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

Apologies: Dr J Hendron (Chairman)
Mr T Hamilton
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 2:07 pm.

Private Session

1. Deputy Chairman's Opening Remarks

The Deputy Chairman advised members that briefing papers on the recent informal meetings that he had with Brook Advisory Clinic, the Northern Ireland Board of Occupational Therapists and the Health Professionals Council would issue shortly. Members would have the opportunity to raise any matters arising from the papers at next week's meeting.

[2.10 pm]

2. Briefing on HPSS Bill by Research Services

Dr Janice Thompson presented a Research Services paper on the HPSS Bill, in relation to the provision of free nursing care.

[2.20 pm]

Public Session

3. Minutes of Proceedings

The minutes of the meeting of 10 April 2002 were agreed.

4. Matters Arising

The Committee's Forward Work programme is covered under agenda item nine.

[2.30 pm]

5. Subordinate Legislation

i. Statutory Rule No.140/02 - Food (Figs, Hazelnuts and Pistachios from Turkey) (Emergency Control) Regulations (Northern Ireland) 2002

Question put and agreed to:

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

Statutory Rule No.140/02 - Food (Figs, Hazelnuts and Pistachios from Turkey) (Emergency Control) 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.

ii. Statutory Rule No. 141/02 - Food (Jelly Confectionery) (Emergency Control) Regulations (Northern Ireland) 2002

Question put and agreed to:

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

Statutory Rule No. 141/02 - Food (Jelly Confectionery) (Emergency Control) 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.

Ms McWilliams highlighted her concern at the recent number of court adjournments in cases taken by environmental health officers against the owners of premises where food was being prepared or sold under unhygienic conditions. Ms Ramsey highlighted a general concern about the shortage of environmental health officers in Belfast.

Agreed: The Clerk will write to the Department to request its response to the concern as raised. He will also invite both the Food Standards Agency and the Food Safety Promotion Board to make presentations to the Committee on their work at the earliest suitable opportunity.

[2.35 pm]

6. Health and Personal Social Services Bill (NIA 06/01)

Witnesses: Prof Robert Stout, Prof. Geriatric Medicine, QUB
Mr Tom Cairns, Age Concern
Mr David McConnell, Age Concern
Ms Caryl Williamson, Age Concern
Mr Ricky Devlin, Belfast Carers Centre

Prof. Stout, the representatives from Age Concern, and Mr Devlin made separate presentations on the free nursing care provision of the Bill. The entire proceedings are recorded separately in verbatim minutes of evidence. The witnesses concerns are summarized as follows:

While not opposed in principle to the provision of free nursing care, Prof Stout felt that it would be unworkable and unfair. This was because it would be very difficult to devise a mechanism that differentiated clearly between nursing care and non-nursing personal care. He also opposed the funding of free nursing care rather than personal care, as this amounted to diagnosis-related rationing, which was unfair. For example, a cancer patient needing Health Service treatment would qualify for free nursing care, but an elderly Alzheimer's patient would not, even though they may need considerable care and help with dressing, feeding, bathing and mobility.

Prof Stout voiced concern that the Bill may introduce a perverse incentive into the system, in that nursing homes would be subsidised, as they are required to have registered nurses on their staff. Residential homes do not. If the nursing home sector becomes cheaper than residential care homes, this could undermine the policy of promoting independence by providing long-term care in the least dependent environment.

Age Concern agreed that the proposed system would be discriminatory and create a two-tier service. They highlighted the considerable confusion that exists among the public, and elderly people in particular, about the system. Many do not make a distinction between nursing and personal care. The representatives raised concern that the interdepartmental working group on the introduction of free nursing care was not taking any submissions from groups such as Age Concern.

Early evidence from the implementation of the new system in England suggests that the nursing assessments are complex to administer. Also, a recent survey found that three out of five health authorities and primary care trusts have clear evidence of nursing homes increasing charges so that they fortuitously match the amount that people have been awarded through free nursing care. There is real confusion in England about to whom appeals should be directed. There does not seem to be a clear and simple appeal procedure.

Mr Devlin reiterated the view that the definition of what constitutes nursing care could prove problematic. Ambiguous boundaries could leave too much room for interpretation and prove distressing for the residents and their families. There is a danger that those who are the strongest advocates will win out and the most vulnerable will suffer the most.

[3.30pm]

Extension of the Committee Stage

Question put and agreed to:

That, in accordance with Standing Order 31(5), the period referred to in Standing Order 31 (3) be extended to 07 June 2002 in relation to the Committee Stage of the Health and Personal Social Services Bill (NIA 6/01).

Ms Ramsey left the meeting at 3.35 pm and returned at 3.49 pm.
Rev R Coulter left the meeting at 3.35 pm and returned at 3.50 pm.
Mr Kelly left the meeting at 3.50 pm.

The meeting was suspended at 3.51 pm and resumed at 3.55 pm.

[3.55 pm]

7. Review of Government Accommodation

Departmental Official: Mr Paul Conliffe, Planning and Resources Group

Mr Conliffe gave a brief summary of the Interim Report on the Strategic Review of Government Office Accommodation, which was issued for public consultation on 11 March 2002. The purpose of the Review is to establish, in the light of devolution, a strategic and operational plan for accommodating Civil Service Departments, taking into account their business needs and the requirements of the Assembly and the NIO.

The three main issues identified by the Review are the structure of the Government Estate, dispersal policy and space utilisation. The Committee agreed that the Review of Public Administration would have a significant influence on its position regarding the Review. The costs associated with any major reorganisation would be another key factor for the Committee's consideration, particularly in the context of the need for maximum input of resources into front-line health services.

Agreed: The Committee will respond to DFP advocating a moratorium on the Government Office Accommodation Review pending the outcome of the Review of Public Administration and the implications that may have for health service management structures.

[4.15 pm]

8. Executive Programme Funds - Infrastructure Fund Bids

Departmental Officials: Mr Don Hill, Deputy Secretary
Mr John McGrath, Dir. Planning and Performance Mgmt

The Officials briefed the Committee on the four outstanding EPF bids from last week's meeting. These were as follows:

• Development of a 35-bedded regional specialist admissions and assessment service and a 23-bedded specialist forensic service at Muckamore Abbey Hospital in support of people with a learning disability and mental disorder living in the community. The Officials undertook to provide the Committee with a briefing paper setting out the distinction in terms of medical provision between the proposed specialist forensic service as above and the specialist psychiatric unit based at Knockbracken.

• Development of a new medical research institute on the Queen's University campus and the Belfast City Hospital. This bid is supported by the Department of Employment and Learning, which is part-funding the scheme.

• Development of a single site to effect the rationalization of three pharmaceutical 'Specials' manufacturing facilities, which would free up accommodation at the Belfast City Hospital and improve the overall efficiency of the operation.

• Investment in an additional 15 ambulances and replacement of a further 29, and development of a centralised Ambulance Control to lead to a reliable and integrated service across all HSS Boards' boundaries.

The Committee welcomed the clarity with which Department's paper set out its case for each of the bids. Members felt that the projects clearly accorded with health as a key priority in the Programme for Government, with several bids having the added advantage of carrying clear New TSN and Equality benefits.

Members agreed that the fact that such major capital projects were submitted under EPF Infrastructure Funds, and not covered under the Department's mainstream Budget, was further proof of the unacceptable fiscal pressures faced by the Health Service.

Agreed: The Committee agreed with the Department's decision to submit the Regional Cancer Centre as the top priority. Members were also unanimous in their support for the remaining bids, which they chose not to prioritize. The Committee opined that these bids reflected quite basic needs in the Health Service, which had not been met due to a lack of investment in recent years.
[5.00 pm]

9. Committee Forward Work Programme

The Clerk will provide a draft work programme for consideration at next week's meeting. He advised the Committee that a heavy legislative programme was anticipated over the coming months. The Committee would need account of this, together with issues such as the new primary care system and the review of acute hospital services, in deciding whether it wished to undertake an inquiry to be completed by January 2003.

10. AOB

i. Agreed: The Committee accepted an invitation to attend a meeting on Monday, 13 May 2002 with the Health and Well-being Subcommittee of the North Belfast Partnership Board at their offices in Duncairn Gardens to discuss health related issues. The meeting will focus in particular on work on cancer, drugs and mental health.

ii. Agreed: Following the recommendation by the National Institute for Clinical Excellence that the drugs for treating severe rheumatoid arthritis should be prescribed on the NHS, the Deputy Chairman will write to the Minister to ascertain the Department's current position on the matter. He will also request that the Minister raise at Executive level the financial implications for the Department were it to follow Nice's recommendation.

iii. Agreed: On the foot of the press release issued by the Royal Group of Hospitals last week in relation to the hospital's backlog of cases needing an autopsy, the Deputy Chairman will write to the Minister to request an assessment of the impact of the suspension of the paediatric post-mortem service due to staff difficulties, and details of action being taken to rectify the situation.

iv. Agreed: The Deputy Chairman will write to invite the Minister to brief the Committee on the outcome of the Human Organ Inquiry, on its completion next month.

v. Agreed: The Committee will meet informally with the Eastern HSS Board at 2.30 pm on Tuesday, 07 May 2002 in Parliament Buildings to receive a presentation on the allocation of funds through the Capitation Formula.

vi. Agreed: The Committee agreed to a request from the Northern Ireland Dyspraxia Foundation for two of the UK's leading speakers on Dyspraxia to brief the Committee and the Education Committee on this learning disorder at an informal meeting in Parliament Buildings on Monday, 29 April 2002.

vii. Agreed: The Clerk will arrange an informal Committee meeting with staff from the Eastern Multifund Group, who have written expressing concerns about possible redundancies following the introduction of the new primary care arrangements.

viii. The Clerk advised members that the Chairman had agreed to write an article for the House of Commons Parliamentary Monitor Magazine on health policy in Northern Ireland post-devolution. A draft article will be tabled for approval at next week's meeting, to meet the deadline of 24 April 2002.

ix. The Clerk drew members' attention to a letter from the Environment Committee in relation to mobile phone masts. It highlighted pubic concerns about the interference between radio transmitters and cochlear implants. The matter will be considered at next week's meeting, following the Clerk's liaison with his counterpart on that Committee.

x. The Committee noted the Department's responses in relation to additional resources for waiting lists and the potential savings associated with the amalgamation of two HSS Trusts.

xi. The Clerk drew members' attention to a letter from a member of the public in relation to the Department's surrendering £23.9m by way of a necessary technical accounting adjustment. The Committee will have an opportunity to examine this further when the Department's Position Report is discussed.

xii. The Clerk reminded members of the visit on 18 April 2002 to Action Cancer House at 11.00 am.

xiii. The Clerk reminded members of the EU Day Conference on Tuesday, 09 May 2002 from 12.30 pm to 2.30 pm.

11. Date and Time of the Next Meeting

The next meeting will be at 2:00 pm on Wednesday, 24 April 2002 in Room 135, Parliament Buildings.

The meeting ended at 5.20 pm.

MR T GALLAGHER
DEPUTY COMMITTEE CHAIRMAN

APRIL 2002

10 April 2002 / Menu / 24 April 2002