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

Apologies: Mrs A Courtney
Mr A McFarland

In Attendance: Mr P Hughes (Committee Clerk)
Mr D Harkin (Assistant Clerk)
Mrs K McFerran (Executive Support)
Mr D Gordon (Executive Support)
Ms L Dempster (Administrative Support)
Mr B Greene (Administrative Support)

Dr Hendron took the Chair at 2:00 pm.

Private Session

1. Chairman's Opening Remarks

On behalf of members, the Chairman welcomed two new members of staff, Mr David Gordon and Ms Lesley Dempster, who recently joined the Committee.

The Chairman referred to a concern previously raised by members about the need for maximum openness and transparency in Committee meetings.

Agreed: The Chairman confirmed arrangements for limiting closed sessions at meetings to any specific item that the Committee agrees should be held in private and to the Chairman's remarks.

2. Briefing by Research Services on the Departmental Budget for 2002/03 and Priorities for Action

Assembly Researchers Mr Rab McConaghy and Dr Janice Thompson provided the Committee with a briefing on issues arising from the Department's Budget for 2002/03 and associated Priorities for Action.

Mr Gallagher joined the meeting at 2:25 pm.

[2.35 pm]

Public Session

3. Minutes of Proceedings

The minutes of the meeting of 27 February 2002 were Agreed.

4. Matter Arising

There were no matters arising.

5. Subordinate Legislation

i. Charges for Drugs and Appliances (Amendment) Regulations (Northern Ireland) 2002

Agreed: That the Health, Social Services and Public Safety Committee is content with the Department's proposal for Charges for Drugs and Appliances (Amendment) Regulations (Northern Ireland) 2002.

ii. Dental Charges (Amendment) Regulations (Northern Ireland) 2002

Agreed: That the Health, Social Services and Public Safety Committee is content with the Department's proposal for Dental Charges (Amendment) Regulations (Northern Ireland) 2002.

iii. Optical Charges and Payments (Amendment No. 2) Regulations (Northern Ireland) 2002

Agreed: That the Health, Social Services and Public Safety Committee is content with the Department's proposal for Optical Charges and Payments (Amendment No.2) Regulations (Northern Ireland) 2002.

iv. The Adoption of Children From Overseas Regulations (Northern Ireland)
2002

Agreed: That the Health, Social Services and Public Safety Committee is content with the Department's proposal for The Adoption of Children From Overseas Regulations (Northern Ireland) 2002.

v. The Health and Personal Social Services (Assessment of Resources) (Amendment) Regulations (Northern Ireland) 2002

Agreed: The Committee deferred consideration of the proposal for The Health and Personal Social Services (Assessment of Resources) (Amendment) Regulations (Northern Ireland) 2002 until next week's meeting.

The Committee noted the following three Statutory Instruments issued by the Department, which have been introduced on a UK-wide basis.

The Medicines for Human Use and Medical Devices (Fees and Miscellaneous Amendments) Regulations 2002

The Clerk will ascertain the implications for Wales of the Welsh Assembly's decision not to increase prescription charges in line with inflation for three years from 2001 and to extend free prescription to the under 25s, in terms of cost and uptake numbers.

vii. Introduction of the Prescription Only Medicines (Human Use) Amendment Order 2002

The Clerk will write to the Department to request details of the range of medicines that are to be covered under the nurse prescribing arrangements.

viii.Introduction of the Medicines (Products Other Than Veterinary Drugs) (General Sale List) (Amendment) Order 2002

[2:50 pm]

6. Departmental Budget 2002/03: Financial Allocations and Priorities for Action

Panel Members: The Minister, Ms Bairbre de Brún
Mr Clive Gowdy, Permanent Secretary
Mr Paul Simpson, Deputy Secretary
Mr Andrew Hamilton, Director of Finance

The Minister gave a brief presentation on the strategic context for the Budget and Financial Allocation for 2002/03. The main points are summarized as follows:

• The Department has received only 50% of the high priority bids submitted.

• Out of a total Budget of £2.5b, £36.8m is available for developmental activity (including £12m efficiency savings).

• The Health Service needs more resources and greater certainty about future funding levels, which will allow meaningful long-term planning. There is ever growing demand and the health care system is caring for more and more people, adding to the pressures.

• The breakdown of the developmental funds is as follows:
  £4.5m to meet part-year costs of free nursing care from October 2002.
  £1.05m for Investing for Health
  £1.8m for Primary Care
  £19.1m for Community Services (including 1,000 community care packages and an uplift of 5.5% in residential and nursing home fees)
  £13.05m for Hospital Services
  £2m for Children's Services

• Successful bids against the second tranche of Executive Programme Funds (EFPs) amounting to £9m have meant that progress can begin on a number of important projects including digital trunk radio for emergency services, the Acquired Brain Injury Unit, and Investing for Health Partnerships.

  The Minister's top priority bid against the first tranche of this year's EPFs will be for capital funding for the Regional Cancer Centre.

  This was followed by a question-and-answer session, and the main points covered are summarised as follows:

• The Minister places a very high priority in reducing waiting lists. The problem can be tackled by providing funds for specific waiting list work and by building up capacity in the services overall. Some £2m will be set aside for protected elective day care work, which has been impacted upon by the rising numbers of emergency admissions to hospitals.

• Short-term decisions on hospitals are constantly being made and are not being deferred pending the outcome of the Acute Hospitals Review, which is due to be finalised in 2002. The Department is in regular contact with the Trusts and any difficulties are dealt with expeditiously. Services will be maintained pending final decisions.

• The Minister recognised that the residential and nursing sector is under severe pressure, as previous uplifts in fees have not kept pace with inflation and pay. No Budget allowance was provided for this sector against the Department's Budget bids. However, the Department treated it as a priority and made £3.6m available from its own baseline figures, through efficiency savings, to contribute towards the cost of uplifting tariffs by 5.5%. The Department wants to see the Boards and Trusts introduce a single Agreed tariff from 01 April 2002 to achieve a greater degree of consistency. Variations in payments made between the statutory and independent sectors may reflect difference in the needs of clients and their degree of dependency.

• Budget limitations will mean that improvements to the Ambulance Service will be modest for 2002/03. A number of essential developments will not take place because of fiscal constraints, but the Department will continue to make strenuous monitoring bids in-year.

• The 7% uplift in the drugs bill follows an historical trend in this field and leaves virtually no room for manoeuvre. The development of drugs is very expensive and the cost tends to rise disproportionately to inflation. There has also been an increase in prescribing. For example, there has been increasing pressure on treating heart disease, which pushes up costs.

• Some £0.3m is to be spent on initiatives to cut down on hospital acquired infection. A "good practice" fund has been established to take forward progress on hospital cleanliness. Hospitals are required to bring forward plans to effect improvements. The Department has asked each Hospital Trust to identify a senior manager to be personally accountable for standards in environmental cleanliness. A regional advisory group is to be established to ensure that good practice is disseminated throughout the service.

• Meritorious service awards system will be examined as part of the sets of ongoing negotiations in England in relation to consultants' contracts, GPs' contracts and Agenda for Change. The £4.7m for these awards is within the existing baseline and is not a draw on the £36.8m additional funds. The Department will provide an update to the information provided to date on the numbers benefiting from the scheme.

• In relation to concerns about the limited funding increase for the Ambulance Service, the Minister emphasized that EPFs would support considerable investment in the Strategic Ambulance Service Review. Also, in the last three years considerable rises in funding have meant that 56 A&E vehicles and 53 Patient Care vehicles were replaced out of a total of 243. Increases in baseline funding will provide for a trial training programme to help crews to deal with potentially violent situations and allow for a pilot community education for children and young people.

• The stabilization of services through the financing of recovery plans reflects the level of underfunding for some Trusts that were facing difficulty in coping with high levels of activity. Acute Trusts cannot plan with precision for levels of emergency care. This funding will have to be made recurrent from 2002/03. There is a robust system for benchmarking performance of Trusts that show levels of expenditure beyond the funding allocations based on activity. The Department scrutinizes HSS Trusts' plans to ensure that they are delivering services efficiently, and the Boards have to be satisfied that the level of activity that they are requiring the Trusts to carry out requires additional funding. The Department will expect all Trusts to live within their resources. In real terms, some £192m has been taken out of the Budget baseline since the 1980s against a background of increasing demands on health care services.

• In response to concern that only £2.7m has been set aside for the continuation of the Drugs and Alcohol Strategy, the Minister stated that this was a cross-cutting issue and that the Ministerial Steering Group has Agreed that the Executive will have to consider how to take forward this budget. Other funds were allocated to the Department and NIO earlier in the year, channelled through the Executive for related work. The Minister undertook to provide the Committee with a further update on the Department's Drug and Alcohol Strategies.

• The Minister stated that the £1.8m for primary care developments in 2002/03 would be supplemented in 2003/04 by the balance of funds redeployed from GP fundholders' management allowances, which are expected to be an estimated £2.5m. This will be allocated to the Local Health and Social Care Groups (LHSCGs) to promote co-operation between primary care professionals. It will be used to allow the maintenance of existing fundholders' services, which was a key concern raised in the consultation process.

The meeting was suspended from 4:10 pm to 4:15 pm.

[4:15 pm]

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

Panel Members: The Minister, Ms Bairbre de Brún
Mr Clive Gowdy, Permanent Secretary
Mr Paul Simpson, Deputy Secretary
Mr Jim Thompson, Acting Director of Primary Care

The Minister gave a brief presentation on the new Local Health and Social Care Groups (LHSCGs) to be established from April 2002, which is summarised as follows:

• The objective of the new groups is to reduce bureaucracy, promote inclusivity among primary care professionals, and move resources into front-line services. The aim is for local people and local health professionals, using their expertise and knowledge of what is needed required on the ground, to come together to ensure those needs are met. The planning for the new arrangements will take account of lessons learnt in GB and the experience from the primary care commissioning pilots.

• The new groups will have delegated budgets, which will extend to prescribing, primary care development, and budgets to cover their management costs. Evidence from the commissioning pilots has shown that groups take 12 months to establish themselves before they can be expected to play an active role in the wider planning, delivery or the commissioning of health and social services.

• The Minister expects that most GP fundholding staff administrative staff can be redeployed within the health and personal social services, or remain in their existing GP practice doing other work.

• Guidance for establishing the configuration of the new groups was first issued in November 2001 followed by further documents this year on the constitution, governance, accountability and remuneration of the groups.

• Meetings took place, before and after the guidance was issued, with the BMA (NI), the GP Forum, the Primary Care Forum, the Boards, Trusts, social workers, midwives, pharmacists and PAMs. The views expressed varied widely and it was not possible to accommodate them all. The Department believes it has a workable and broadly acceptable set of proposals.

• In relation to the Executive's wish to review public administration, the Department is confident that the new groups are flexible enough to be accommodated in any wider structural change.

• The Minister intends to deploy £1.8m towards primary care developments in 2002/03, rising to £4.3m in 2003/04, once the balance of the money tied up in GP fundholding management allowances has been released. Resources for General Medical Services will be ring-fenced.

There followed a question-and-answer session, which is summarised as follows:

• In response to concerns raised about why the guidance on the new arrangements had taken so long, the Minister advised that staff and resources had been tied up in the extension of the GP fundholding system and the complicated winding down of the scheme. The development of the guidance on the new arrangements was complex, and the consultation process with the various stakeholders had been extended after the legislation did not go through last year.

• In relation to the make-up of the primary care management boards, the Minister expressed her confidence that the configuration was such that no one group would dominate and that the representation was well balanced.

• The Minister confirmed that the LHSCGs would begin to take on responsibility for commissioning health and social services from April 2003. As the groups are essentially statutory committees of the Boards, they can assume delegated responsibility for commissioning without a requirement to change primary legislation. There will be a development programme, and additional funds will be made available to the groups to allow them to develop the expertise needed to commission services.

• Midwives are not excluded from the management boards; the guidelines say that there will be two posts for nurses, which will also be open to midwives and health visitors.

• In response to concerns raised that some nurse-led services would be lost under the new primary care arrangements, the Minister gave an assurance that all health care services provided under the GP fundholding arrangements would be maintained.

• The £3 per head under the LHSCGs for management costs will allow for the transfer of £2.5m from administration to front-line services. The fee itself will meet the cost of running the management board and pay the salaries of the group's administrative staff. The management allowance expected to increase substantially from £3 per head when the groups draw down responsibilities for commissioning a wide range of health and social services.

• The Minister expects the Staff Redeployment Unit to match administrative staff from the GP fundholding schemes with jobs arising elsewhere in the health and social services field. She expressed her hope that many would be successful in obtaining jobs in the LHSCGs.

8. Primary Care - Association of Directors of Social Services

Panel Members: Mr Noel Rooney, Secretary
Mr Des Quillan

The panel endorsed the concept of the new integrated primary care structures and the development of the LHSCGs. They welcomed the inclusion of social care in the new arrangements, which will provide equity of esteem for the different strands. They emphasized the importance of engaging with a range of other agencies to bridge linkages, and welcomed the user/community involvement.

Agreed: The Clerk will invite additional organisations that have written to the Committee in support of the new arrangements for primary care to give evidence.

9. AOB

i. Agreed: The Committee will receive a private briefing from Research Services at next week's meeting on the work undertaken to date in relation to local Health Service structures, which was commissioned in December 2001.

ii. Ms McWilliams advised that the Mental Health Group had held a very successful meeting today, where a powerful message had been delivered on infant mental health. She will write a note of the meeting, which will be copied to members.

iii. The Clerk will confirm the arrangements for the reports of the Public Accounts Committee to be sent to the other Assembly Committees. He will request that any response from the Minister be copied to the Committee.

iv. The Committee will receive a note of the informal meeting between the Chairman and a number of members with the BMA NI Council on 04 March 2002.

10. Date and Time of the Next Committee Meeting

The next Committee meeting will be at 2:00 pm on Wednesday, 13 March 2002 in Room 135, Parliament Buildings.

The meeting ended at 6:17 pm.

DR J HENDRON
COMMITTEE CHAIRMAN

March 2002

27 February 2002 / Menu / 13 March 2002