Members present:

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

Witnesses:

Mr P Deazley ) Department of Health, Social
Mr J McKeown ) Services and Public Safety

The Chairperson: The Committee welcomes Mr Peter Deazley and Mr John McKeown, who have returned to discuss the Health and Personal Social Services Bill. Matters were raised last week, especially regarding the possible appeals system. If you will update the Committee on what has happened since then, my colleagues will then ask questions.

Mr Deazley: There is a model review process on which the Department has previously consulted. It can easily be developed to take account of the nursing care assessment process. The process is brief and would obviously have to be redrafted to suit nursing care and be put out to professional colleagues and any interested professional bodies, including the Committee.

Essentially, the process requires the assessment to be reviewed within one week to the satisfaction of the service user, the carer, the family or other interested parties. Where it is not satisfactorily sorted out, a panel must be constituted and a further review completed within two weeks. Therefore, the complete process takes three weeks.

The Chairperson: The other point concerned whether the check on feedback can be made available to the Committee.

Ms McWilliams: It would be better to discuss each point one at a time; otherwise, it will be more difficult.

The Department already had that model review for other purposes?

Mr Deazley: Yes. It was used for guidance on continuing healthcare.

Ms McWilliams: Why would you use that model? Because it has been tried and tested, and it works? I am concerned that we are dealing with nursing care, which, in its own right, is a very specific area and for which a particular assessment tool is being produced.

Mr Deazley: I did not say that that particular process would be used. I said that the model could be adapted and developed for nursing care purposes. The consultation for it was done in 1998, so it is out of date.

Ms McWilliams: That was what I wanted to clarify.

Secondly, we expressed concern last week that the primary legislation as it stands does not have a method of appeal in it. Is the Department going to consider the inclusion of an appeal mechanism?

Mr Deazley: We propose to issue a statutory direction to the boards and trusts that will incorporate the guidance and the review process. That statutory direction comes from article 17(1) of the Health and Personal Social Services (Northern Ireland) Order 1972.

Ms McWilliams: Here is where our learning curve must match yours. That is a statutory regulation that will come after the legislation has received Royal Assent. It is part of the legislative process. Why can it not be included in the primary legislation in the first place?

Mr Deazley: We do not see the need to have it in the primary legislation or to have a separate regulation. Article 17(1) of the 1972 Order gives us the right to issue a direction. There is no legal process to go through. We simply issue the direction to the boards and trusts. That carries the force of regulation under the 1972 Order.

Ms McWilliams: So this legislation amends the 1972 Order?

Mr Deazley: Yes.

Ms McWilliams: Are you saying that an appeal process already exists?

Mr Deazley: A legal process exists by which we can issue direction to the boards and trusts. It comes from article 17(1).

Ms McWilliams: My only concern is that on reading the legislation, as we have, it is not immediately clear that there is a right of appeal.

Mr Deazley: That is true.

Ms McWilliams: I am concerned that those in receipt of nursing care should know about this. I might have a concern either as a relative, or as someone wishing to ensure that a person was correctly assessed. If I accessed this legislation, I would not know about the appeal mechanism. However, if I worked for the board, I would know about it. The people with that knowledge might not always want to grant that right.

Mr Deazley: The directions and the guidance that go along with them will be publicly available. We will not prepare the directions and the guidance and simply issue them to the boards and trusts. They will be available through the same media as the legislation itself. It will be publicly available on the Internet.

Ms McWilliams: If you are going to explain the legislation, will the directions and guidance be included? Are you going to disseminate widely the fact that that right is available?

Mr Deazley: We would not make the right available and not publish the fact that it existed.

Ms McWilliams: Are there other pieces of primary legislation in existence that are similar to this one? Is the right of appeal normally dealt with in the way that you have described? Are there precedents where, by whatever means, you have sought to include it in the legislation?

Mr Deazley: Our research shows us that reviews are normally carried out as a result of departmental direction. On some occasions, where there is professional input through the General Medical Council or nurses’ bodies, it is also done by regulation and direction.

Mr Gallagher: If an individual is unhappy with his or her assessment and wishes to appeal, how does that happen?

Mr Deazley: The service user, his or her family, or the carer will simply ask for a review of the decision. It will not be a financial decision. The decision is based around the level of nursing care that the patient needs.

Mr Gallagher: Who carries out the review? Is it done within the trust in question, or is it independent?

Mr Deazley: A nurse will do the initial assessment. A different assessor will undertake the first review — it will be a professional nurse, but not the nurse who carried out the first assessment.

Mr J Kelly: That assessment is done on the individual?

Mr Deazley: Yes, on the individual.

Mr J Kelly: Is it on the individual — whether that is a daughter, son or whatever — and not any circumstances around the individual?

Mr Deazley: All aspects of the individual’s physical and mental health are taken into account. I have a copy of the assessment tool with me. It is going to the Minister, and as soon as the Minister has cleared it, we will pass it, the guidance and the consultation letter to the Committee.

Mrs Courtney: I want to pick up on what Ms McWilliams said. We were told that the review would take place within three weeks, and, it is hoped, to the satisfaction of the resident or carer, or whoever made the original application for a review. I take it that that includes when the first complaint was made? When a person is on a ward and meets the ward sister, she does the first assessment. The ward sister then has to take that assessment to someone else. Will the whole process take three weeks?

Mr Deazley: Absolutely. It will take three weeks from first complaint to the completion of the second stage.

Rev Robert Coulter: This review on assessment is only for patients. What happens when a nursing home is not happy with the result of an assessment?

Mr Deazley: Nursing homes will have the same right to ask for a review of the assessment.

Rev Robert Coulter: They will have that right as well? It is not just the patient?

Mr Deazley: It is not necessarily aimed at patients. The first people to be assessed under this legislation will be residents in nursing homes who are funding their own care.

Rev Robert Coulter: Will the nursing home have the right of appeal?

Mr Deazley: The nurse manager will have that right.

The Chairperson: You were to check on the feedback that can be made available to the Committee on the work of the pilot projects on the assessment tool.

Mr Deazley: I have copies of the assessment tool, the consultation letter going out with that, and the guidance. I do not have the report on the findings of the pilot study, which has been completed by the University of Ulster. It will accompany all of those documents going to the Minister. It will also be included in the documents coming to the Committee.

The Chairperson: Is everyone happy with that?

Ms McWilliams: Will that be next week?

Mr Deazley: It will be as soon as it is ready. I cannot say that it will be ready next week. I tried to get the missing document this morning, but could not contact the person who has the material.

Ms McWilliams: We are holding up the process to do that. We would like to have it urgently so that we can clear the legislation. We are almost at the final stage, but we would not want to clear it without having access to the document and its evaluation.

Mr Deazley: I expected to be able to tell the Committee today that it was on the way. I hope that that will be the situation between now and next week.

Mrs Courtney: Will we have all the documentation by next week, including the paper you have today?

Mr Deazley: I will attempt to get everything to you by next week.

The Chairperson: It is important to have everything. If the Committee is not satisfied, it will have difficulty in accepting clause 1. We were talking about appeals and the consideration of a fast-track appeals complaints procedure on nursing needs through the statutory regulations. The Department will consider how such a complaints process could be monitored to ensure that trusts implement its directions.

Those are the main points. Do my colleagues want to raise anything? Would Mr Deazley or Mr McKeown like to raise anything?

Ms McWilliams: We have discussed the right of appeal, and you will provide the Committee with information on the tool and its evaluation. Last week, the Committee asked about the payment mechanism. England and Wales have chosen the flat-tier option. The Committee does not know which option the Department prefers, and it would like guidance on that.

Mr Deazley: The Minister will receive the Department’s submission on its recommendations tomorrow.

Ms McWilliams: Therefore, the Committee will leave that until next week.

The Chairperson: Thank you very much. We hoped to conclude clause 1 today, but in view of what has been said, we cannot do so. Therefore, we will wait until next week. Clauses 3, 4 and 5 follow clause 1. Therefore, we will leave them as well.