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

Apologies:
Mr T Gallagher (Deputy Chairman)
Ms S Ramsey

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 Chris Thomas (NHS Management Trainee)

1. Chairman's Opening Remarks

i.The Chairman reiterated the imperative to maintain a quorum throughout evidence-taking meetings of the Committee. He expressed regret that the loss of a quorum for part of yesterday's oral evidence hearing, in relation to the Inquiry into Child Protection Services, had prevented the Committee from conducting business. While acknowledging that members had competing priorities within the Assembly, particularly on plenary siting days, the Chairman appealed to members to exercise responsibility in ensuring that there was no repeat of this unacceptable situation.

ii.The Chairman advised members that the Clerk and Assembly Researcher Dr Thompson had attended a conference on cross-border co-operation on child protection that was held on 17 September. A note on the meeting will be issued to members.

[1.40pm]

2. Minutes of Proceedings of the Last Meeting

The Minutes of Proceedings of the meeting of 18 September 2002 were agreed.

3. Matters Arising

The Clerk advised that the letter to OFMDFM and the Department of Finance and Personnel responding to the Needs and Effectiveness Evaluation of Health and Social Services would issue shortly, and would reflect the outcome of yesterday's Assembly debate on the draft Budget.

[1.45pm]

4. Subordinate Legislation

Mrs Robinson requested that her dissension with the above statutory rule be added to that of Mr Berry and Rev R Coulter, who had voiced discontent at last week's meeting. The Clerk explained that the statutory rule had been laid with the Business Office, and that Assembly Members would have the opportunity to pray against it. Members could put down a motion of annulment within 30 calendar days or 10 Assembly sitting days of the rule being laid.

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

Statutory Rule No. 283/2002 - 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.

Departmental Officials: Mr John McGrath

Mr Fergal Bradley

Mr McGrath gave a brief presentation of the background to and rationale for the above Bill. This was followed by a question-and-answer session. The main issues raised are summarised below. The main elements of the framework are to promote the quality of health and care services.

• This will include a system for implementing existing standards and guidelines.
• The extension of the regulation of services to cover a much wider range.
• Minimum care standards to be developed for the regulated services.
• A new statutory duty of quality to be introduced for the HPSS.
• The system of clinical and social care governance to be formally introduced to the HPSS.
• A new single independent regulation and inspection body - The HSS Regulation and Improvement Authority to be established with the twin roles of regulating services and inspecting and monitoring governance within the HPSS.
• The establishment of Service Development Frameworks analogous to the National Service Frameworks developed in GB for key priority areas of service.
• An overall performance management framework to be developed.

The Bill makes provision for the statutory quality requirement to apply to all HPSS bodies delivering services. It establishes the new HSS Regulation and Improvement Authority, which will review the clinical and social care governance arrangements within the HPSS. It also provides for the new Authority to be responsible for the regulation and inspection of an extended range of services. The Bill does not set out an exact timetable for the regulation of services, which will be dependent on the feasibility of the arrangements and resourcing.

Mr McGrath confirmed that the revalidation process for General Practitioners under the General Medical Council would be a contributory element to the clinical and social care governance arrangements.

In response to a query by Ms McWilliams on the arrangements for monitoring Trusts' fostering and adoption services, Mr Bradley explained that the same minimum inspection standards would apply as to the voluntary and independent sector, and would be reported on in the same way. There is no registration or de-registration process for the Trusts' fostering and adoption services because this would be impractical - the Trusts are obliged to provide statutory services.

Mr Bradley undertook to provide Mrs Robinson with projected staffing figures for the new Regulations and Inspection Authority. These numbers are based on equivalent bodies in England and the local Registration and Inspection Units' staffing complement.

In response to a concern raised by Mr Berry that the new Authority could be seen as another layer of bureaucracy, Mr McGrath underlined the need for a body to ensure that health care standards are being met and that clinical and social governance issues are being addressed. The Human Organs issue highlighted the need for a watchdog body to check that corporate organisations have best care systems in place and are adopting the right practices. The aim of the Bill was also to lead to more economical work practices and to minimize bureaucracy. There are moves towards risk management controls assurance across the HPSS.

In response to a query raised by Mr Kelly on whether sanctions would be applied in respect of non-compliance of standards, Mr McGrath stated that the statutory duty of quality would apply to all services that are delivered by the HPSS. The Department and Minister would take a serious view where an organisation in the public health sector had breached its statutory requirements.

In response to a query by Ms Armitage, Mr McGrath confirmed that medical records management would also come under the issue of clinical and social care governance and the quality duty. Mrs Robinson asked if the provisions of the Bill would cover the many alternative clinics that are opening. Mr McGrath advised that the Bill would be sufficiently flexible to cover

Rev R Coulter asked how the effectiveness of the new Authority would be monitored and evaluated. Mr McGrath advised that the Authority would have to produce an Annual Report to the Department, and the results of its inspections would be published. While the Authority would operate independently from the rest of the HPSS, the Department would hold it to account and authorize its work programme. The Authority's membership would derive from the public appointments procedure.

Ms McWilliams raised concern that, while the aim of the Bill to develop minimum standards was welcome, social workers, for example, felt strongly that, because of the severe staffing shortages that they face, they could not possibly reach the quality standards set in respect of their statutory duty towards children. Mr McGrath advised that once a codified system was in place that set out clear standards, it would be easier to identify and address resourcing gaps.

The entire proceedings relating to the oral evidence given by the two witnesses listed below are recorded separately in verbatim minutes of evidence.

Witness: Mr Scott Hollander, Executive Director, KidsVoice, Pittsburgh USA

Dr Hollander gave a brief presentation on his experience of child protection services from a US perspective. The main points are summarised as follows:

• KidsVoice is a private non-profit organisation, with a staff of 40, which brings advocacy to 5,000 children per annum involved in abuse and neglect cases in the Pittsburgh area. The organisation is paid $450 per child per annum, which is woefully inadequate. This income is supplemented by generous donations. Other experts such as paediatricians, child psychiatrists, psychologists and experts in substance abuse provide additional help. Requests can be made for the social services agency to conduct and fund a psychological evaluation.
• Child welfare is under-resourced in the US. The fact that it takes a long time to see the dividends from investment in children's issues militates against the necessary expenditure in this area.

• KidsVoice advocates for the interests of children and young people from newborn children up to the age of 21. The philosophy is not to advocate solely for the child's wishes. Much time is spent with the child educating them that their first choice may not happen in the short term, as it would not be in their best interests.
• The child's wishes are, however, very important and the court will always be made aware of the child's views. Sometimes the wishes of the child will prevail with the proviso that strict measures have to be followed including detailed monitoring arrangements, in order for the placement to continue.
• Many of the success stories in helping children and their families have actually resulted in net savings of public expenditure by early intervention. There may be viable options to a child being placed in an expensive residential care setting by, for example, arranging for a willing and suitable relative or family friend to care for the child.
• Relatives providing care for child are paid the same rate as a foster parent in the US, but this is substantially less than the cost of an institutional facility. The child can attend the local school and has contact with family.

Witness: Dr Eileen Vizard, Consultant Child and Adolescent Psychiatrist, London

Dr Vizard gave a brief presentation on her work with the Young Offender's Project, which was followed by a question-and-answer session. The entire proceedings are recorded separately in verbatim minutes of evidence. Dr Vizard's presentation is summarised as follows:

• Evidence shows that child sex offenders also have many other problems. They often come from disadvantaged families and have been sexually, physically or emotionally abused themselves. They have had many placements in local authority care and professionals have great difficulty in dealing with them. Consideration should be given to recommending that state services for these offenders be significantly developed to support the voluntary sector.
• There needs to be a raising of awareness among professionals and the public about the general nature of the problem, because the public has mixed feelings about offenders. There needs to be support for assessment and treatment services.
• An important human rights issue is how society treats children from age 8 or 10 when they appear in criminal courts charged with an offence. In England the Children Act provision does not apply to children who are in prison or within the secure estate. This has attracted controversy because the local authority takes no responsibility for the welfare of the child who has been charged with a criminal offence. The issue of parental responsibility in terms of the Children Act is crucial. There is an absence of moral parenting for these children who are in trouble and in prison or in secure accommodation awaiting trial. This issue needs to be addressed urgently.
• The appointment of a Children's Commissioner is a welcome and progressive step for Northern Ireland.
• The procedure in England for the handling of serious case reviews where a child has died in suspicious circumstances is not satisfactory. It is launched in an ad hoc way by an Area Child Protection Committee (ACPC).

There is no central Government-based Standing Committee that can co-ordinate the way in which these serious case reviews are organised. Nor is there any guidance as to who should undertake them.

• Huge wide-ranging public inquiries are not always necessary into these tragedies. Lessons can be learnt from previous meticulous work and published reports. The issue is about implementing the recommendations from those reports rather than setting up hugely expensive inquiries. Public inquiries must have appropriately appointed professionals who will cover all areas.
• The Crown Prosecution Service has published a helpful booklet on pre-trial therapy for children who are witnesses in criminal proceedings around child abuse. It is a helpful basis for the argument that children with major trauma ought to be given access to the treatment they need before the criminal trial. Work is ongoing in the Department of Health to produce a similar booklet for children who are facing charges of criminal offences in the court. Further work is ongoing for the commissioning of a child defendant's pack.
• There needs to be a medium- to long-term strategy for training of a range of professionals involved in child protection. Before the opening of assessment facilities for vulnerable children, careful strategic thought should be given to the numbers of professionals needed, the disciplines from which they should come and the types of training they would require, in order to provide skilled and appropriate treatment for those children. The disciplines would include all those who may be involved with vulnerable children within the child protection context - judges in the criminal and civil court systems, barristers, solicitors, mental health professionals, social services and probation, education, medicine and nursing.

7. Protection of Children and Vulnerable Adults Bill - Consideration of Evidence

The Chairman referred members to a paper prepared by the Clerk that set out the range of issues raised in the written and oral evidence. This included a number of proposed amendments. The Clerk explained that the paper was by way of a preparatory guide to members in advance of the clause-by-clause consideration of the Bill, which was due to commence at next week's meeting. Members undertook to examine the paper in the overall context of the Bill prior to the next meeting.

The Clerk confirmed that letters of invitation to provide oral evidence had issued to the Northern Ireland Office and the Police Service of Northern Ireland.

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 22 November 2002, in relation to the Committee Stage of the Protection of Children and Vulnerable Adults Bill. (NIA 22/01).

The Clerk referred members to a Committee Work Programme and highlighted key areas of responsibility, particularly in terms of legislation. He advised that the Committee Stage of the Protection of Children and Vulnerable Adults Bill might have to be run concurrently with the HPSS (Quality, Improvement and Regulations) Bill for a short period. There was also the Private Member's Bill on the area of child protection, which the Committee may have to deal with.

The Clerk advised that work was ongoing in sifting responses to the Committee's consultation on 'Developing Better Services' and that a number of relevant organisations would be identified to provide oral evidence to the Committee. He added that this might necessitate an additional morning session to the weekly meeting.

The Clerk has approached the Department, on behalf of the Chairman, to invite the Regional Co-ordinator to brief the Committee on the work being undertaken to tackle hospital waiting lists. This meeting is provisionally scheduled for Wednesday, 09 October 2002.

The Department will be invited to brief the Committee on the implementation of the Local Health and Social Care Groups

The Clerk canvassed the Committee's view on whether a meeting would be feasible on Wednesday, 30 October 2002, during Halloween Recess, in light of the particularly heavy work programme.

Agreed: Members will advise the Clerk individually over the coming week as to their availability to attend the meeting as provisionally scheduled above.

Mrs Robinson requested the Committee's support for the case for the 100,000 people in Northern Ireland with hearing difficulties to have their analogue hearing aids replaced by digital aids. She added that Wales had introduced the digital aids universally, as have 50 Trusts in England.

Agreed: It was unanimously agreed that the Chairman should write to the Minister to request that consideration be given for the release of the necessary funds to support the upgrade to the digital system.

The next meeting will be at 10.00am on Thursday, 26 September 2002 in the Senate Chamber, Parliament Buildings, when the Committee will continue its evidence-taking on the Inquiry into Child Protection Services. The Committee will meet as normal next Wednesday, 02 October 2002 in Room 135, Parliament Buildings.

24 September 2002 / Menu / 26 September 2002