Present:
Mr P Berry
Rev R Coulter
Mrs A Courtney
Ms M McWilliams
Ms S Ramsey
Mrs I Robinson

Apologies:
Mrs P Armitage
Mr T Gallagher (Deputy Chairman)
Dr J Hendron (Chairman)
Mr J Kelly

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)

The Clerk took the Chair at 2:07 pm.

Private Session

1. Election of Temporary Chairperson

In the absence of both the Chairman and Deputy Chairman, the Clerk sought nominations for a temporary Chairperson. Mr Berry proposed the Rev Robert Coulter, who was seconded by Mrs Robinson. There being no other nominations, Rev R Coulter took the Chair.

Rev R Coulter in the Chair.

2. Temporary Chairman's Opening Remarks

The Temporary Chairman asked the Clerk to brief the Committee on the latest round of informal meetings and hospital visits. The Clerk reported on the informative presentation yesterday by the Eastern HSS Board on the application of the Capitation Formula, which builds in local area weightings for age, special needs and client incomes. The data will be updated when the census results are published. The Clerk advised that the accompanying documentation would issue to members as soon as possible.

The Clerk advised that a report of the informal meeting with the Eastern Local Medical Committee would issue to members shortly. Members who attended that meeting expressed concern about the standard of health care provision, particularly in relation to patients' access to consultants, as highlighted by the GPs.

Agreed: The Clerk will prepare a draft letter to the Department highlighting the Eastern Local Medical Committee's concerns in relation to the lack of resources for secondary care and the need for improved communication between the acute sector and primary care professionals.

Mr Berry reported on the Committee's visits to the Daisy Hill and Lagan Valley Hospitals. The senior medical, nursing and administrative staff at both hospitals had emphasized the importance of the Executive's making an urgent decision on the future of hospital services, following the recommendations of the Hayes Report. The need to end uncertainty on the issue of acute hospital provision was cited as particularly important in terms of the recruitment and retention of medical and nursing staff.

[2.25 pm]

Public Session

3. Minutes of Proceedings of the Last Meeting

The minutes of the meeting of 01 May 2002 were agreed.

4. Matters Arising

i. The Clerk will prepare a draft letter to the Department, for consideration at next week's meeting, highlighting the concerns of the Mental Health Commission, as raised at the recent informal meeting with the Committee. These include problems associated with resource allocations, restrictions imposed by the current legislation, and the Commission's relationship with the Department.

ii. The Committee will consider the draft response to the Department's consultation document on the Review of Community Care at next week's meeting.

iii. Agreed: The Clerk will arrange for the NIPSA Social Services sub-committee to make a formal presentation to the Committee on its concerns about the lack of resources to implement the Children (Northern Ireland) Order 1995 at the meeting scheduled for Wednesday, 19 June 2002.

[2.35 pm]

Mrs Courtney joined the meeting at 2.35 pm.

5. Health and Personal Social Services Bill: Committee Stage

Departmental Officials:
Mr Mike Hendra
Mr Peter Deazley
Ms Judith Hill
Ms Jennifer Thompson

The Committee commenced its clause-by-clause scrutiny of the HPSS Bill, taking evidence from the above-named Officials. The entire proceedings are recorded separately in verbatim minutes of evidence.

The Officials gave a number of undertakings in relation to Clause 1 and the Schedule to the Bill, as listed below:

Clause 1(Charges for Nursing Care)

• The Department reiterated its commitment to provide the Committee with a copy of the Interdepartmental Group's consultation document on the assessment tool for free nursing care and the guidance for its use, which is due to be sent to the Minister in the next few days.
• The Department will check on what feedback can be made available to the Committee on the work of the pilots on the assessment tool.
• The Department will give consideration to making provision for a fast-track appeals/complaints procedure on nursing care needs through the Statutory Regulations. The Department will consider how such a complaints process could be monitored to ensure that Trusts implement its directions.

Clause 2 (The Northern Ireland Practice and Education Council for Nursing and Midwifery)

Question, That the Committee is content with Clause 2, put and agreed to.

Schedule (The Northern Ireland Practice and Education Council for Nursing and Midwifery)

Question put and agreed to:

That the Committee recommend to the Assembly that paragraph 21 (1) (a) be amended as follows: delete

"Nursing and Midwifery Order 2002"

and insert

"Nursing and Midwifery Order 2001 Statutory Instrument 2002 No.253".

Question, That the Committee is content with the Schedule, subject to the Committee's proposed amendment, put and agreed to.

The Committee suspended further clause-by-clause scrutiny of the Bill until at next week's meeting, when Departmental Officials will be re-invited to attend.

[3.25 pm]

6. Eastern HSS Board - Funding Issues

Board Officials:
Mr David Russell, Chairman
Dr Paula Kilbane, Chief Executive
Ms Angela Paisley
Ms Anne Lynch

The Officials gave a presentation on the strategic funding issues facing the Eastern HSS Board as a result of the 2002/03 Financial Settlement. The briefing is summarized as follows:

General Financial Issues

• While the Board welcomes the additional £60.8m Budget allocation for 2002/03, this will only provide for £8.3m in respect of service development (a 1.4% increase). The remainder of the allocation is taken up mainly by pay and price inflation, and maintaining existing services. There is, therefore, a concern about the adequacy of service development resources to meet both existing and emerging needs.
• The Eastern Board cost model suggests that, in spite of the welcome additional resources set aside for a tariff uplift for the independent sector, there will continue to be a significant gap between costs of care specified and the HPSS payment rate. There are deep concerns that this could lead to further home closures, placing greater pressure on the community care sector. Evidence from England suggests that the additional resources set aside for free nursing care in Northern Ireland may simply be offset against "top-up" fees imposed by nursing homes, thereby negating any benefit to the client.
• There is deep concern that the public expectations about the improvements that can be expected to the Health Service, following the Chancellor's Budget statement, are way beyond what can actually be delivered, given the deficiencies in the Barnett Formula. This system fails to take into account the relatively higher health care needs of Northern Ireland. In fact, the Barnett share of the 2003/04 settlement will fall short of the level required to maintain 2002/03 services at acceptable care standards. The Northern Ireland Block allocation must be skewed in favour of HPSS. If not, public expectation must be actively managed to reflect the fact that the Health Service is not funded to provide services at a similar level to GB.
• The Board holds to the objective of equal access to care according to need and seeks to achieve this by spreading its resources across the area. The usage of the 3rd Capitation Formula in the last year has updated the equity exercise. This has shown that the Down Lisburn area to be 6.4% relatively underfunded while the South and East Belfast area is relatively overfunded. A 3-month communication exercise is being undertaken to determine how this inequity can be redressed.
• Historically, the Board has used flexibility in the system to top-up underfunded localities. It would clearly prefer to have sufficient additional "unearmarked" resources to continue this practice, rather than "level down" by reducing services in relatively overfunded localities.
• Contrary to views often expressed in the media, services here are generally provided as effectively as in GB. Northern Ireland Confederation has recently commissioned work on management costs, which demonstrate local costs per capita as equating to England and much lower than Scotland and Wales.

Service Developments

• The renal dialysis service will be expanded to treat the expected number of additional patients over the next year. A live donor transplant service will be initiated.
• Improvements will be made to the cardiac and spinal surgery services, which are regional by nature. All Boards have agreed to work in partnership to contribute their fair share.
• The paediatric neurosurgery service is being moved to the Children's Hospital.
• Modest improvements will be made to the inpatients fracture service, with treatment within the target time of 48 hours being made more consistently available.
• Small improvements will be made to the intensive care service and the A&E service, as well as investments in neurology and the decontamination of reusable instruments.
• In the Ulster Hospital some improvements will be made to the fracture service, and a 20-bedded medical ward is being refurbished in readiness for winter pressures later this year.
• In the Downe Hospital an investment is proposed for an additional physician with a cardiological interest.
• The Mater and Lagan Hospitals have been encouraged to bring forward proposals for protected elective centres, to provide dedicated surgical services all the year round.
• Investments are proposed across programmes for elderly people, physically disabled, learning disabled and people with mental health problems, to facilitate their discharge from hospital to appropriate settings and prevent inappropriate admissions. The Board expects to be able to provide for a minimum of 500 people.
• There will be a modest investment in improvement of services for carers, in response to the Carer's Strategy.
• In relation to mental health services, modest improvements continue to be made in the out-of-hours arrangements for accessing acute beds and the enhancement of out-of-hours psychiatric liaison services.
• In relation to children's services, investments will be made in additional trainee social worker posts, improvements in foster care fee rates, and investments in appropriate care of a small number of individual children.

Areas where the Board has significant concerns about its ability to provide services at an appropriate level

• In a significant part of the Board area (North Down and Ards), the resources for community care were already committed in 2002/03. This will mean that additional resources will not be available to invest in the discharge of patients to the community. The Board has been engaged in talks with the Ulster Hospital and Community Trusts to explore the possibility of creating a "midway house" for patients while they await their preferred placement in the community.
• While the modest investment in "Protected Elective Capacity" is welcome, this will not make a significant impact on the current waiting lists for surgery. Sustained additional funding is required.
• The year-on-year rises in the numbers of emergency medical admissions will mean that there is little prospect in the short to medium term of reducing the numbers of "trolley waits" and those waiting for discharge from hospital into the community.
• The Board would have liked to be able to invest more in mental health services, particularly for children and adolescents.
• More community investment is required for people with physical and learning disabilities, to reduce the need for investment at the specialist end.
• In relation to cancer services, significant investment in staffing will be required as the new MRI scanners come on stream.

Mrs Robinson left the meeting at 4.08 pm.

Agreed: The Clerk will draft a letter to the Department outlining the Committee's concerns about the services restrictions imposed by the funding limitations for 2002/03, as outlined above.

[4.15 pm]

7. Future Work Programme

The Committee will consider possible areas for a future inquiry at next week's meeting. These will include the issue of child and young infants' protection, which was raised by a number of members, in light of the tragic Jasmine McGowan case and the allegations of physical abuse against disabled children at a Belfast school.

Agreed: The Clerk will invite Officials to next week's meeting to brief the Committee on the Department's policy in relation to child protection, including consideration for additional safeguards by the Boards and Trusts as a result of lessons learnt from the above case.

8. AOB

A Research Services paper on waiting lists has been copied to members, which will inform the Committee's further consideration of this matter in the autumn. A presentation on the paper will be scheduled for late May or early June.

9. Date and Time of the Next Meeting

As the visit of the Queen next Wednesday will affect members' availability for the meeting scheduled for 15 May, it will be rearranged for 2.00 pm on Tuesday, 14 May 2002 in Room 152, Parliament Buildings.

The meeting ended at 4.30 pm.

REV R COULTER
TEMPORARY COMMITTEE CHAIRMAN
May 2002

1 May 2002 / Menu / 14 May 2002