Wednesday 6 March 2002

Primary Care: Implementation of
Local Health and Social Care Groups

Members present:
Dr Hendron (Chairperson)
Mr Gallagher (Deputy Chairperson)
Ms Armitage
Mr Berry
Rev Robert Coulter
Mr J Kelly
Ms McWilliams
Ms Ramsey
Mrs I Robinson

Witnesses:
Ms B de Brún )
Mr C Gowdy ) Department of Health, Social Services and Public Safety
Mr P Simpson )
Mr J Thompson )

Mr Chairperson, since you have invited me to speak on this topic, can I make some opening comments?

Absolutely.

Thank you. Local health and social care groups will be multidisciplinary partnerships that deliver improvements in the quality of locally provided services. They will begin to take responsibility for commissioning health and social services from April 2003.

In establishing the new structures, the Department has taken account of the lessons learned in England, Scotland and Wales, as well as experience gained through the primary care commissioning pilots. When local health groups were established in Wales, local health co-operatives in Scotland and primary care groups in England, they were not established as free-standing legal entities. In each case they were subgroups of existing Health Service bodies. During the early stages of the development of those groups, concern and anxiety was expressed by would-be stakeholders in the new organisations. There were many teething problems. However, once the groups had been established, many of the concerns were resolved, and in four years of being in operation they have become established as central bodies within the National Health Service.

Local health and social care groups are more inclusive than any other model. Primary care professionals and service users will work in co-operation for the benefit of the patients in their area. The groups will include people from trusts who will be able to deliver the plans agreed by the group. It is essential that those involved in the planning and delivery of services are working together from the start. An objective of the new arrangements is to reduce bureaucracy and move resources into front-line patient care. By holding the administrative costs of the new groups to an average £3 per head, £2·5 million can be diverted from administration into primary care front-line services.

The membership of the groups is well balanced: five GPs and five board or community trust representatives (of whom three will be nurses), one social worker and one professional allied to medicine. There will also be a nurse, a social worker and a professional allied to medicine who will self-nominate, an acute trust representative, a pharmacist, two community user representatives and a manager. In this context "nurse" refers to nurses, midwives and health visitors.

The Department and the health and social services boards are working to put the groups in place as quickly as possible, and I expect them to be established during April 2002. The boards are currently advertising for applicants for the management boards of the new groups. From the outset the new local health and social care groups will have delegated budgets, which will extend to indicative budgets for prescribing, budgets for primary care development and budgets to cover their management costs. The groups will be expected to identify local health and social care needs and to draw up plans to meet gaps in services, using their primary care development funds to commission local primary care and community care services as appropriate. They will decide on local priorities, taking account of resource constraints and other factors. They will also contribute to the commissioning decisions of their health and social services boards, reflecting their knowledge of local needs.

Evidence from the commissioning pilots has shown that groups take 12 months to establish themselves before they can be expected to play an active role in the wider planning delivery or the commissioning of health and social services. All four boards have agreed that all services currently provided by GP fundholders, with the exception of a few minor services, will be maintained until local health and social care groups can decide on their future. I expect the professionals who are currently providing these services to continue to do so. I expect most GP fundholding administrative staff to be redeployed within health and personal social services, or to remain within their existing GP practice, doing other work. There will also be employment opportunities for some staff in the new local health and social care groups.

When the Assembly decided to extend GP fundholding for a further 12 months, the resources were, once again, locked into that scheme. Managing and monitoring the scheme in its final difficult year has absorbed much of the resources which would otherwise have been devoted to the development of the new groups. However, there has been no delay in the process.

The first piece of guidance was issued in November, following my announcement on 16 October. It charged boards with the responsibility of establishing the configuration of the new groups. There will be 15 groups and, following a round of consultation and discussions with key stakeholders, boards have put forward proposals for group configuration in their areas.

The second and third guidance documents that dealt with the constitution, governance, accountability and remuneration of the groups were issued before the configurations were settled.

Officials from my Department met with many groups and individuals to discuss the content of that guidance, and took account of the views of a wide cross-section of key stakeholders. Before and after the guidance was issued, meetings took place with the BMA (NI), the GP forum, the primary care forum, the boards, trusts, social workers, nurses, midwives, pharmacists and professions allied to medicine.

The views expressed diverged widely, and it is not possible to accommodate all of them. However, there is a workable and broadly acceptable set of proposals that, with commitment from those involved, can deliver a better service.

The issue of wider structural change in the Health Service remains firmly on my agenda. In developing that service to meet the needs of the twenty-first century, it is important to ensure that the organisational structure is appropriate for the efficient and effective delivery of services. It is equally important to ensure that any new arrangements support the close working of all parts of the Health Service and facilitate essential links with other key public services such as education and housing.

The Executive's wish to review public administration and the issues involved in the development of acute hospital services provide a wider context for the development of any proposals for organisational change. The new groups are flexible enough to be accommodated in any wider structural change.

I am fully committed to the success of the new groups. That success depends on the availability of funding for the development of primary care services. It will be necessary to maintain those primary care services which have been paid for out of fundholder savings. Next year I intend to deploy £1·8 million towards primary care developments. That sum will rise by £2·5 million to £4·3 million in 2003-04, once the balance of the money tied up in GP fundholding management allowance has been released.

Local health and social care groups provide an opportunity for primary care to assume a central position in health and social services. They provide the initial step towards a more inclusive and co-ordinated system for the planning and delivery of services and will ensure the multidisciplinary working together of local people and local health professionals to make decisions about services at local level.

Those decisions will be informed by the skills, experience and knowledge of health professionals who work in front-line services. It will be up to the management boards of the new groups to ensure that there is a bottom-up approach. They must devise effective mechanisms to ensure that other stakeholders are involved, together with those members of the wider local health and social care group whose concern is at the grass-roots level.

As Chairperson of the Health Committee I want to be positive, but the Committee must reflect and comment on what other responsible organisations tell it.

In your original document you referred to consultation. In your response, the word "respondent" was used repeatedly. That irritated me, because all responses were grouped together as respondents regardless of whether a submission had been from the Royal College of Nursing or from someone living at the top of the Cave Hill. Expressions such as "most respondents felt this" or "some respondents felt the other" were unsatisfactory.

You mentioned a bottom-up approach, and I hope that things will turn out that way. The set-up, however, is top-down, given that the boards will have committees. I accept that with regard to the running and organisation, only time will tell, but I hope that the approach is bottom-up and closely linked to the community. You have already mentioned possible legislation, and I think you would accept that in respect of trusts.

In the matter of guidelines, a seamless transition to the new primary care structures has been discussed repeatedly. The first statement was issued in October and documentation followed in November. The Committee met representatives of the Royal College of Nursing (Northern Ireland), the Royal College of Midwives and the BMA (NI) General Practitioners' Committee on several occasions, most recently concerning primary care. Although the financial implications and the problems of almost a year ago are understood, those organisations question why the process is taking so long. My Colleagues and I ask the same question.

A letter was sent to you, dated 19 February, and signed by Dr Brian Patterson, chairman of the BMA (NI) General Practitioners' Committee, Mrs Hilary Herron on behalf of the Royal College of Nursing (Northern Ireland) and Mrs Breedagh Hughes of the Royal College of Midwives. The Committee had hoped that you might have spoken to those organisations, and possibly they are happier about the situation. They were not happy about it when we spoke to them.

Those organisations represent many people involved in primary care. I am experienced in primary care, and I speak with conscience. We have had - and I hope that we still have - an opportunity to have the best possible primary care service in Northern Ireland. The people deserve that. If the "big baseline" of primary care is not right, there is no way to get the hospitals and secondary care right. That baseline must be firm. The approach is top down, but I hope that its operation will be bottom-up.

The extension of GP fundholding meant that people and resources were tied up in maintaining that and were not immediately free to work on arrangements for setting up the new groups. The problem was not simply money; there was also the problem of people, and that final year was particularly difficult. On my last visit to the Committee I attempted to explain why GP fundholding should not be extended. It was already in difficulty, and the signalling of its final year meant that there were difficult issues to maintain.

There were complex issues to resolve on the development of guidance on the new arrangements. Soundings had to be taken from various stakeholders. There was no delay. Excellent progress has been made on the basis of the guidance issued to date. The configurations of the groups have been determined and management boards are being established.

During the consultation on 'Building the Way Forward in Primary Care' a level of support was expressed, and there have been recent expressions of support from the Association of Directors of Social Services, the advisory committee for professions allied to medicine, the directors of nursing of the four health boards, the Foyle Area Nurse Practitioners In General Practice Forum, the Community Practitioners' and Health Visitors' Association, and Armagh City and District Health and Social Services Community Forum. I am proceeding because the success of the commissioning pilots on which those new groups are based has demonstrated their experience to address some of the points in that letter. The fear that boards and trusts will be dominant is not borne out by the commissioning pilots which have board and trust staff on their management boards.

The experience there has been one of collaboration and partnership between the interests involved. Indeed, many of them have also been able to set up subgroups that allow for even greater user community involvement and other grass-roots involvement. That is one of the reasons why I have asked the management boards of the group to devise effective mechanisms and to build on those experiences to ensure the involvement of other stakeholders and members of the wider local health and social care group who are involved at the grass roots.

Board and trust representatives will fill six of the 18 places on the management boards and GPs will fill five, so no one group or profession will dominate the new groups. As part of their quotas, trusts must nominate a nurse, a social worker and a member of a profession allied to medicine. That means that there will be two nurses, two social workers and two PAMs on each group, as well as the five GPs and the six nominees from the trusts. There will also be two community service users and the manager - no one group will dominate.

The remuneration package for the chairperson and the members of the local health and social care groups is the same as that on offer to the primary care groups level one. That is the stage at which these groups are at now, relative to the stage that they were at at the time they were set up at level one.

You said that all professions are equal, and we accept that there must not be any one dominant group. Of the groups that you mentioned that unreservedly supported what you are doing, some of those are not people who are at the coalface; they are people who are well up in their relevant organisations.

The Chairperson said that the Committee is not unanimous in its thinking on the way forward for primary care and the end of GP fundholding. That must be said. There are also many groups - and the Chairperson chose to put them into different categories - that are supportive of the transition, and the Minister listed them. This morning, my Colleague Ms Ramsey and I met two pilot commissioning groups that are supportive of the transition.

I mentioned three of the main professional organisations in Northern Ireland. Of course there are other people - directors of social services and other groups, for example. I accept that, but I am talking about main groups.

I am also talking about main groups. We also know that there are tensions in the groups that we met last week - the Royal College of Nursing, the British Medical Association and the Royal College of Midwives. We asked them to go collectively to meet the Minister, and I do not know whether that suggestion has been taken up. It is a difficult area, and we are all trying to work our way through it.

Those who are involved in primary care pilot commissioning at the coalface are by and large in agreement with the transition from fundholding to primary care. There are no arguments about that in the groups that I have met; there may be difficulties about how it will be achieved, but those are things that we can work our way through.

Can the Minister confirm her intention that local health and social care groups will assume commissioning responsibilities from April 2003, and that her Department will hold area boards to account to ensure that this happens?

Can the Minister also confirm whether legislative changes will be required to allow area boards to devolve commissioning responsibilities to the local groups? There is a feeling within the primary care bodies that the boards may be tinkering with the idea that the legislation must be changed before they can assume responsibilities.

As I said at the outset, the local health and social care groups will begin to take on responsibility for commissioning health and social services from April 2003. That does not mean that every single group everywhere will automatically, on 1 April, take on that commissioning, but in general, local health and social care groups will begin to take on commissioning. Some groups will be ready at that time.

So the concerns being expressed by professionals working in the local health boards have no basis? That is the way forward.

No. The main thing is to get that message out. I was on a TV programme the other night and was delighted to get the opportunity to say that. They said that they would hold me to it, and I am sure that they will.

Even before 1 April 2003, the groups will have prescribing budgets, management budgets and some budgets for commissioning some primary care services.

There will be no need for legislative changes. The idea of making these groups committees of health and social services boards - and they are basically statutory committees of boards - is that the boards can delegate responsibility to those groups without us needing to put legislation in place. The groups will also be able to commission services in the future without primary legislation.

There has been some confusion with regard to the relationship between the groups and the health and social services boards. Some people talk about these groups being subcommittees of boards. Subcommittees are groups to which the boards turn for advice. Committees of boards are bodies to which the boards can delegate responsibility. Our intention and expectation is that the boards will delegate responsibility to these groups.

The reason I ask is that a view is being expressed about scaremongering in the minds of those involved in the commissioning of the pilots; that without legislative change, area boards cannot devolve commissioning. I am glad that it can be clarified that there is no need for a change in the legislation.

The Royal College of Nursing (RCN), the Royal College of Midwives (RCM) and the British Medical Association (BMA) were here last week, and I see this Committee as a conduit between those groups and you. Therefore, some of the questions that I am going to ask are questions that they have raised with me, both through the Committee and through other meetings that I have attended. I hope that the Committee is also committed to giving the same time to the groups that support the new arrangements as we did to the RCN, the RCM and the BMA last week.

The Chairperson said that this was a top-down approach rather then a bottom-up approach. What steps has the Department taken to ensure that the views and concerns of the front-line primary care workers can be fed into the new groups so that we can support a bottom-up arrangement? One of the RCM's priorities is to reduce teenage pregnancies.

Why is the RCM not represented on the new group? Its representatives made it clear to me that they are not nurses, and that nursing and midwifery are completely different disciplines. I had not been aware of that.

In your opening remarks you spoke about the guidelines for the new groups, which state that nurses, professionals allied to medicine and social workers wishing to apply for the new groups must be employed by a community trust. I am aware that there is self-nomination. Can you clarify that for me?

My last question concerns general medical services (GMS) budgets. I know that I am not flavour of the month with the BMA on that issue. A letter from the BMA states that it had received assurances from you that the GMS budget would be ring-fenced. I would like clarification on what that means.

All of those points have been raised. Where possible, fears have been allayed. I was delighted to allay fears about commissioning from April 2003. I am also delighted to give an assurance that GMS budgets will be ring-fenced. Some GPs were worried that people other than GPs were taking those decisions. That would happen only if the GPs in any of the groups wanted it to happen.

On the question of midwives, I stated in my opening remarks that the generic term used here means nurses, midwives and health visitors. PAMs is an unofficial term that the professional body will not use either. It is understood to designate a wide range of professions allied to medicine, such as physiotherapists, occupational therapists, speech therapists, chiropodists, podiatrists, dieticians and so on.

According to the guidance, that means that midwives are not or will not be excluded.

They will not be excluded. The guidelines say that there will be two nurses. One nurse will come from the board or community or trust representatives on the group, and the second nurse will be self-nominated, but both posts will be open to nurses, midwives and health visitors. A concern was expressed about midwives who, although working in community trusts, are employed by acute trusts. To overcome their fears, they have been assured that the advertisements will say "employed in a community trust" and not "employed by a community trust".

There are two ways of meeting some of the other views and concerns. The first is to meet specific concerns as they arise, and the other has been to point to the experience of the pilot schemes. In my visits to those schemes I have discovered that the management board and the groups that they have established have put services in place that meet the specific needs of the local community in local areas. That is best illustrated by citing the example of cardiac rehabilitation services and some mental health services. I recall that we looked at orthopaedics services in John Kelly's constituency. At meetings with the groups, they told us how those structures worked at every stage, how they had ensured that different people had input and how they had set up other mechanisms. That is why, in my opening remarks, I said that trust managers must ensure that other mechanisms are put in place so that wider forums are established for people to contribute to. The idea of the groups is that local people and local health professionals, using their expert knowledge of what is needed locally, come together to ensure that those needs can be met, within the resource constraints.

The Minister will be aware that witnesses have voiced concern at the absence of any training and development to prepare for the new primary care arrangements. How will the Department ensure that staff are fully equipped to assume their new roles and responsibilities, including service commissioning, under the new infrastructure?

Staff will not be expected to suddenly take on all of those onerous responsibilities from 1 April. We have made it clear that the boards should facilitate the development of the groups to the point where they will be able to commission services. I will ask Mr Thompson to address that issue.

It is important to say that we were not able to prepare people for the groups, because we did not know who would be on them. Groups will be appointed over the next few weeks. The development process will start as soon as the groups are formulated. There will be a development programme, and additional money will be made available to the groups to allow them to develop the expertise needed to commission services.

Given that little has been done to push the system forward, would it not be appropriate to postpone the deadline and allow for more consultation with the various professionals? I have received many letters from people who tell me that the lack of information and direction is so tangible that they fear that services will not be delivered to the most important people - the patients.

It is incorrect to say that because the people on the groups have not yet taken up their posts and could not receive specific training, that things have not moved forward. Much work has been done to prepare those groups. The experience of the commissioning pilots has shown that it will take time to put everything in place when the group is established. We have already identified their requirements. As Mr Thompson said, we have identified how we will make training available so that the boards can fulfil their responsibility to help the groups to develop their expertise in the commissioning of services.

There would be no justification in delaying the development of the groups. Delaying the ending of fundholding last year tied up staffing and financial resources that could have been used for their development. Putting off the establishment of the new groups would have a similar effect, and would delay progress. We are in a position to establish those groups. The work that they can do is considerable, even from the outset. There is no reason to delay.

The arrangements for the new groups are based on the proposals that I set out in the consultation document 'Building the Way Forward in Primary Care', which received widespread support. The configurations of the groups have been announced. Action has already been taken by boards to ensure that the management boards are established, as far as possible, by April.

I am not an expert on medical issues. However, the Committee and I have listened to several presentations from the people at the coalface who know what they are talking about. When we met Dr Rea, he said that

"we have been led to believe that there would be a seamless transfer to the new structures, but we are deeply disappointed that fundholding arrangements are being stopped at a time when the new local health and social care groups are not sufficiently developed to take these responsibilities over" .

There are several doctors who want fundholding to continue. I do not know whether Dr Rea is one of them. I am aware that there are people who want fundholding to continue, and who do not want to move to new arrangements. As in any transition process, a period of change is a period of uncertainty. There are people who would rather not change because it is easier to stick with what they have. When April comes around, however, people will still be seen by their GPs.

I said at the outset that all services put in place by the GPs would be maintained, except for some small services. I have now been told that as of yesterday, the boards have confirmed that all services will be maintained. People can still go to their GP and receive the same service that they always did. The other primary care professionals will still be able to work in the way that they have. The difference is that those people who up until now spent all their time maintaining a GP fundholding system will now be engaged in winding down that system and building up new arrangements.

I am not suggesting that the groups that came to us are opposed to the ending of GP fundholding.

They all want to see the end of GP fundholding.

They all want to see that, but directives and guidelines were issued a mere seven to eight weeks before the start of the project. That is a serious matter that must be addressed. Unless the boards are going to pull out all the stops to inform and direct the groups, I have yet to be convinced that we are doing the right thing.

The period from November to 1 April is not seven to eight weeks. Several sets of guidance materials have been distributed at different times.

There seems to be confusion among primary care professionals as to what the £3 per head provided for administration under the new scheme will cover. What front-line services will it provide?

You have said that there will be a 12-month delay before the groups are fully operational, and that professionals providing services are to continue to do so before provision has been made to remunerate them. You have more or less answered my second question. The Committee has been advised that nurse-led clinics will disappear, and there is a concern that nursing posts in the fields of diabetes, mental health, health promotion and screening will also be discontinued. Can the Department guarantee that services provided under GP fundholding will be maintained under the new arrangements?

I have answered that question. All services will be maintained. The second set of guidance, about which Mr Thompson will speak in more detail, shows how professionals would be compensated.

The figure of £3 per head represents the management budget of the group.

As requested, I have been keen to ensure value for money and, as the service develops, keeping to the cost of £3 per head will allow for the transfer of £2·5 million from administration to front-line services. I know from your past comments that you will welcome that transfer. That money is separate from the funding that I proposed today in the Budget allocation that will go towards maintaining services.

The fee of £3 per head is for administration costs. There has been some confusion about that, because some people have suggested that that is all that will be available to pay for the development of primary care services. Additional resources will be available for that. That fee will meet the costs of running the management board and it will pay the salaries of the group's administrative staff. In the first year, while the group develops its infrastructure, we do not anticipate its having a big administrative tail. In the future, when the groups draw down responsibilities for commissioning services, we envisage that the management allowance would be increased through the movement of resources from the health and social services boards. Therefore, in several years' time, when the groups are commissioning a large range of health and social services, their management allowance will be much greater than £3 per head.

I cannot allow the issue to pass without commenting on it. There is a lot of confusion. On several occasions, I have criticised the amount of money that is spent on administration rather than front-line services. A £3 per head cap on administration is welcome. The Minister confirmed that the funding for administration will be separate from the Budget allocation, and I welcome that. I also welcome the Department's assurances that money will go directly to patient care rather than be wasted on administration.

Change can be painful, but we debated this issue last year, and everyone was prepared for 1 April. Would you do things differently now? Following November's guidance, was there an opportunity to consult with the groups, some of whom the Committee met last week, or do you believe that the consultation was completed in November? Some concerns expressed to the Committee were that groups had not been consulted fully after the release of November's guidance. I am heartened by your response to the question about services, because there was some confusion over that. The Committee has the Eastern Board's concerns on record. It believes that all boards have concerns, and your response confirms that. It is great for the Committee to have that cleared up.

Some Committee members attended the health forum conference at which the Minister delivered the keynote speech. It described what is happening in England, Scotland and Wales, and the four steps that those countries are taking to move forward. Can you outline the targets and deadlines that the groups could follow for commissioning?

I have made one clear point with the target of April 2003. Members of some groups will have been involved in commissioning pilot schemes. However, they will be part of much wider groups that will include members who have not been involved in commissioning pilots. Therefore, it will take time for people to come forward. One of the major differences has been where our wider structures go from here. In England, and elsewhere, stages were set out, because there has not been a review of public administration.

Before the Executive came to the point of launching its review of public administration and stating its principles and terms of reference, there was no opportunity for me even to debate exactly where the work that I am doing would fit in with it. There was an intention to review public administration, but the principles, terms of reference and timetables had not been agreed and publicly set out by the Executive.

The review of public administration that has now been announced, and the discussions that will take place around the acute hospitals review, will provide the wider context in which that discussion can now take place. I expect to have some discussion on the later stages and on where the end point of all this will be, but while I understand the concerns of some members of the British Medical Association, in particular - they continually asked me what the end point would be - I hope that they understood that no one wanted to hide that from them.

We are in a very different situation here. We have a new Executive and a new Assembly. We will be taking on a review of public administration. We are addressing a number of major interlocking questions that had been left alone pending the setting up of the Executive, which was delayed at a time when Scotland was getting a Parliament and Wales was getting an Assembly. We are not in exactly the same position as people elsewhere.

In the consultation document I said that these groups would be set up in a way that would allow sufficient flexibility for them to meet whatever new arrangements may ultimately emerge. I have now been able to give specific assurances about work that they will be able to do from the outset. They will have prescribing budgets, management budgets and some budgets for commissioning primary care services. I expect that, from April 2003, they will begin to take on responsibility for commissioning.

This has been a matter of great concern, and the Committee still has concerns about it. We recognise that GP fundholding is ending, as does everyone we have met, but we are still concerned about the seamless transition. We put down a motion in the Assembly last year. Why, after that debate, were clear guidelines not brought in so that we could have had a whole year of a good process going forward? That would have been much more efficient and seamless. We have not heard that people wanted GP fundholding to stay, but that has been a big concern. It is worth pointing that out.

I have seen a letter from one of the GP fundholding groups to its employees about possible redundancies. Witnesses have told us that little or no information has been made available about the staff redeployment unit in the Central Services Agency (CSA). A witness last week - I cannot remember who it was - said that a member of staff had received one of these letters and phoned the redeployment unit, but that there was something wrong with the phone line. That is a matter of concern. What is happening there?

Who is responsible for issuing communication about the unit to primary care professionals? What steps have been taken to ensure that all relevant staff are aware of this facility? How many staff, if any, will be affected?

What assurances can the Department give that those concerned will be offered jobs at an equivalent grade in the community sector? The last thing we want is to lose important professional people from the Health Service. They are of great benefit to everybody and it would be a tragedy to lose them. We would like an assurance on that.

Once again, the reason we did not move forward last year is that we did not end fundholding last year. The extension of GP fundholding meant that people and resources could not be freed up immediately to work on the arrangements for the new groups. They were tied up in maintaining and completing the work of operating GP fundholding, which takes up considerable amounts of time and resources, so that people are unable to take on other work. Notwithstanding that, they also worked on the development of the guidance on the new arrangements and the many complex issues there.

There was no delay other than the fact that fundholding continued and, therefore, instead of winding down one group and putting another set of arrangements in place, they were maintaining the previous arrangements for an entire year. That final year was a very difficult year, and it took up the available time and resources. Even so, people still worked to develop guidance on the new arrangements and took soundings from various stakeholders as the guidance was being developed.

I welcome Mr Berry's reference to "possible" redundancies. We have seen today some of the difficulties and the reasons why there is confusion and fear. We go from "possible redundancies" to "redundancies" to "people have already lost their jobs". This is like Chinese whispers. People make statements of fact, and other people pick them up and say, "Well, I heard from so-and-so, and therefore .". Without the same resources, I am desperately trying to say that services will be maintained and the professionals who provide those services will be kept in place.

Many fund management staff will need to be retained for a further six months after the end of the scheme in order to close down accounts. I expect the redeployment unit to match others with jobs arising elsewhere in the health and personal social services field. I also hope that former fund management staff will be successful in obtaining many of the jobs that will be created in the local health and social care groups. I was delighted to have the opportunity to say, at the conference that Ms McWilliams mentioned earlier, that I expect few, if any, redundancies.

I understand what you are saying about the redeployment unit. I spoke to the chief executive of the CSA a few days ago to clarify matters. It is a unit that has not been used much in the past, so it must be rusty. Employers, such as fundholders, are expected to contact the unit, and then a search is done through the system. It could mean that an employee in Belfast might have to go to Coleraine, Derry or Newry. I hope that you are correct, Minister, and that no one will lose their job. However, I think that unless there are some major changes in the unit, some people probably will. I am not scaremongering, simply trying to be objective.

I do not want to repeat the debate that we had in January 2001, but the whole purpose of it was to do with this seamless transition into new primary care structures.

If we were to have had those structures and the end of fundholding on 1 April 2001, one assumes that the guidelines must have been on paper at that time. That is a key point. If the work was done then, why did it take until October or November to get this seamless transition?

The organisations that have given evidence to us represent thousands of people. In their letters, they state that they speak with the permission of their organisations. They are not stupid people. They are frustrated. Those guidelines must have been known long ago.

The reason we put down that motion last year was that we were concerned about the seamless transition. It was not that we wanted GP fundholding in place. We thought that if that motion was carried, there would be no difficulty this year and everything in the garden would be rosy, but as the year went on, that was not so. Now we are down to the last few weeks, and there are still many concerns.

If our motion had not been carried last year, surely this whole thing would have been in place. Where did all those guidelines go? Why were they not put in place? Why was everybody not consulted - the boards, the trusts, and these groups? Then everything would have been rosy in the garden. That is the big concern.

It is unfortunate that so many points are being raised one after the other without letting me come in.

My apologies.

It makes it very difficult for me to address them all. These points are being made strongly and repeatedly, and then I am given two minutes to reply.

Paul Berry was speaking, and I came in because it was relevant. I made my point. You had been speaking before that, and I thought it was only polite to let Mr Berry finish. I apologise. Please continue.

The point we had last year was that you decided to try to change the legislation that was going through. You wanted people to be given more time and more consultation. You put that forward to the Assembly, which accepted it. GP fundholding did not end, and the consultation period was extended. That is why it took longer. The consultation period was extended after the legislation did not go through, because you had said that you wanted people to have more time.

Secondly, the groups were never going to be set up on 1 April 2001. That was one of the discussions you were talking about. There was going to be a winding down, and groups were going to be set up. We were talking about groups being set up by September. One of the points that you made at the time was that you wanted the groups to be set up in April, or not at all. They were never going to be set up in April, so it has not been a year. Half of the work was to have happened by September, and that was on the basis that GP fundholding ended on 1 April.

Then the consultation period was extended, and, because GP fundholding continued, people, resources and money were tied up in that, so it was not possible to put them into the development of the new groups. People had to do that as well as the work they were doing in maintaining fundholding - not winding down fundholding and putting new things in place, but maintaining fundholding as it was.

I have noticed that we are not going to have more arguments in the Assembly about the legislation concerning the setting-up of these groups. Mr Thompson has told us that they are to be statutory committees of the boards, and therefore do not require legislation.

I am sure that you are as well aware as we are of the widespread dissatisfaction out there with the level of bureaucracy in the Health Service.

The high level of bureaucracy is one reason why the service is not delivering. Another concern is the lack of accountability and the fact that there are no elected members serving on the health boards, and that will continue.

We have general agreement that a new initiative should be started from the bottom up. How do you expect people serving on the boards, and the watching public, to be motivated and enthused about an initiative that is just more of the same, and is part of the existing statutory arrangements? People are concerned about the new arrangements - it is not scaremongering

Coming here today, taking questions, and listening and responding to those concerns is valuable. The difficulty is that the considerable enthusiasm of people who want to set up and join those new groups is overshadowed by more powerful voices, including those of political representatives, who say that people will lose their jobs and services will be cut, when that is not going to happen.

With respect, Minister, major organisations representing thousands of people at the coalface are saying that. Some politicians may express that in a different way. Those organisations cannot be dismissed by saying that there is great enthusiasm out there - perhaps there is among some people. I want to see those groups working and I want to be positive, and my colleagues - or at least most of us - want to reflect that.

However, you cannot dismiss the Royal College of Nursing, the Royal College of Midwives and the BMA (NI) General Practitioners' Committee, and say that there is great enthusiasm out there. We will have to agree to disagree on that.

First, there is great enthusiasm out there. Secondly, I have said that I welcome the chance to take questions today and, thirdly, the points made repeatedly by the media have unsettled people. I have spoken to the media and answered those concerns, and people have been reassured. Those three points are not mutually exclusive. Earlier today I mentioned several professional organisations that said that they welcome the new arrangements.

Mr Gallagher raised the question of reducing administration and bureaucracy. A total of 150 GP fundholding practices will be reduced to 15 local health and social care groups. That is a fairly big reduction in bureaucracy.

In the Budget debate I outlined boards' accountability in carrying out their functions through the priorities for action and the health and well-being investment plans. They will be held to account.

I have not made a final decision about what will happen about the structures before the review of public administration or before a debate by the Executive. The Executive has yet to debate that. I would be expected to present my arguments to my Executive Colleagues first.

The context for that debate taking place is, first, the review of public administration - the terms of reference of which were announced only recently - and secondly, the discussion that the Executive will have about the acute hospitals review, which includes mention of the structures.

All the work is progressing in a planned way. According to what I have seen - regardless of the fact that there have been concerns, which we are addressing -any form of change is difficult and leads to uncertainty. Change is not easy for anyone concerned. However, if we all work together and co-operate to try to resolve people's concerns and to move forward together, this change represents the best opportunity for primary care that we have ever had.

Minister, it is the only opportunity that we have at present.

I have just one brief supplementary question. Minister, have you met with some of the groups and discussed the problems that they have expressed to the Committee? Have you made them feel that they have nothing to worry about?

I have spoken to representatives of some of the groups. When this topic came up, I checked whether they had requested meetings with me. They had not; at least, that is what I have been told. I see surprise on some of the Committee members' faces. However, when the question came up, I was told that such a request had not arrived.

I have met some people, and others were in the audience of a television programme, which was specifically designed to give people who work in the Health Service an opportunity to question me. They asked questions, and I answered them, and they appeared to be reassured. Some other people went directly to Jim Thompson. They asked him questions and told him that they were satisfied with his responses to some of their concerns.

The concern about the boards will still be there, because it is not something that the Committee or I, or anyone else, can resolve prior to an Executive discussion about the review of public administration and the structures that have been sent out for consultation for the acute hospitals review. The concern is whether there will be boards in the future. That has not been, and will not be, resolved.

All the other points can be addressed. If there are continuing concerns, people can still come forward to have them addressed. Many of the organisations did that at various stages in the past year.

Presumably, after today's meeting, you will feel that it is important to meet concerned people, as the Minister, to put their minds at rest, because you want the plans to work. What effort will you make to try to meet with those groups? For example, the Committee met a group of doctors last week, who were anxious to meet you. If they did not try to arrange a meeting - [Interruption]

Yes. I thought that the Royal College of Nursing and the other groups that signed the letter - [Interruption]

Yes, but the Committee decided that the Chairperson would write to the Department to encourage its representatives to meet with those four groups that appeared before the Committee last week. We made that decision.

Presumably, if those people request a meeting, the Minister will do her best to accommodate then and put their minds at rest?

Yes.

I can confirm that the Committee sent the letter requesting that the Minister meet those people.

The matter is cleared up if the Minister is prepared to meet those groups.

I am not sure whether impressing on me my willingness to meet a group is the same as asking me to meet groups who have not asked me for a meeting.

We said that they should request a meeting with you and that we would support their request. We did not demand; we merely requested.

The point is that they did not seek a meeting with the Minister. We have met with the concerned bodies. We have not met with the bodies that are supportive. Even the groups that we have met have not met with the Minister.

We are meeting with the directors of social services after this meeting.

That is fine. However, there are many groups - supportive bodies - that we did not meet with. It is wrong to say that this is the end of the story, based on our meetings with the concerned bodies.

We are becoming divisive. Everybody has a right to the best care they can get. They were looking at both groups. Leave it at that.

The point is that we have not consulted with the supportive groups. The motion will be debated in the Chamber next week, yet we have not spoken to the people who support the transition to primary care.

They requested a meeting.

I am not aware of any major groups that have asked to see us and been refused.

Jim Thompson would like to comment on your previous point, because there appears to be a double standard. I am told that I should meet with groups that did not request to meet me. However, I am also told that that is not what the letter says.

We have a letter, dated 19 February, but it does not ask for a meeting with the Minister. It sets out the various issues that the group raised with the Committee last week.

Do we have a copy of that letter?

That was before the meeting with us.

That is an earlier letter.

That is to do with last week's meeting.

It was clear last week that if those people wanted a meeting, they would have asked. However, it could still happen. I have no doubt that the group will write to the Department about their concerns, as they have done in the past, and request a meeting.

Is the staff redeployment unit a full-time unit? Just to get our minds at ease, can we have a telephone number? Someone said at the meeting that the number they had was not connecting. I would like to know more about the redeployment unit.

The redeployment unit is not entirely new, and it has always been part of the Central Services Agency. It was set up some years ago to allow the redeployment of staff following a reorganisation in health and social services. It has been reinvented specifically for redundancies that might arise as a result of the changes we are putting in place and is probably going through a winding-up process.

The redundancy notices have only been issued in the last week, and employers are forwarding the names to the redeployment unit. That is the process. The redeployment unit has informed the trusts and boards in the Province that any active redundancies should be passed on to it.

People are moved on, and they could take lower salaries if they were placed elsewhere. They can drop three points if they go back into the acute sector.

I do not know the individual circumstances, but the redeployment unit will match individuals with jobs. The indications are that the vast majority of people who are currently employed in GP fundholding have skills that will be valuable to the service, and it should not be difficult to redeploy them.

I asked the people who were here last week about the redeployment unit, but they knew nothing about it. Therefore, I suggest that it might be a good idea to get more information as quickly as possible.

Minister, we agree on many things, and some things we just have to agree to disagree on. Thank you.

27 February 2002 / Menu / 10 April 2002