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

Apologies:
Mr T Gallagher (Deputy Chairman)
Mrs I Robinson

In Attendance:
Mr P Hughes (Committee Clerk)
Mr D Harkin (Assistant Clerk)
Mr D Gordon (Executive Support)
Mr B Greene (Administrative Support)
Mr M Norman (Administrative Support)
Mr C Thomas (NHS Management Trainee)

1. Chairman's Opening Remarks

The Chairman reported briefly on the successful dinner last evening attended by Committee members and representatives of the BMA (Northern Ireland) in Parliament Buildings. The main items discussed included the implementation of the Local Health and Social Care Groups, hospital waiting lists, shortages of health service staff, and the EU Directive in respect of junior doctors' hours, which is due to come into effect in 2004.

2. Minutes of Proceedings of the Last Meeting

The minutes of the meeting of 11 September 2002 were agreed.

3. Matters Arising

There were no matters arising.

Ms McWilliams joined the meeting at 2.20pm.

4. Subordinate Legislation

i. Fire Services (Appointment and Promotion) (Amendment) Regulations (Northern Ireland) 2002

The Chairman explained the latest position in relation to the above Statutory Rule, which sets out the criteria for the appointment of the Chief Fire Officer for Northern Ireland and is intended to widen the pool of potential qualified candidates for the post. Following the Committee meeting of 11 September 2002, the Clerk had written to the Department to request clarification of the meaning of "equivalent qualifications" and details of the criteria under which certain public sector posts are exempted from the EC freedom of movement legislation.

A written response had been received, which explained that the Department had laid the Regulations on 16 September 2002, to ensure that the post of Chief Fire Officer was filled as soon as possible. This meant that the Committee would not have the opportunity to suggest any amendments to the draft regulations. The letter gave further information on the requisite experience and qualifications for the post and confirmed that judgements on the equivalence of posts would rest with the Northern Ireland Fire Authority Board, on advice from HM Inspector of Fire Services.

Mr McMahon reiterated the Minister's strong desire for the post of Chief Fire Officer to be filled as soon as possible by the best candidate. The Department's legal services had confirmed that it would not be advisable to prescribe in law the equivalence of qualifications and experience in respect of the requirements for the post of Chief Fire Officer, as this would result in future sporadic amendments to the legislation. Mr McMahon emphasized the Department's confidence that the new arrangements would not dilute the standards currently required for the post of Chief Fire Officer in terms of the level of experience and type of qualification.

Mr Berry advised that he was not content that the reference to "equivalent qualification and experience" in the amendment to the regulation would require applicants from outside the UK to match the same experience and qualifications of local candidates. He felt that the amendment called into question the capabilities of local senior fire officers, and he voiced concern at the lack of consultation on the proposed changes. Rev Robert Coulter stated that the new provision under which equivalence must apply to both experience and qualifications was still somewhat ambiguous. He was not satisfied that direct comparisons could be properly be made between applications from UK and non-UK nationals.

Ms Armitage emphasized that her support for the statutory rule was contingent on there being the facility to appeal to the Equality Commission by an unsuccessful candidate.

The Chairman emphasized that the most important point was that the person appointed to the position of Chief Fire Officer should be completely competent and enjoy the full confidence of the Fire Brigade staff. He also underlined the importance of the Committee's having due regard to the principle of equal opportunities and the freedom of movement for workers across the EU when considering the amendment to the legislation.

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

Fire Services (Appointment and Promotion) (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.

The Committee divided: Ayes 6, Noes 2

Ayes: Dr Hendron, Ms Armitage, Mrs Courtney, Mr Kelly, Ms McWilliams, Ms Ramsey

Noes: Mr Berry, Rev R Coulter

Question accordingly agreed to.

ii. The Adoption (Hague Convention) Regulations (Northern Ireland) 2002

Agreed: The Health, Social Services and Public Safety Committee is content with the Department's proposals for The Adoption (Hague Convention) Regulations (Northern Ireland) 2002.

5. Needs and Effectiveness Evaluation of Health and Social Care -Briefing

Departmental Officials: Mr Don Hill, Deputy Secretary

Mr Andrew Hamilton, Director of Finance

Mrs Karen Campbell

Mr Hill gave a brief presentation on the above review, which was commissioned by the Executive and jointly chaired by the Department of Finance and Personnel and OFMDFM. The reviews (six across the departments) were therefore independent of each Department. Mr Hill underlined the critical nature of the document as an objective assessment of the scale of underfunding and of the effectiveness of the service. The main issue of importance in relation to the reviews was to test whether the Barnett Formula, which is population based, was still the best formula for distribution of UK resources. The terms of reference are directly related to a relative needs exercise. Key points arising from the Needs and Effectiveness Evaluation are as follows:

Factors that affect relative need for HPSS resources

• Demographic pressures with rapid increase in the growth of elderly population
• Socio-economic status - for example, 15% of population in Northern Ireland can meet the full cost of nursing home treatment compared to 31% in England
• Disability levels are 20% higher than in GB
• Rurality - proportionately some £40m needed more than England
• Take-up of private health care provision is considerably more in England
• High levels of mental illness and prescription costs for anti-depressants as a result of community tension

Result of Needs Assessment

• Northern Ireland health care spending should be at least 17% - some argue as much as 21%- higher than in England. The funding gap now is estimated at between £100m and £200m for 2000/01.
• The gap has widened further since. The Spending Review has given significantly more resources to England over the past two years for health and social services. And England is considered one of the worst health providers in Europe.
  
  

Implications of spending gap

• Long waiting lists for acute and community services
• Lack of investment in community services
• Lower per capita spend on family and child care services
• Range of initiatives in mental health, disability and public health not replicated here
• Lack of investment in equipment and infrastructure, particularly IT systems



Effectiveness

• In spite of funding deficits, there has been a considerable improvement in the delivery of health service provision. For example, productivity in the hospital sector has increased by almost 100% over the last 10 years.
• In terms of efficiency and economy, the evaluation confirms broadly similar unit costs and management and administrative costs to GB.
• There are numerous examples of local efficiency initiatives and rationalization measures designed to improve effectiveness in, for example, cardiac services and child care.
• The Department is acutely aware of the need to demonstrate that additional resources must be associated with measurable outcomes.



Areas that need to be addressed

• benchmarking work in the hospital sector shows Northern Ireland to be broadly comparable with GB peers but more work is necessary
• differences in the performance of HSS Trusts
• the need to improve management of clinical negligence
• costs of prescribing are too high (29% more items per person)
• average length of stay in maternity hospitals is longer than GB
• disproportionate use of nursing homes rather than residential homes
• scope for savings through restructuring of administration and more shared services



Key messages

• The findings have implications for the Barnett Formula and should consequently affect the Budget
• In addition to dealing with immediate and critical need, the paper identifies "getting the pattern right" and "Investing for Health" as key priorities
• Too many people are admitted to hospital and too many people stay longer than they should: this will require major reforms in terms of tackling the determinants of poor health, enhancing primary and community care, and rationalising hospital provision
• The need to invest to achieve change; it is not possible to meet costs from "fat" within the Budget

Mr Hill advised that the existing arrangements for auditing are subject to change under the Audit and Accountability Bill. The Comptroller and Auditor General will have direct responsibility for audit of the entire health service under the new arrangements.

In response to a query by Rev Robert Coulter on the reduced beds capacity in the face of increased service demands, Mr Hamilton advised that this was a consequence of the health service being obliged to make efficiency savings over a number of years in order to meet financial targets. Some £195m had been extracted from the HPSS by annual 1%-2% cuts in the baseline between 1983 and 1996/97. Prior to that time, Northern Ireland had the lowest waiting lists in the UK. It is now recognised that this was a short-term measure that was not in the best interests of patients. As a result of the recent RRI initiative, some additional 100 beds are to be made available across three acute hospital sites. Additional funding for waiting lists will provide added protected elective capacity.

Mr Berry voiced concern at the plight faced by the private residential homes sector and asked what was being done to support that sector. Mr Hamilton undertook to provide the Committee with the numbers of homes that have withdrawn. He acknowledged that private residential homes are essential to health and social care services, which requires sufficient resources to enable the homes to meet the required standards. A programme of phased funding increases has been developed to achieve this aim.

Mr Kelly asked whether there was a solid foundation in current funding levels for building up the health care system. Mr Hill explained that, unless there was a sustained increase in resources, the current difficulties would continue. He advised that the plans and strategies were in place but needed to be supported by a major investment of resources. He pointed to the objective assessment that Northern Ireland was being funded by up to £200m less than England. Total expenditure per head on health is 45% of the total spend in England, in Scotland 41%, Wales 43%, but in Northern Ireland the figure is just 35%.

Ms McWilliams asked how the Department was ensuring that collaboration was taking place among Trusts to ensure that hospital capacity is optimised across the region. She expressed concern that, for example, tonsillectomy services were being underused in one hospital while the same services in a neighbouring hospital were overstretched. She asked what was being done to compare core financial costs across Trusts.

Mr Hamilton confirmed that the Department intended to develop new systems to support management and decision-making, as well as dealing with core financial issues. He advised that the Department has embarked on an initiative that will provide a detailed comparison of costs of Trusts. The results of the surgical specialities have been published on the Internet. The aim is to have all hospital specialities costed in this way by 2004. The figures show that Northern Ireland's average costs are broadly comparable with GB. This data will give a focus by setting costs alongside activity figures for hospitals. The Committee will receive updates on performance by way of a Departmental monitoring report. Mr Hill undertook to provide details of collaborative work being taken among HSS Boards to tackle "winter pressures".

The Trusts are now managing their operations under the new strict financial regime, which means that the historical deficits will no longer exist. In terms of an audit trail, clear links exist between additional resources and the associated outputs.

Agreed: The Clerk will write to OFMDFM and the Department of Finance and Personnel, as joint sponsors of the Needs and Effectiveness Evaluation Review, to ascertain what steps they intend to take as a consequence of the clear findings in relation to relative health care needs assessment and the widening funding gap between Northern Ireland and GB.

The Clerk will also write to the Department to request details of the recommendations for seven projects to be taken forward in the next stage of the Review of Community Care.

[3.45pm]

6. Protection of Children and Vulnerable Adults Bill: Oral Evidence

Probation Board for Northern Ireland

Witnesses: Mr Brian McGaughey

Mr Paul Doran

Ms Val Owens

The witnesses gave a brief presentation on the relevance and importance of the Bill to the Probation Board for Northern Ireland. The organisation listed five main issues arising from the Bill, which are summarised as follows:

• There is confusion among the public about the PECS register. A public information campaign is necessary to provide clear guidance on the Register and who can access it. The Board welcomes the establishment of the PECS Awareness Group in this regard. There needs to be an overarching public safety strategy to highlight parents' responsibility for the safety of children.
• Only those convicted of an offence that leads to a sentence of 12 months or more can be considered for disqualification orders. The Probation Board supervises people who may never have gone to prison and may assess them as being still a risk to the public. The Board believes that the reference in clause 23 (1) (a) to a prison sentence of 12 months or more should extend to community sentences. The protection and welfare of the child is paramount and should override everything else.
• Criminal and court records should clearly identify if the victim was a young person or a vulnerable adult, for example, in a case of abduction or kidnapping.
• Concern at the large unregulated area of children working with children. One of the unintended consequences of the legislation might be to encourage people to go into that area. It is important that agencies representing people working in such areas as private tutoring can apply for accreditation.
• There needs to be parity of safeguards on a cross-border basis, as there are concerns about the current vetting arrangements in the Republic of Ireland, where there is not an equivalent to PECS.

Ms McWilliams recommended that consideration be given to suggesting an amendment to clauses 21 and 22 (on disqualifications) by way of strengthening the provision of the court to make a disqualification order.

The entire proceedings are recorded separately in verbatim minutes of evidence.

SSAFA Forces Help

Witness: Mrs Maggie Smith

Mrs Smith gave a brief presentation on the perceived gaps in the provisions of the Bill in relation to the arrangements for carrying out background checks on persons serving with the Armed Forces and their families.

• Mrs Smith emphasized the importance of educating the public of the facility to access background details of Armed Forces personnel and their families through SSAFA Forces Help. She undertook to write to the Chief Executives of the HSS Boards with details of the services available by SSAFA Forces Help.
• Gaps in provision may occur when an individual serving overseas is tried but not convicted by Courts Martial of an offence against a child, as the records and any "soft" information may not be passed on. Mrs Smith will write to the Committee to clarify the position in relation to relevant information that can be made available from Courts Martial.

Agreed: The Clerk will write to invite the Police Service of Northern Ireland Superintendent who is responsible for child abuse investigation to request evidence in relation to the implications of the extension of Part V of the Police Act 1997 to Northern Ireland. The Clerk will also write to the Three Bureaux Implementation Group for details of its co-ordinating work on the protection of children and vulnerable adults.

7. AOB

i. The Clerk reminded members of the visit to Belfast City Hospital Trust at 12.30pm on Thursday, 19 September 2002 for an update on progress on the Cancer Centre.

ii. A copy of the Health and Personal Social Services (Quality, improvement and Regulation) Bill will issue to members. The Clerk will make provision for the Committee Stage of the Bill in the future work programme.

iii. The Clerk advised that a thank-you letter had been written to the Director of Public Health of the Southern HSS Board, Dr Anne Marie Telford, following the Assistant Clerk's attendance at the recent meeting of the Board's Managing Acute Pressures Group. Documentation had been issued to members on the work of the Group, recent initiatives and the obstacles to improvement, which the Committee found valuable.

Agreed: The Clerk will write to invite Dr Telford and other representatives of the Group to make a presentation to the Committee on its work and to provide an update on the effectiveness of its initiatives over the winter period. This meeting will be scheduled for early in the new year.

iv. Agreed: As part of its scrutiny of the Budget and Programme for Government, the Committee will focus on the resource allocation for community care and examine what services were delivered in the last year in this area. This will include a comparison of the variation in rates set for residential care homes in the statutory and private sector.

v. The Clerk reminded members of the confidential nature of part of a written submission received from a parent on the Protection of Children and Vulnerable Adults Bill.

vi. The Chairman reminded members that the next Committee meeting would take place at 10.00am on Tuesday, 24 September 2002 in the Senate Chamber. This will commence the evidence-taking process in relation to the Inquiry into child protection services. Members were reminded of the need to maintain a quorum throughout the proceedings.

8. Date and Time of the Next Meeting

The next meeting will be at 10.00am on Tuesday, 24 September 2002 in the Senate Chamber, Parliament Buildings. The normal weekly meeting will take place at 1.30pm on Wednesday, 25 September 2002 in Room 135, Parliament Buildings.

The meeting ended at 4.45 pm.

DR J HENDRON

COMMITTEE CHAIRMAN
September 2002