Present:
Mr T Gallagher (Deputy Chairman)
Mr P Berry
Mrs A Courtney
Mr T Hamilton
Mr J Kelly
Ms M McWilliams
Ms S Ramsey

Apologies:
Dr J Hendron (Chairman)
Mrs P Armitage
Rev R Coulter
Mrs I Robinson

In Attendance:
Mr P Hughes (Committee Clerk)
Mr D Harkin (Assistant Clerk)
Mr D Gordon (Executive Support)
Ms L Dempster (Administrative Support)
Mr B Greene (Administrative Support)
Dr J Thompson (Assembly Researcher)

Mr Gallagher took the Chair at 2.06 pm.

Private Session

1. Deputy Chairman's Opening Remarks

i.The Deputy Chairman advised members that he would be chairing the meetings for the next few weeks, in the absence of the Chairman, who is recuperating from a recent operation.

Agreed: The Deputy Chairman will write to extend the Committee's best wishes to the Chairman for his full and speedy recovery.

ii.On behalf of the Committee, the Deputy Chairman welcomed back Mrs Courtney following her recent illness.

The Minutes of Proceedings of 20 March 2002 were agreed.

3. Matters Arising

Agreed: The Committee considered and agreed the final draft of the Service Delivery Agreement (SDA) 2002/03, which highlighted a number of amendments to reflect the views expressed by members at the meeting of 20 March 2002. The Deputy Chairman will write to notify the Minister of the Committee's contentment with the SDA.

[2.15 pm]

4. Subordinate Legislation

i.Statutory Rule No. 82/02 - Food (Star Anise from Third Countries) (Emergency Control) Order (Northern Ireland) 2002

Question put and agreed to:

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

Statutory Rule No. 82/02 - Food (Star Anise from Third Countries) (Emergency Control) Order (Northern Ireland) 2002

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

ii.Statutory Rule No. 113/02 - The Health and Social Services (Assessment of Resources) (Amendment) Regulations (Northern Ireland) 2002

Question put and agreed to:

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

Statutory Rule No. 113/02 - The Health and Social Services (Assessment of Resources) (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.Food (Jelly Confectionery) (Emergency Control) Regulations (Northern Ireland) 2002

Agreed: That the Health, Social Services and Public Safety Committee is content with the Department's proposal for the Food (Jelly Confectionery) (Emergency Control) Regulations (Northern Ireland) 2002.

iv.Food (Figs, Hazelnuts and Pistachios from Turkey) (Emergency Control) Regulations (Northern Ireland) 2002

Agreed: That the Health, Social Services and Public Safety Committee is content with the Department's proposal for the Food (Figs, Hazelnuts and Pistachios from Turkey) (Emergency Control) Regulations (Northern Ireland) 2002.

v.The Committee noted a proposal by the Department of Finance and Personnel to make a Statutory Rule to commence the Family Law Act (Northern Ireland) 2001.

[2.25 pm]

5. Primary Legislation: Health and Personal Social Services Bill

Departmental Officials: Ms Judith Hill, Chief Nursing Officer

Mr Peter Deazley

Ms Jennifer Thompson

Mr Mike Hendra

Mr Deazley gave a brief presentation on the background to, and rationale for, the Health and Personal Social Services Bill, which was followed by a question-and-answer session. The entire proceedings are recorded separately in verbatim minutes of evidence.

The Officials explained that some 2,000 people who fund their own care in nursing homes in Northern Ireland would benefit from the introduction of free nursing care. A detailed survey will be carried out over the next few weeks to establish the precise numbers involved and the level of that funding. Just over £9m per year has been set aside from the Budget to cover the costs of free nursing care.

Mr Deazley advised that the Department is aware of the publicity surrounding the issue of nursing homes in England increasing their charges with the advent of free nursing care there, and that it would consider ways to avoid that happening in Northern Ireland. However, he admitted that this was an extremely difficult issue.

The Department is currently piloting a detailed assessment tool in relation to the definition of "nursing care". The tool, which will take into account all the physical, mental and social needs of people, will be going out to consultation soon. A training programme will be developed to roll out the use of the tool. Appropriate arrangements will be made to monitor and evaluate its effectiveness. The Department undertook to provide the Committee with a copy of the assessment tool when it is published.

In terms of training, the Department will provide the resources, so the main issue will be the costs involved in the release of nursing home staff. Nursing assessment will come under the arrangements that Trusts operate for care management.

Members expressed some concern that it would be particularly difficult to distinguish between people with long-term illnesses, in terms of which aspects of their care are nursing and which are personal.

The normal health and social services formal complaint procedure will apply, with the necessary support available to the nursing home resident or their advocate.

In relation to a point raised by Ms McWilliams that Northern Ireland's proportionately higher number of nursing homes than GB may have financial implications for Budget resources, the Department undertook to provide a written response.

Clause 2 establishes a Northern Ireland Practice and Education Council for Nursing and Midwifery, in line with a major review of nursing regulation Orders across the UK. The new Council will focus on practice development, the establishment of new knowledge and technologies, developing the educational process and examining the performance of nursing and midwifery services. The estimated £1m budget for the new body will be financed from the resources available for the national board, which is being stood down from 31 March 2002.

The Chief Nursing Officer undertook to respond in writing with regard to the position of health visitors vis-à-vis their satisfaction with the title of the Bill.

Mr Hamilton left the meeting at 2.50 pm.

6. Executive Programme Funds - Infrastructure Fund Bids

Departmental Officials: Mr Don Hill

Mr John McGrath

Mr Hill advised that this fund relates to the development and renewal of key strategic assets. The Executive does not envisage the fund as meeting any of the recurring implications of bids. Three new elements of the criteria are:

• alignment with Programme for Government and Public Service Agreement commitments;

• relevance of proposals to the Executive's key strategic priorities of health, education, and transport; and

• the need to address significant infrastructure deficiencies

There will be £11m available for allocation in 2002/03 and £59m in 2003/04. An estimated £100m will be available for 2004/05, but no final decisions have been made yet as that will be a Spending Review year.

To set the bids in context, Mr McGrath explained that the Department estimates that some £2 billion is needed for the development and renewal of the Health Service's capital infrastructure. Normal capital investment is £50m p.a., which falls significantly short of what is required. The Department has therefore developed business cases for eight preferred schemes as follows, the bids for which take into account inflation:

DHSS&PS Infrastructure Fund: Bids Summary

Mr Hill advised that the Department would welcome the Committee's views on the bids, in advance of the final proposal being submitted to DFP and EPU by 22 April 2002. There will then be a period of analysis by EPU and DFP, with a paper going to the Executive by mid-May.

Mr McGrath explained that the EPF bid of some £58m in respect of the Regional Cancer Centre is based on two components. First, it covers the public funding of the building, which would transfer on completion to HSS Trust ownership and be operated, maintained and refurbished by the Trust. In parallel with that, the equipment would be provided through the PFI scheme, which would ensure that it is kept fully up-to-date. Such a model would allow the Department to move quickly towards commencement of the new Centre once the green light was given. Funding of the Cancer Centre is the Department's number one priority.

Ms McWilliams welcomed the decision to opt for public funding for the building of the Cancer Centre, which the Committee had advocated in its recent Report on the Delivery of Cancer Services.

Mr McGrath explained that the bid in respect of Altnagelvin Hospital is for a strategic modernisation and extension of ward accommodation, and extension of support services, across its entire site, with a full upgrading of the Main Tower as a first step.

The bid for the Dalriada Doctor on Call project is for purpose-built accommodation on four strategic sites, which would provide the infrastructure to develop high quality local community-based initiatives and promote equality of access for all. If successful, this approach will be rolled out across all Board areas.

The bid in respect of the North and West Belfast H&PSS Trusts' Strategic Development Plan is, in the first instance, to establish two new Health and Wellbeing Centres in North Belfast and modernise facilities on the Everton site. The second stage would be to move to develop sites in West Belfast. The aim is to transform the Trust's current, mainly fragmented, method of delivering services to a co-ordinated, integrated, person-centred service. The Trust at present delivers its services from 44 buildings, 88% of which require significant work carried out.

The Officials undertook to provide Ms McWilliams with details of a similar initiative in South and East Belfast, which is at a more developed stage. However, that project has the advantage in that the South and East HSS Trust can dispose of a number of properties/land that command premium rates, in order to offset the costs of the scheme, which will provide for three Health and Wellbeing Centres.

Agreed: Members agreed to conclude their consideration and prioritization of the EPF Infrastructure Bids at next week's meeting. This will enable the Committee to communicate its response to the Department by the 22 April deadline.

Ms McWilliams left the meeting at 4.10 pm.

[4.10 pm]

7. Committee and DHSS&PS's Future Work Programme

Departmental Officials: Mr Clive Gowdy, Permanent Secretary

Mr Paul Simpson, Deputy Secretary

Mr Don Hill, Deputy Secretary

Mr Gowdy explained that demand continues to rise across all parts of the Health Service. This will require a commensurate increase in resources, in order to deliver on the level and quality of services demanded in acute hospitals, as well as primary and community care settings. Historical underfunding has undermined the ability of the Health Service to meet the rising levels of demand and to undertake new developments. Mr Gowdy emphasized the importance that the Department attached to the Committee's lending its support for an increased level of funding for the HPSS under the 2002 Spending Review.

• In terms of priorities, the Department attaches significant importance to arresting the growth in the numbers waiting for hospital treatment and to exerting a downward influence.

• The Department also wants to build capacity in the community in order to provide services for people at local level, to avoid inappropriate admissions to hospital where possible, and to facilitate prompt discharge of people from hospital.

• In terms of the 1,000 community care packages for 2002/03, the distribution, which will be spread out seasonally, will be based on the weighted capitation formula and will take into account the list of priorities from the interim review of community care. Priority will be given to those who are already on waiting lists. The packages will include places for the elderly, children with special needs and those with mental health problems.

• The Department will be working with primary care professionals to take forward developments in primary care, and to ensure that the new Local Health and Social Care Groups are fully and effectively established. Intensive negotiations are ongoing at national level regarding GPs' contracts, which may bring about changes to allow more flexibility in the way that GPs deliver primary care services with their professional colleagues.

• The measures set out in the 'Investing for Health' document will be progressed, in order to tackle issues of inequality.

• The Executive will decide on major Departmental proposals in relation to the future of Acute Hospital Services, which will then be subject to public consultation. The plan is for implementation of the new structure by the end of the year.

• The Minister views the establishment of the Regional Cancer Centre as a top priority, and she intends to make significant progress before the Summer Recess.

• The Department views health care standards and quality as crucial, and, following extensive consultation on 'Best Practice-Best Care', is ready to move forward with the necessary legislation.

• The Department is well advanced in its detailed workforce planning process with each of the health care professions, including speech and occupational therapy, where the problem of staff shortages has been frequently highlighted to the Committee.

Agreed: The Clerk will revisit the draft Committee Work Schedule in the light of the Departmental update, which will be tabled for discussion at next week's meeting.

[4.40 pm]

8. Presentation by Fire Brigade and Ambulance Service TU Representatives

Witnesses: Mr Tony Maguire, Fire Brigade

Mr Jim Barbour, Fire Brigade

Mr Tom Herrington, Ambulance Service

Mr Paddy Milligan, Ambulance Service

The witnesses highlighted a number of priorities for the Fire Brigade and Ambulance Service, which are summarized as follows:

Fire Brigade:

• Attacks on Firefighters - There were 716 recorded attacks on fire crews last year, with 36 officers sustaining physical injuries. The Union would like to see all political representatives becoming more proactively involved, at local community level, in challenging anti-social behaviour. Funding is needed to sustain outreach initiatives and to facilitate community education programmes.

• Funding - In the last month, £53m additional funding was announced for the Fire Brigade in England and Wales. Scotland received £18m, to include resources for station upgrades to meet equality targets, while Northern Ireland has not received any additional funds. Northern Ireland needs to be brought into line with GB in terms of fire cover provision.

• Uniform Staffing Levels - The Fire Brigade has only 870 whole-time firefighters in post from a complement of 919. There are 50 staff in Brigade controls, which is nine short of the complement. Overall staffing shortages must be urgently addressed.

• Amalgamation of Fire Brigade and Ambulance Service and Control Centres - The Union would caution against such a move, given the highly specialized nature of the work of the Fire Brigade and the need for a dedicated Fire Service unencumbered by commitments to other emergencies. And as the skills required for the two jobs are totally different, training would be a major issue, particularly since some 1,000 part-time firefighters in Northern Ireland receive just two hours per week at present.

Ambulance Service:

• As an effective deterrent to stop attacks on staff, there should be a change in the legislation to make any attack on health workers in general a criminal offence. There must a concerted publicity campaign to highlight attacks on public servants, particularly emergency personnel, as being totally unacceptable.

• The Ambulance Service should be classed as an emergency service. At present it is an essential service, with retirement set at age 65.

• There should be adequate funding to enable the services to keep updated in terms of vehicles, equipment and staff training. This should be centralized under the Department to achieve a uniform, equitable service across Northern Ireland. Funding should also be made for locating devices, which could be life-saving if and when staff come under attack.

• The shared radio system between the Ambulance and Fire Brigade will be a big advancement in developing communication at the scene of a major incident and between emergency vehicles that are en route to an emergency.

Agreed: The Committee will decide on its further action in relation to the points raised, on receipt of written briefings to be provided by the two unions.

9. AOB

i.The Committee noted the Department's revised 'Priorities for Action 2002/03' document, which had been copied to members.

ii.The Committee noted a letter from the Minister to the Chairman on the cancellation of outpatient clinics, which outlined a number of recent initiatives by HSS Trusts to reduce waiting times and minimize the level of cancellations.

iii.Members noted the Department's progress report on the implementation of the Committee's recommendations from its Report on Residential and Secure Accommodation for Children.

iv.Members noted a letter from the Mental Health Commission, highlighting issues for discussion at the meeting scheduled with the Committee on 1 May 2002.

v.Agreed: The Committee noted and agreed not to respond to the Department's consultation document 'Racial Equality in Health'. The Clerk will write a letter of acknowledgement to the Department.

vi.The Committee noted the Second Report of the Regional Advisory Committee on Cancer for Northern Ireland, which records some of the key developments in cancer services over the last three years.

vii.Members noted the Executive's 'Investing for Health' document, which the Committee will revisit at a later date to consider the implementation of its proposals.

10. Date and Time of the Next Meeting

The next meeting will be at 2.00 pm on Wednesday, 17 April 2002 in Room 135, Parliament Buildings.

The meeting ended at 5.20 pm.

MR T GALLAGHER
COMMITTEE CHAIRMAN
April 2002

20 March 2002 / Menu / 17 April 2002