MINUTES OF PROCEEDINGS OF THE
HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY COMMITTEE
AT 2:00 PM ON WEDNESDAY, 27 FEBRUARY 2002
IN ROOM 135, PARLIAMENT BUILDINGS

Present: Dr J Hendron (Chairman)
Ms P Armitage
Mr P Berry
Rev R Coulter
Mr T Gallagher (Deputy Chairman)
Mr J Kelly
Mr A McFarland
Ms M McWilliams
Ms S Ramsey
Mrs I Robinson

Apologies: Mrs A Courtney

In Attendance: Mr P Hughes (Committee Clerk)
Mr D Harkin (Assistant Clerk)
Mrs K McFerran (Executive Support)
Mr B Greene (Administrative Support)
Dr J Thompson (Assembly Researcher)

Dr Hendron took the Chair at 2:05 pm.

Private Session

1. Chairman's Opening Remarks

i. The Chairman apologised if he had inadvertently caused any members offence by bringing forward his motion on primary care at last week's meeting. He explained that he had taken the action due to the wide range of serious concerns that have been brought to the attention of members about the impending implementation of the new primary care arrangements.

ii. The Chairman advised members that he had met informally with Prof Brew Atkinson, Head of Endocrinology and Diabetes at the Royal Victoria Hospital, on Monday last, when the increase in diabetes cases and the pressures on staffing and resources was discussed. Members will be copied documentation on the subject.

iii. The Chairman reported briefly on the extremely useful morning visit that he and a number of members had made to Antrim Area Hospital. The Hospital's Chief Executive will send the Committee a briefing paper covering all the main points made during the visit.

2. Minutes of Proceedings

The minutes of the meeting of 20 February 2002 were agreed.

In relation to a point raised by Ms McWilliams about the level of detail included on the item on the Implementation of the Ambulance Service Review, the Clerk advised that the level of detail to be included in the minutes came down to a matter of judgement. He explained that the aim was to include the major points raised, but he undertook to ensure that the minutes of proceedings are as informative as possible.

3. Matters Arising

There were no matters arising.

Rev R Coulter and Mr McFarland joined the meeting at 2:20 pm and 2:22 pm respectively.

[2:25 pm]

Public Session

4. Subordinate Legislation

i. Food (Star Anise From Third Countries) (Emergency Control) (Northern Ireland) 2002

Agreed: That the Health, Social Services and Public Safety Committee is content with the Department's proposal for the Food (Star Anise From Third Countries) (Emergency Control) (Northern Ireland) 2002.

Ms McWilliams drew attention to the fact that the explanatory note from the Department did not specify the precise date that the Rule was due to come into effect, which made the Committee's scrutiny role difficult. The Clerk will write to the Department to request that future notifications of proposals for Statutory Rules include specific dates where appropriate.

ii. Statutory Rule No. 52/02 - The Road Traffic (Health Services Charges) (Amendment) Regulations (Northern Ireland) 2002

Question put and agreed:

That the Health, Social Services and Public Safety Committee has considered Statutory Rule No. 52/02 - The Road Traffic (Health Services Charges) (Amendment) Regulations (Northern Ireland) 2002 and, subject to the Examiner of Statutory Rules being satisfied as to its technical correctness, has no objection to the Rule.

iii. Statutory Rule No. 35/02 - Notification of Marketing of Food for Particular Nutritional Uses Regulations (Northern Ireland) 2002

Question put and agreed:

That the Health, Social Services and Public Safety Committee has considered Statutory Rule No. 35/02 - Notification of Marketing of Food for Particular Nutritional Uses Regulations (Northern Ireland) 2002 and, subject to the Examiner of Statutory Rules being satisfied as to its technical correctness, has no objection to the Rule.

iv. Statutory Rule No. 39/02 - Sweeteners in Food (Amendment) Regulations (Northern Ireland) 2002

That the Health, Social Services and Public Safety Committee has considered Statutory Rule No. 39/02 - Sweeteners in Food (Amendment) Regulations (Northern Ireland) 2002 and, subject to the Examiner of Statutory Rules being satisfied as to its technical correctness, has no objection to the Rule.

v. Statutory Rule No. 33/02 - Food and Animal Feedingstuffs (Products of Animal Origin from China) (Control) (Amendment) Regulations (Northern Ireland) 2002

That the Health, Social Services and Public Safety Committee has considered Statutory Rule No. 33/02 - Food and Animal Feedingstuffs (Products of Animal Origin from China) (Control) (Amendment) Regulations (Northern Ireland) 2002 and, subject to the Examiner of Statutory Rules being satisfied as to its technical correctness, has no objection to the Rule.

[2:40 pm]

5. Primary Care - Implementation of Local Health and Social Care Groups

The Chairman welcomed the following representatives from four primary care professional bodies, who briefed members on their respective points of concern relating to the implementation of the Local Health and Social Care Groups:

Dr Brian Dunn, General Practitioners' Committee BMA (NI)
Mr David Gowdy, Primary Care Multi-disciplinary Care Forum
Ms Breedagh Hughes, Royal College of Midwives (NI)
Ms Carole McIlrath, Royal College of Nursing (NI)

The presentations were followed by a question-and-answer session, and the entire proceedings are recorded separately in verbatim minutes of evidence. The main points of concern are summarized as follows:

• Royal College of Nursing

• Lack of groundwork and consultation to facilitate a smooth transition to new Primary Care (PC) arrangements. Front-line community nurses have not had an input to the guidance on the constitution governance and accountability arrangements.

• The current arrangements do not reflect a bottom-up approach. Instead they will maximise bureaucracy, and there may be conflict between the PC professionals, the Trusts and Boards.

• Seeks assurances that the Boards will not dominate the Groups and that nurse-led PC initiatives will continue and develop.

• Lack of clarity as to what the £3 funding per head of population will cover. Is it for management/admin support, or does it support PC development and/or infrastructure development?

• The current arrangements do not support a "bottom-up approach" to PC-led services, as advocated by the Hayes Report.

• Unsure as to what training and development has taken place. This is crucial to the development of the new PC infrastructure.

• Some nurses are deeply concerned that they will lose their jobs. Some have been told they will be moved and may have to leave community nursing and go into the acute sector.

• The Boards and Trusts should have non-voting rights on the management boards.

• There should be timescales for the devolved budget allocation with a clear vision towards a PC-led service.

• Funding should be restored to the target initiative to provide professionals in PC practices with dedicated time off for training each month.

Primary Care Multi-disciplinary Care Forum

• Concern about the level of commitment to the new PC arrangements. They will need the active support of everyone in the Assembly, Department and health and personal social services.

• Need for clarity about what is expected of the policy and of the Groups. At present there is no vision of how the Groups are expected to develop. In GB there is a four-stage progression from advisory group level to PC trust level.

• Concern about the composition of the Groups: will they be designed to be key partners in the process?

• The need for confidence-building measures. The energy of coalface staff drives change, but that is being eroded. A Northern Ireland-wide steering committee involving Groups is essential, but it does not appear to be a prospect.

Royal College of Midwives (NI)

• Dismay that there is no recognition in any of the guidance of the vital work of midwives in the community.

• A clear distinction should be made between nursing and midwifery.

• There is no evidence of training having been provided for those people for whom commissioning is a new experience.

• Concern about mechanisms for ensuring effective community and user representation on the new Groups.

General Practitioners' Committee BMA (NI)

• Insufficient advance notice given to PC professionals in relation to guidance on core issues - less than 7 weeks before "go-live date". Unlikely that Groups will be functioning well into the new year.

• LHSCGs have not been empowered to influence either the commissioning of secondary care or the development of PC. They will an advisory capacity only.

• Boards and Trusts will dominate the management boards, with not a great deal of scope for PC teams to exert their influence effectively. The Groups will entrench the position of the Boards and Trusts and make rationalization impossible.

• No detail of the timetable for empowering the Groups in the commissioning of services has been provided.

• Patients have received no guarantees on service provision after 1 April. Some practices have yet to be approached by Boards with regard to preserving services.

• There are fears about the future for staff in fundholding practices and PC commissioning pilots. Many staff have been issued with redundancy notices, and there is uncertainty about the effectiveness of the staff redeployment unit in the Central Services Agency.

• The funding level of £3 per head is inadequate. No identification of new PC development funding.

• There has been no meaningful involvement with stakeholders on the constitution of the management boards or on the levels of remuneration.

Mr Gallagher left the meeting at 3:45 pm and returned at 4:00 pm.
Mr McFarland left the meting at 3:55 pm and returned at 4:00 pm.
Rev R Coulter left the meeting at 4:00 pm and returned at 4:25 pm.

[4:15 pm]

6. Primary Legislation: Personal Social Services (Amendment) Bill

The Clerk advised members that the Committee's proposed amendments to the Personal Social Services (Amendment) Bill had been lodged with the Bill Office, for the Consideration Stage on Monday, 04 March 2002. He further informed the Committee that the Department had contacted him to advise that it would be proposing five amendments to the Bill tomorrow, which were intended to reflect and address the concerns of the Committee.

Agreed: The Clerk will liaise with the Chairman to consider whether the Department's proposed amendments fully address the Committee's concerns, in which case the Chairman will withdraw the Committee's proposed amendments. The Clerk will contact members to confirm the withdrawal, or to arrange a special Committee meeting in advance of the Consideration Stage to discuss further action.

[4:25 pm]

7. AOB

i. Agreed: The Committee gave permission for the papers that it had commissioned from the Assembly Research Team on the MMR Vaccine and the Victims' Strategy to be published on the Assembly's website.

ii. The Clerk advised the Committee that there had been a printing error in the Cancer Inquiry Report and that members would receive their corrected copies tomorrow.

iii. The Clerk drew the Committee's attention to a request for the Department for the Minister and Senior Officials to attend next week's meeting to discuss the Financial Allocations for 2002/03 and Priorities for Action. The Budget paper was issued to members at the meeting. The Department has advised that the paper on Priorities for Action will follow.

Agreed: The Clerk will write to the Department to accept the offer and to request that additional time be set aside to facilitate a discussion on the new primary care arrangements.

iv. Ms McWilliams voiced concern about the direct allocation of £8m to the Department by the Executive Committee, as part of the December Monitoring Round, without the funding proposal being subjected to the statutory Committee scrutiny process. The Minister of Finance and Personnel acknowledged the oversight in a written response to Ms McWilliams.

v. Ms McWilliams drew members' attention to the Department's written response to the Committee regarding sums surrendered in the 2001/2002 Monitoring Rounds. She highlighted as a concern the fact that £3.3m allocated to the Department in 2001/2002 to meet the cost of free nursing care from October 2001 was surrendered as a result of the necessary legislative and other preparatory work not having been done in-year.

vi. Agreed: The Clerk will write to the Department to seek clarification on the resignation of the Chairman of the Causeway HSS Trust.

vii. The Committee noted a thank-you letter to Dr Hendron from Ms Joan Ruddock, Chairman of the Belfast City Hospital Trust, for his article on A&E services in the recent Belfast Telegraph Health Review.

viii. The Committee noted a thank-you letter from the Chairman of the NI Ambulance Service following the recent meeting that he and the Chief Executive had with Dr Hendron in Parliament Buildings.

ix. The Committee noted a summary report of a study of patient satisfaction with GP out-of-hours services in the Eastern HSS Board area.

x. The Committee deferred making a decision on a request from GlaxoSmithKline for a meeting to discuss areas of common concern until a later date.

xi. Ms McWilliams drew members' attention to the All-Party Mental Health Group meeting on Infant and Child Mental Health on Wednesday, 06 March 2002 at 1:00 pm in Room 21, Parliament Buildings.

xii. Mrs Robinson requested that consideration be given to enlisting the services of a Specialist Advisor to the Committee in relation to the forthcoming Departmental review of mental health.

Agreed: The Clerk will take the matter forward, in line with established protocol.

xiii. Agreed: An invitation from British Telecom for the Committee to meet with the BTNI Health Team at BT Riverside Tower Belfast was agreed. The Clerk will make the necessary arrangements.

8. Date and Time of the Next Meeting

The next meeting will be at 2:00 pm on Wednesday, 06 March 2002 in Room 135, Parliament Buildings.

The meeting ended at 4:40 pm.

DR J HENDRON
COMMITTEE CHAIRMAN

March 2002

20 February 2002 / Menu / 6 MARCH 2002