Present: Dr J Hendron (Chairman)
Rev R Coulter
Mrs A Courtney
Mr T Gallagher (Deputy Chairman)
Mr J Kelly
Ms M McWilliams
Ms S Ramsey
Mrs I Robinson

Apologies: Mrs P Armitage
Mr P Berry
Mr T Hamilton

In Attendance: Mr P Hughes (Committee Clerk)
Mr D Harkin (Assistant Clerk)
Mr D Gordon (Executive Support)
Mr W Long (Executive Support)
Mr B Greene (Administrative Support)

The Chairman reported briefly on the successful briefing by Arthritis Care Northern Ireland to Assembly Members in the Long Gallery yesterday on its work to empower people with arthritis and to promote their health and well-being through the provision of support services, self-help and information. He referred to the recent recommendation by the National Institute for Clinical Excellence (NICE) that new drugs to treat rheumatoid arthritis should be available through the NHS for all patients for whom they were considered medically appropriate. The Committee expressed concern that almost 200 people in Northern Ireland are still waiting to receive the new drugs.

Agreed: The Chairman will write to the Minister to ascertain the current position in relation to the availability on the NHS of arthritis drugs such as Remicade and Embrel. This request follows the Minister's written response to the Deputy Chairman of 12 June 2002, when she gave a commitment to seek the Executive's support in securing the additional resources to cater for all those awaiting treatment. The Chairman will also advise the Minister of the Committee's full support in her pressing for the necessary resources to be made available in the Executive's draft Programme for Government to meet the cost of the treatment.

The Chairman advised members that the clause-by-clause consideration of the Protection of Children and Vulnerable Adults Bill had been postponed until the next meeting, to allow the Department to respond fully to the areas of concern raised by the Committee on a number of clauses.

The Chairman advised members that Ms McWilliams and the Clerk had attended a seminar by the Northern Ireland Sex Offenders Strategic Management Committee in the morning on the assessment and management of risk of sex offenders. A note of the seminar will issue to members.

The Minutes of Proceedings of the meetings of Wednesday, 02 October and Thursday, 03 October 2002 were agreed.

A response is still awaited from the Northern Ireland Office to the Committee's request for Officials to provide oral evidence in relation to the Protection of Children and Vulnerable Adults Bill.

i. Medicines (Products for Animal Use - Fees) (Amendment) Regulations (Northern Ireland) 2002

Agreed: That the Health, Social Services and Public Safety Committee is content with the Department's proposal for Medicines (Products for Animal Use - Fees)(Amendment) Regulations (Northern Ireland) 2002.

ii. Report of the Examiner of Statutory Rules to the Assembly - Fire Services (Appointments and Promotion) (Amendment) Regulations (Northern Ireland) 2002

Agreed: The Chairman will write to the Minister to bring to her attention a number of minor points raised by the Examiner of Statutory Rules in relation to the above Statutory Rule.

Officials: Mr Brian Gryzmek, Deputy Secretary
Dr Miriam McCarthy, Senior Medical Officer
Ms Jillian Anderson, NHS Modernization Programme

Ms Ramsey left the meeting at 2.10pm.

Regional Maternity Hospital

Mr Gryzmek confirmed that the Department had received a response from the Royal Group of Hospitals Trust in relation to concerns raised by the Committee at a previous meeting about overcrowding, staffing levels at the neo-natal unit, and the building infrastructure at the Royal Maternity Hospital. He advised that he had subsequently met with the Chief Executive and his senior management team to discuss the situation. A copy of the response will be forwarded to the Committee.

As the Royal Maternity Hospital building is old and outdated (in spite of a short-term refurbishment), the Minister is determined to proceed as soon as possible with plans for the siting of a new Regional Maternity Hospital. An announcement is expected in the New Year. Mr Gryzmek confirmed that there are occasions when parts of the service are quite stretched. As regards the neo-natal unit, when the numbers of Type 1 babies (needing the most intensive care) exceed the planned case mix, this has a disproportionate effect on staffing levels. At present, the unit is operating at the whole time equivalent of 10.5 nurses below complement. Nurses are increasingly opting to work part-time, family-friendly hours, which necessitates the recruitment of more nurses. The unit is currently advertising for additional staffing and is seeking to increase training.

There is insufficient space in the building, particularly to cater for the increasing numbers of disposable items that have to be brought in regularly and which have greater storage requirements. Due to chronic storage problems, a nursery has had to be converted into a store, which generates problems. There is no room for expansion, and it is evident that the current unit cannot sustain the present levels of demand indefinitely.

Significant efforts are being made to ensure that the building is kept clean. There was a one-off problem with a breakdown of the sewerage system within the maternity hospital, which was dealt with speedily. A separate incident in which the steam system broke down was also resolved promptly. These problems reinforce the need to move to a new building as soon as possible.

The Chairman reminded the Officials of the recommendation by the Committee some time ago for a task force to be set up, for a limited period, of experienced doctors and nurse working in A&E and in primary care, together with managers and administrators, to examine the reasons for blockages in the hospital system and find practical solutions that could be applied across Boards and Trusts' boundaries. He expressed deep disappointment that the Minister had not adopted this recommendation. The Chairman asked what steps the Department had taken to address the capacity problems within the acute sector, which were now perennial.

Mr Gryzmek assured the Committee that the Minister had valued its well-intentioned recommendation and had taken on board the spirit of the suggestion. However, it was felt that there was sufficient communication at present within the existing arrangements to identify and highlight all the major issues. He emphasized that the winter planning structures were rooted in a bottom-up approach, with Boards, Trusts and GPs involved in developing plans through major workshops and seminars. Attendees at HSS Board "Winter Planning" workshops include public health consultants, programme planners, representatives from the HSS Councils, directors of nursing, the Ambulance Service, bed managers, medical directors, financial advisers, representatives of the out-of-hours co-operative, PAMs, the Boards, Trusts and the Department.

Mr Gryzmek emphasized the importance of taking an integrated approach to the problem of winter pressures, involving the primary and community care sectors as well as hospitals. The problems affecting A&E services were often related to a shortage of back-up facilities. The four HSS Boards' plans are shared across all participants. As well as providing for beds and hospital staff, resources will support rapid response units in individual Community Trust areas, increases in the number of GP sessions, increased staffing of out-of-hours GP services at peak times and community pharmacists.

Waiting Lists

Mr Gryzmek advised that the Minister was adopting a three-pronged strategy to tackling the waiting lists. One component was the protected elective resource. Some £2m recurrent resources was allocated to this scheme at the beginning of the year, supplemented by £1.75m in the June Monitoring Round. The Minister has stated that the additional element will be made recurrent next year. A further £0.25m has been allocated to support the management of the scheme.

The second component was the additional 110 beds (and 20 in the Ulster Hospital) funded by RRI resources, to come on stream between January 2003 and March 2004. These beds will provide much needed flexibility, because the additional influx of medical patients associated with winter take up elective surgical beds, thereby displacing those who would otherwise have received routine surgery. This additional capacity should help reduce the problem of "trolley waits".

The third component was the work spearheaded by Ms Anderson in training local staff and introducing techniques developed outside Northern Ireland over the past few years in managing waiting lists effectively. The Department expects individual Trusts to have action plans in place to implement the changes required and to set their respective programmes to improve the waiting lists position. Although the Boards are responsible for co-ordinating and quality assuring this process, the Trusts, as providers of the service in their area, will be expected to assume co-ownership of the problem. The Minister has made it clear that she expects the necessary improvements to be achieved now that the components are in place.

Ms Anderson has produced a skills development programme for beds managers in service improvement techniques, which should help improve the flow of patients through emergency admissions. An initiative begun in September will support the improvement and management of waiting lists and waiting times. The length of waiting times was accepted as being much more important. Ms Anderson advised that the waiting list situation in Northern Ireland was very similar to that in England and that good practices could be adopted from the successes of other countries' schemes.

She highlighted the importance of scrutinising the systems for admitting patients, theatre utilisation, minimising last-minute cancellations, validation of lists to ensure that patients are being properly prioritised, to manage waiting lists effectively. Effective validation of waiting lists elsewhere has made significant advances in reducing inequalities in waiting times. The aim is to have the right people, on the right lists, in the right order. Ms Anderson stated that the existing waiting list systems are often too rigid, which contributes to inefficiencies through the high percentage of cancellations.

Ms Anderson explained that she had developed an approach to managing waiting lists, entitled 'Primary Targeting Lists', which builds on lessons learned from England and Wales. This has been tailored to the specific circumstances of Northern Ireland and has been adopted across the region following workshops last week. It will help address the inequity of current systems whereby patients who have the same clinical priority wait completely different lengths of time for the same treatment.

Ms Anderson commented on the heavily performance managed system for waiting lists and times that was in place in GB as part of the NHS Modernisation Programme. The NHS Plan 2000 sets out challenging targets for reducing waiting times for elective surgery to a maximum 15 months for the current year, reducing to six months by 2005, and finally to a maximum of three months by 2008. This will require detailed accountability and monitoring arrangements.

The pooling of waiting lists is a significant advance for clinicians to make, and requires strong clinical leadership. This can also have an impact on reducing waiting times. Mr Gryzmek confirmed the Department and Minister's confidence that the combination of additional resources and implementation of good practices in the management of waiting lists will ease the pressure on elective beds in the main hospitals. He cautioned, though, that success would not be achieved overnight given the increased numbers of clinical procedures and overall demands on the system.

Ms McWilliams requested a paper from the Department summarising the set of initiatives, management practices and processes introduced across the HSS Boards and Trusts following the appointment of the Service Improvement Manager.

i. Inquiry into Child Protection Services in Northern Ireland

The Clerk advised members that the oral evidence-taking section of the Child Protection Inquiry had now been substantively completed. In order to inform the public of the range of views expressed by witnesses to the Inquiry, the Chairman recommended that the Committee approve for publication the written submissions, corrected minutes of evidence, and explanatory memoranda.

Question put and agreed to:

That the written submissions received, minutes of evidence (as amended) and explanatory memoranda, and the minutes of proceedings relating to the Committee's Inquiry into Child Protection Services in Northern Ireland be printed.

ii. Protection of Children and Vulnerable Adults Bill

In order to keep the public informed of the range of views and suggested amendments expressed in witnesses' written submissions and oral evidence, the Chairman recommended that the Committee order the publication of the evidence received.

Question put and agreed to:

That the written submissions received, minutes of evidence (as amended) and explanatory memoranda, and the minutes of proceedings relating to the Protection of Children and Vulnerable Adults Bill be printed.

iii. Developing Better Services

In order to inform the public of the range of views and concerns received in response to the Committee's consultation on 'Developing Better Services', the Chairman recommended that the Committee order the responses to be printed.

Question put and agreed to:

That the minutes of proceedings, minutes of evidence and written submissions received in relation to the Committee's consideration of the Department of Health, Social Services and Public Safety's consultation document on 'Developing Better Services' be printed.

iv. Agreed: The Clerk will prepare a draft press release, for approval by the Chairman on behalf of the Committee, highlighting members' continuing concerns about the waiting list figures. A further press release will issue to provide an update on the Child Protection Services Inquiry.

v. Ms McWilliams and Mrs Robinson raised joint concern about letters that they had both received in relation to a Human Organs case dating back some years. The parents of the deceased child had expressed deep concern about a number of questions to which they had not received satisfactory answers, in spite of considerable correspondence with the hospital.

Agreed: The Chairman will write to the Minister to ascertain the circumstances surrounding this case in relation to the findings of the Human Organs Inquiry.

vi. Agreed: In light of the current political uncertainty, the Chairman will approve the minutes of proceedings of Wednesday, 09 October 2002 on behalf of the Committee, for publication on the Assembly Website.

vii. Agreed: The Committee approved for publication documents that it had commissioned to date from Assembly Research Services, including papers on

Child Protection Services and Equality Impact Assessments.

The next meeting will be at 2:00 pm on Wednesday, 16 October 2002 in Room 135, Parliament Buildings.

DR J HENDRON
COMMITTEE CHAIRMAN
October 2002

3 October 2002 / Menu