Present:
Mr T Gallagher (Deputy Chairman)
Mr P Berry
Mrs A Courtney
Rev R Coulter
Mr T Hamilton
Mr J Kelly
Ms M McWilliams
Mrs I Robinson

Apologies:
Dr J Hendron (Chairman)
Mrs P Armitage
Ms S Ramsey

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)

1. Deputy Chairman's Opening Remarks

i.Agreed: On behalf of the Committee, the Deputy Chairman will write a letter of congratulations to staff member Mrs McFerran on the birth of her baby girl yesterday.

ii.The Deputy Chairman reported briefly on the week's informal Committee meetings with the NI Dyspraxia Foundation, PAPA (Parent and Professionals & Autism), NI Hospice Care Council of Management, and the Mental Health Commission. A written summary of each meeting will issue to members.

iii.Agreed: The Deputy Chairman will write to the Minister highlighting the deep concerns of the NI Hospice Care Council about its £1m funding shortfall and the serious implications for the capacity of the organisation should the situation continue.

iv.Agreed: The Clerk will prepare a draft letter to the Department for consideration at next week's meeting, setting out the main points of concern raised by the Mental Health Commission at the informal meeting of 01 May 2002.

[2.10 pm]

Public Session

2. Minutes of Proceedings

The minutes of the meeting of 24 April 2002 were agreed.

3. Matters Arising

i.Agreed: The Committee agreed the draft response, as amended, to the Department's Position Report 2002.

ii.Agreed: In the light of its current heavy work programme, the Committee will defer rescheduling the visit to BT Tower until further notice.

iii.The Clerk has written to invite Mr Derek Wanless to give a presentation to the Committee and interested Assembly Members on the findings of the Wanless Report on the long-term trends affecting the health service.

iv.The Clerk advised that the meeting provisionally arranged with NIPSA Social Services sub-committee for May would now take place at a later date, as the proposed day of action to highlight the lack of resources to implement the Children Order had been postponed until June 2002.

[2.15 pm]

4. Subordinate Legislation

i.Statutory Rule No. 144/02 - The Adoption of Children from Overseas Regulations (Northern Ireland) 2002

Question put and agreed to:

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

The Adoption of Children from Overseas 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.

The Clerk will write to the Department to request clarification on the relatedness of the above Statutory Rule to the Adoption (Intercountry Aspects) Bill that passed through the Assembly last year.

ii.Statutory Rule No. 136/02 - The Personal Social Services (Preserved Rights) Regulations (Northern Ireland) 2002

Question put and agreed to:

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

Statutory Rule No. 136/02 - The Personal Social Services (Preserved Rights) 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.

iii.General Dental Services (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 the General Dental Services (Amendment No.2) Regulations (Northern Ireland) 2002.

iv.General Medical Services (Amendment) Regulations (Northern Ireland) 2002

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

v.Travelling Expenses and Remission of Charges (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 the Travelling Expenses and Remission of Charges (Amendment No.2) Regulations (Northern Ireland) 2002.

[2.30 pm]

5. Review of Community Care - First Report

Departmental Officials:
Mr Leslie Frew
Mr Paul Martin
Mr Peter Deazley
Mrs Bernie McNally

Mr Frew gave a brief presentation on the objective and findings of the above report, which was commissioned following the recommendation of 'Facing the Future: Building upon the lessons of Winter 1999/2000'. These are summarized as follows:

• The main purpose of the review was to consider the implementation of community care policy and to examine the type and adequacy of the services available, with a view to, for example, preventing inappropriate admissions and discharge arrangements. It was also to make recommendations about the type of community care provision appropriate for the future, identifying good practices and barriers to the delivery of good community services.
• The HSS Boards and Trusts will be expected to adopt the principles and good practices of the schemes outlined in the review in their plans to support an additional 1,000 people in community care settings in 2002/03. Boards will be expected to submit their detailed proposals for achieving this shortly.
• The review identified the need to involve service users, their families and carers in the planning process and the SSI Quality Standards include this requirement.
• A database of good practices has been drawn up, which will be placed on a website soon. The challenge will be to replicate the principles of those schemes across Boards and Trusts that will lead to sustained service improvements.
• There will be a monitoring and reporting process that will allow the Department to measure success against the recommendations. Health and Wellbeing Investment Plans and Trust Delivery Plans will be agreed between the Department and each of the Boards and Trusts.
• The Department intend to set up a high level co-ordinating group to oversee the evaluation of current practices, with a view to producing a clear strategy for community care policy and practice for the next ten years and beyond.

Members voiced a number of concerns in relation to the review, which are summarized below:

• There is considerable variation in the levels of service between the Trusts, which is inequitable and completely unsatisfactory. The Committee is concerned at the delay in actually delivering on a range of community care packages given the urgent demand. Lack of movement on this leads to inefficient usage of limited health funds, with some integrated Trusts advising that up to 40 hospital beds are being "blocked" at any one time by patients who are unable to be discharged due to the unavailability of suitable community care provision.
• Members felt that acute care services needed to be reorganized significantly so that all patients were treated in the appropriate environment. In order to begin to move more medical services out of hospitals, there would need to be a radical examination of the extent of such community-based provision on a 24hr/7days basis. The Committee wants to see urgent movement on the replication of Trusts' good practices across the region to achieve better outcomes and eradicate health inequalities.
• The Department acknowledged the need for a reorientation of acute/primary/community care services, in order to prevent inappropriate hospital admissions in the first place. Rapid response schemes, hospital at home schemes and intensive domiciliary care systems have made an impact but have tended to be developed in isolation rather than on a regional basis.

• The Committee sought assurance that the Department had robust accountability arrangements for ensuring the Boards and Trusts produced workable, innovative service improvements, and that these would be followed through as swiftly as possible. The Deputy Secretary has met extensively with the Chief Executives of the four Boards, to impress the importance of having detailed plans and evaluation measures to make the review a success. The Department will be challenging Trusts to see if they are implementing good practices and proactively setting stretching targets.
• Members were concerned that GPs and other primary care professionals, who are responsible for delivering community services and prescription on the ground, need to be taken on board.
• There was concern about the capacity within the community, nursing profession and nursing home sector to cope with the extra demands that would be placed on it as a consequence of the review.
• There was concern that until the Local Health and Social Groups were established and operating effectively the lack of uniformity in community care provision would continue.
• There was some confusion as to the meaning of "intensive" in the context of domiciliary services and rehabilitation/care packages, in terms of the extent of care intervention in the home setting.

Agreed: The Clerk will prepare a draft response to the Department for consideration at next week's meeting.

Mr Kelly left the meeting at 3.25 pm and returned at 3.50 pm.

[3.45 pm]

6. Committee Stage of the HPSS Bill (NIA 6/01)

The Committee considered a paper from the Clerk highlighting the main provisions in the Bill and key concerns raised by witnesses, particularly in relation to the separation of nursing and personal care, and the recourse to appeal and complaint mechanisms. Members agreed to return to the matter at next week's meeting, when the formal Clause-by-Clause consideration would begin. The Clerk will arrange for the attendance of Departmental Officials to facilitate the discussions. The Committee's deliberations are recorded separately in verbatim minutes of evidence.

7. Committee Work Programme

Agreed: The Committee considered a draft paper outlining a number of options for an inquiry. It was agreed to re-examine the matter at next week's meeting, when Members could table additional suggestions for an inquiry.

The Clerk reminded members that the Eastern HSS Board was scheduled to give a presentation to the Committee at next week's meeting on resourcing concerns, including funding of primary care. In order to provide members with background information on resource allocation, the Eastern Board will give an overview of the capitation process and its impact on equity of funding at 2.30 pm on Tuesday, 07 May in Room 135 Parliament Buildings.

8. AOB

i.Agreed: The Clerk will invite Departmental Officials to give the Committee a presentation on the Department's consultation document, Proposals for a Carer's Strategy, at a suitable future date.

ii.The Committee noted a Public Petition in relation to the Ards Out of Hours GP Services, which was laid in the Assembly on 22 April 2002 by Mr Kieran McCarthy.

iii.Agreed: The Committee agreed, in principle, to holding periodically its weekly meeting at venues across Northern Ireland, in the interests of openness and transparency. The Clerk will investigate possible future venues, for the Committee to consider.

iv.Ms McWilliams referred for the Clerk's attention a letter from a constituent highlighting her concern about the availability of services for people with Asperger's Syndrome. The Clerk advised the Committee that the Department had provided a response to a previous letter from the Committee requesting information on the Syndrome and example of developments in services.

9. Date and Time of the Next Meeting

The next meeting will be at 2:00 pm on Wednesday, 08 May 2002 in Room 135, Parliament Buildings.

The meeting ended at 4.00 pm.

MR T GALLAGHER
COMMITTEE DEPUTY CHAIRMAN
May 2002