to request that the Committee be advised promptly of any future epidemic outbreak.
i. Agreed: Following a request from Mrs Breige O'Kane, who is a member of the UK Lymphoedema Support Network, for a meeting with the Committee to discuss the issues affecting its members, the Clerk will arrange a suitable date for an informal lunchtime meeting. ii. Agreed: Following a letter from the Southern HSS Council requesting the Committee's support for funding of appropriate services for adults with Asperger's Syndrome, the Clerk will write to the Department to request any data it holds on the numbers of adults affected, together with any proposals to develop services for this group. iii. Agreed: Following a request from the Chief Executive of Northern Ireland Mother and Baby Action (NIMBA) to make a presentation to the Committee, the Clerk will arrange a suitable date for an informal lunchtime meeting. iv. Agreed: Following a letter to Mr Berry from Parents and Professionals Autism (NI) offering to give the Committee a presentation on the work of the charity, the Clerk will arrange a suitable date for an informal lunchtime meeting. v. The Committee noted the Southern Area Children's Services Plan 2002-2005 Consultation Paper. vi. The Chairman reminded members of the morning visit to Antrim Area Hospital scheduled for Wednesday, 27 February 2002. Members will receive a copy of the itinerary.
The next meeting will be at 2:00 pm on Wednesday, 27 February 2002 in Room 135, Parliament Buildings.
The meeting ended at 5:35 pm. DR J HENDRON |
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