MINUTES OF PROCEEDINGS OF THE HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY COMMITTEE AT 2:00 PM ON WEDNESDAY, 13 MARCH 2002 IN ROOM 135, PARLIAMENT BUILDINGS

Present:
Dr J Hendron (Chairman)
Mr P Berry
Rev R Coulter
Mr T Hamilton
Ms S Ramsey
Mrs I Robinson

Apologies:
Mrs A Courtney
Mr T Gallagher (Deputy Chairman)
Mr J Kelly
Ms M McWilliams

In Attendance:
Mr P Hughes (Committee Clerk)
Mr D Harkin (Assistant Clerk)
Mr D Gordon (Executive Support)
Mrs K McFerran (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 Mr Tom Hamilton, who replaced Mr McFarland on the Committee with effect from Monday, 11 March 2002. Dr Hendron will write to Mr McFarland to thank him for his dedication and valuable contribution to the work of the Committee since its inception.

Public Session

2. Minutes of Proceedings

The minutes of the meeting of 06 March 2002 were agreed.

3. Matters Arising

The Chairman is writing to his counterpart on the Public Accounts Committee (PAC) and the Minister requesting that the Minister's response to the PAC's report on Pathology Laboratories be copied to the Committee for its consideration.

4. Subordinate Legislation

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

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

ii. Statutory Rule No. 66/02 - The Health and Personal Social Services (Northern Ireland) Act 2001 (Fund-holding Practices) (Transfer of Assets, Rights and Liabilities and Transitional Provisions) Order (Northern Ireland) 2002

Question put and agreed to:

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

Statutory Rule No. 66/02 - The Health and Personal Social Services (Northern Ireland) Act 2001 (Fund-holding Practices) (Transfer of Assets, Rights and Liabilities and Transitional Provisions) Order (Northern Ireland) 2002

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

iii. Statutory Rule No. 46/02 - Travelling Expenses and Remission of Charges (Amendment) Regulations (Northern Ireland) 2002

Question put and agreed to:

That the Health, Social Services and Public Safety has considered:

Statutory Rule No. 46/02 - Travelling Expenses and Remission of Charges (Amendment) Regulations (Northern Ireland) 2002

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

[2.30 pm]

5. Hospital Waiting Lists

Mr Grzymek made a brief presentation on the background to the current waiting list problem, which is summarised as follows:

• · Waiting lists for elective procedures have been a problem in Northern Ireland for a number of years. Substantial cuts in resources in resources for health in 1995/96 led to a 30% reduction in elective procedures that year. There has been a downward spiral since that year, in spite of substantial non-recurring funds directed into elective surgery.

• · The Minister introduced the Framework for Action in 2000 that set out arrangements to tackle waiting lists. The Minister made the point that the necessary resources needed to be found to increase the capacity to meet the demand for elective surgery.

• · The Framework identified a number of clinical initiatives and management actions, proposals for service planning and efficiency measures. It was recognised that there was no quick fix to the problem. The Minister has previously explained there needed to be a sustained commitment of management input and resources. As well as improving management of the waiting lists, an important component is increasing capacity. Over the last 10 years bed capacity has decreased by 18%, while inpatient surgery has increased by 10%. Last year saw a 9% increase in general medical emergencies, which, given the limited capacity, had a knock-on effect on non-urgent electives.

• · The Minister and Department are greatly concerned that the waiting list figures has risen to almost 58,000, in spite of concerted efforts to reduce the numbers. General medical beds are running at practically 100% capacity. A major dilemma has been the considerable increase in emergency admissions in recent years, which has had the effect of pushing back the electives. This year is expected to see a further 10% increase in emergency medical admissions.

• · Delayed discharges account for 8-10% of beds. The Department is examining this area very carefully, including increasing resources for community care services. Patient choice is a factor in building up pressure in this area.

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

• · Mr Grzymek acknowledged that there would not a quick solution to reducing the numbers waiting for hospital admission but emphasized that this was a top priority for the Department. The £2m identified for waiting lists initiatives in 2002/03 will be targeted at protected elective admissions. A dedicated ward has been set aside in Altnagelvin Hospital for protected elective admissions, which is expected to deal with 1,000 cases this year. This year will see a one per cent growth in the number of elective surgeries carried out. The Department's aim is to increase this type of provision. Dr Maurice Hayes had highlighted the possibility of transforming Lagan Valley Hospital into a protected elective facility. Next year's Priorities for Action aims to constrain the growth in numbers as a first step to bringing them down.

• · The Health Service is now dealing with substantially more very sick patients, which places greater strains on capacity. Outcomes are improving, for example, cardiac surgery is available to much older people than before, but this comes at a cost to the system. Three out of every four patients awaiting surgery are treated within three months. Nineteen out of 20 receive surgery within a year.

• · No non-emergency elective surgery has taken place at the Ulster Hospital since December 2001, although Ward 12 will open shortly to increase general medical care provision, which is expected to make a substantial difference.

• · The waiting lists co-ordinators of the four HSS Boards meet monthly with the co-ordinators in each Trust, who provide reports on progress, which are consolidated into a quarterly report to the Department. This is helpful in raising the profile of actions on waiting lists. A major waiting list workshop took place last October, which was useful in exchanging best practices. Additional initiatives have been set in train as a result of this forum, which will form part of a series of programmes.

• · The Framework for Action has failed to reduce the numbers but has led to improvements in services, including the provision of mobile MRI scanners, which substantially reduced MRI waits. Over 200 people have had cardiac surgery in hospitals outside Northern Ireland in the last year. Work has been undertaken on validating waiting lists. A number of pilot projects have been established to examine areas such as chronic pain clinics and rheumatology.

• · More health procedures are available to patients now, which means that there are increasing referrals but with limited capacity in the system. More complex work is being undertaken against a background of a reduction in the number of beds.

• · Some 456,000 inpatients were treated in Northern Ireland's hospitals in 2000/01. The recruitment and retention of doctors, nurses and technical staff has been identified as a problem. There are shortages of staff in a number of key specialities. The Department is considering the work of specialist nurses operating in parts of GB, who examine patients for GPs and offer medical advice that may negate the patient having to go on to a waiting list.

• · HSS Trusts have identified senior staff to provide a specific focus on waiting lists, which will provide for greater accountability and help develop better management approaches in assessing activity levels and identifying problems as they arise.

• · Some £3m was channelled into recurring waiting lists initiatives in the current year, along with £5m that was consolidated to maintain essential non-recurrent services from the previous year. It is acknowledged that robust processes must be put in place to ensure maximum efficiency across the system.

• · If the problem of delayed discharges were eradicated it would have the effect of reducing the waiting lists figures by some 3,500.

• · The Department will not sacrifice issues of clinical priority for expediency and undertook to examine how it issues waiting lists figures, while setting them in the overall context of hospital activity.

Agreed: The Committee considered and approved a draft press release highlighting its concern about the latest waiting list figures, for immediate release. The Chairman will write to the Minister to express the Committee's alarm at the escalation of numbers and to request that the Department redouble its efforts to tackle the problem.

[3.30pm]

6. NI Nurse Practitioner Forum

Ms Conlon gave a brief presentation of the role of the nurse practitioner and the benefits these professionals can bring to the health care system. She also expressed concern about the potential job losses or deskilling of nurse practitioners under the new primary care arrangements. The main points are summarised as follows:

• · Nurse practitioners are highly skilled and qualified (to at least first degree level). They plan, prescribe and carry out treatment, and review the effectiveness of that treatment. They can make a diagnosis and discharge patients from care after treatment or refer on to other agencies as necessary. They augment the care of the doctor and have proved successful in easing the workload of GPs and pressures in primary care. They free up doctors' time so that they can see more complex cases. They also provide patient choice between being seen by the nurse or the doctor. Normally appointments with the nurse practitioner are longer than with the doctor, thereby allowing for time to be spent on health education at the same consultation.

• · A major benefit that nurse practitioners can bring is a reduction in the waiting times at A&E departments, particularly in relation to relieving winter pressures. They are ideally placed to take on more clinical responsibility, to carry out telephone triage, assess and prioritize patients, allocate appointments if necessary or give advice over the telephone. They can carry out home visits and post-operative visits.

• · There are 2,000 qualified nurse practitioners in the UK. Northern Ireland has 200, of whom 40 are in post. They are ideally situated in the primary health care setting. Some are employed in hospitals dealing with minor injuries in A&E. Emergency nurse practitioners can fill shortfalls caused by reduced doctors' hours in the A&E department. This can lead to improved morale in the acute sector and ultimately help in the retention of staff by reducing pressures.

• · The majority of nurse practitioner posts had been paid for out of savings from GP fundholding practices, which begs the question as to what will happen when this scheme goes. There had been a lack of consultation with nurse practitioners on the new local health and social care groups and they were concerned that the new arrangements would not be 'grassroots-led'.

Agreed: The Chairman would write to the Minister and the Department's Chief Nursing Officer to seek clarification on the Department's policy on the role and use of nurse practitioners; and to highlight their concern about the threat of job losses or jobs being de-skilled.

7. Implementation of Strategic Review of the Ambulance Service: Draft Response

Agreed: The Committee considered and approved the draft response to the above report, as amended.

8. AOB

i. Agreed: The Clerk will arrange an informal lunchtime Committee meeting with representatives of Extra Care's Committee of management and staff to discuss concerns about the provision of domiciliary care for older people.

ii. Agreed: Following a concern raised by the Eastern HSS Council about additional payments that relatives of residents in nursing and residential care homes are being asked to pay, the Committee will write to the Department for up-to-date information on the HSS Boards' policy on the relevant tariff arrangements.

iii. The Committee noted the Report of the Chief Medical Officer: The Health of the Public in Northern Ireland.

iv. The Clerk advised that members would receive copies of the programme for the visit to Altnagelvin Hospital on Thursday 21 March with their weekly papers.

9. Date and Time of the Next Meeting

The next meeting will be at 2:00 pm on Wednesday, 20 March 2002 in Room 135, Parliament Buildings.

The meeting ended at 4:05 pm.

DR J HENDRON
COMMITTEE CHAIRMAN

March 2002

6 March 2002 / Menu /20 March 2002