Members present:

Mr Gallagher (Deputy Chairperson)
Mr Berry
Rev Robert Coulter
Mrs Courtney
Mr Hamilton
Mr J Kelly
Ms McWilliams
Mrs I Robinson

Witness:

Dr J Thompson ) Researcher,
Northern Ireland Assembly

The Deputy Chairperson: The Committee Clerk has prepared a paper on issues relating to the Health and Personal Social Services Bill. He will summarise those issues for us now.

The Committee Clerk: I prepared the paper for Members’ information and to allow them to consider further the evidence taken from Prof Stout, Age Concern and the Belfast Carers’ Association.

The witnesses raised several concerns about the part of the Bill that deals with free nursing care. The two key concerns were the separation of nursing from personal care and how nursing care is defined in the Bill. I have outlined various associated concerns that have been expressed, including the effectiveness of any split between nursing and personal care, and the experience of operating the system in England, where nursing homes used the money that was provided for nursing care to cover increased residential fees.

Other concerns include the monitoring arrangements; ensuring that residents in different homes receive equality of treatment; publicity and the entitlement process; the appeal and complaints mechanisms to be put into place, including the possible utilisation of the existing arrangements; and the impact on benefits to residents and their families. There is a detailed note about separation, its definition and the implementation arrangements.

There are several options in the paper that Members will wish to consider. The interdepartmental working group on personal care is not due to report until the end of June. That prevents the Committee from considering the Bill in the context of what, if any, recommendations on personal care would come from the working group.

Personal care has been outlined in the research paper, and Janice Thompson, who is here to answer questions on that, said that the cost of personal care would be substantial — £30 million to £40 million. If it happens, that would have to be met from the Department’s budget.

I will briefly go through the options. The Committee could accept the Bill as it stands. There are major benefits for the residents of nursing homes, including increased financial assistance and correcting the anomaly of residents’ having to pay for aspects of nursing care that are received free of charge by patients in hospital.

If Members’ concerns were significant, the Committee could look at the feasibility of amending aspects of the Bill to widen the definition. Concerns were raised over Alzheimer’s disease. The Committee could also look at the monitoring and appeal mechanisms. The most extreme action would be to recommend the rejection of that clause, but that would have to be set in the context of there being a commitment to introduce personal care — something that the Committee is not in a position to know of at present.

If the Bill were to progress on the provision of free nursing care, the Committee would want a firm commitment from the Minister as to how the Bill would be implemented and what Regulations would result. The Bill is quite short, and it essentially just allows free nursing care to be introduced. The guidance that the Department issues to trusts will set out the parameters under which nursing care will be provided. The Committee will want a firm commitment from the Minister about how the assessment process, which is being developed at present, would operate.

The fee mechanism must also be looked at. Will there be a flat rate or a tiered system? My information is that it is likely to be a flat rate similar to that in Wales, rather than the tiered system in England. A flat rate would be simpler to administer.

A question was raised about changing the short title of the Bill. There are difficulties about changing the title. It is difficult to describe the contents accurately and to meet the legislative requirements of a short title.

The Deputy Chairperson: The Committee Clerk has raised the main issues for us — ranging from accepting the Bill, through to the other extreme of rejecting the Bill, and a few things in between that will probably require more detailed examination. It is now over to members.

Mrs Courtney: I should like clarification. You said that we should have formal clause-by-clause scrutiny of the Bill next week. Is that your recommendation?

The Committee Clerk: At present that very much depends on members’ views regarding the Bill itself. One option is that, if members were broadly content with the Bill’s direction as it stands, I could invite the officials to attend the Committee next week. That would allow us to take forward the formal clause-by-clause scrutiny and ask the officials what each clause means and how the provisions would be implemented, thus reassuring members of the Bill’s intent and allowing them to raise further questions if they wish. The opportunity today is to clarify how we go forward in the case of any major concerns which must be investigated and developed.

Mr Berry: The briefing note is most informative about what is happening, and I commend you for keeping us all appraised. In relation to the second option and Alzheimer’s disease, under ‘Separation and definition’ the paper states:

Mr Berry: Neither do we want to be seen as putting everything back by taking the fourth option, which would be quite a big step.

The Committee Clerk: It would have to be very extreme.

The Deputy Chairperson: Is there agreement on that view?

Members indicated assent.

Mr Berry: Perhaps we might work on the top three options to try to agree a way forward.

The Deputy Chairperson: Have we to agree on one of the options before you invite departmental officials along for the detailed clause-by-clause consideration?

The Committee Clerk: It is not so much a matter of agreement on one option. It was the opportunity for members to discuss the issue, and, in the case of a major objection or problem in an area, such as the separation of nursing care from personal care, that would make implementing the present draft of the Bill very difficult. I should need to investigate certain aspects before we reached that stage to ensure that members had sufficient information to question officials and suggest amendments. The clause-by-clause scrutiny will take the first clause and move through the Bill, thus allowing members to determine what each aspect of a clause does so that they are reassured that the provisions laid down meet the Bill’s intent.

The key aspect is the separation of free nursing care from personal care, which is what England and Wales have undertaken; Scotland has done things differently. I wanted the Committee to have the opportunity to consider comments such as those of Prof Stout from Age Concern before we took the next step.

The Deputy Chairperson: What has been implemented in Scotland?

The Committee Clerk: Initially, the Scottish Executive were proposing free nursing care along the lines of England and Wales. The Scottish Parliament examined it and decided that it wanted free personal care inclusive of nursing care. That was debated in the Scottish Parliament, and it was put back to the Executive. On the face of opposition to free nursing care, and excluding free personal care, they decided to take the issue forward. England and Scotland have kept the two issues separate, and they have introduced free nursing care. England has a tiered system of payment, and Scotland and Wales have a flat rate payment. Scotland must accept the financial consequences of accepting the need for free personal care.

The Deputy Chairperson: What stage is that at?

Dr Thompson: It will be implemented in July in Scotland. It should have been implemented sooner, but it was delayed for administrative and financial reasons.

The Deputy Chairperson: Has the Scottish Parliament agreed to provide the funding to cover nursing and personal care?

Rev Robert Coulter: It is still costing that.

Mrs Courtney: Can the Committee see the costings before it makes that decision? It is important to get that right.

The Committee Clerk: The research paper that Dr Thompson provided to the Committee indicated the overall cost implications. In England, the Health Department decided that the money that it would cost for free personal care would be better spent on the other pressures that it faced.

Dr Thompson: In England, it was going to cost around £1 billion, but the Department thought that it would be better spent elsewhere. In Northern Ireland, it will cost a minimum of £30 million for free personal care and £9 million for free nursing care a year.

The Committee Clerk: The Royal Commission on Long Term Care looked at it and put forward a proposal. It indicated £1·1 billion, in 1995 prices, rising to some £2·6 billion by 2021 and £4·6 billion by the middle of the next century. On a pro rata basis, if you read that across to Northern Ireland, they are still substantial figures.

Rev Robert Coulter: There is a statement in the paper that, for Northern Ireland, it would cost £25 million to £30 million a year.

The Assistant Committee Clerk: Dr Thompson’s research paper notes that the anticipated costs of introducing free personal care in England amounted to £1 billion. It was decided against introducing it there because of the costings and the fact that a similar amount of money could be used to provide 5,000 more NHS beds, to enable an additional 50,000 elderly people to live independently at home and to extend break services that would enable at least 75,000 carers to take a break from their caring role.

The Deputy Chairperson: In their view, those services could be implemented rather than putting the money into personal care.

Rev Robert Coulter: If we accept the Bill as it stands, can we then table amendments to it?

The Committee Clerk: The Committee can recommend amendments to the clauses if necessary during the clause-by-clause consideration.

Rev Robert Coulter: Would the Committee be accepting the Bill in principle?

The Committee Clerk: Provided that its amendments were agreed to, the Committee would accept the Bill in principle. In cases where it becomes clear that the content of the Bill does not meet what the Committee believes to be its requirements, the clause-by-clause process allows the Committee to recommend amendments. We have a number of weeks yet before we have to report to the Assembly. The Committee must report to the Assembly on 7 June; therefore, it has two or three weeks to complete its consideration, and it can recommend amendments as necessary.

The Deputy Chairperson: Are there any questions?

The Committee Clerk: If members are content, I shall invite officials to meet with the Committee to begin the examination of the clauses.

The Deputy Chairperson: Will that begin next week?

The Committee Clerk: Yes.

The Deputy Chairperson: Thank you.