Members present:

Dr Hendron (Chairperson)
Mr Gallagher (Deputy Chairperson)
Mr Berry
Rev Robert Coulter
Mrs Courtney
Mr Hamilton
Mr J Kelly

Witnesses:

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

The Chairperson: For reasons that have been discussed recently, it is important that we agree the Health and Personal Social Services Bill today. On Monday, Members received a folder containing the results of the Minister's consideration of the issues that were before the Committee last week. The Committee must complete its consideration of the remaining clauses today in order to meet the Committee Stage deadline. Our concerns centre on, first, the consultation on the professional assessment tool; secondly, the fast-track review and appeal mechanism; and, thirdly, the payment system.

I welcome Mr Peter Deazley, Mr John McKeown and Ms Janice Smyth. The document concerning the assessment tool is lengthy. Some Committee members may have received it on Monday, but not have had time to look at it. Perhaps you could outline its central points, bearing in mind what we requested.

Mr Deazley: Ms Smyth will cover the central points, but there are a couple of issues that I must raise first. Prof McCormack has got back to us to change the title of the assessment tool.

The Chairperson: The long title?

Mr Deazley: The title of the actual assessment tool; it is now simply called the "nursing needs assessment tool", as opposed to the "older people's nursing assessment tool", because it applies across the board. That is the only change that has been made in that area.

Ms Smyth: Prof Brendan McCormack and his research associate Paul Slater, from the University of Ulster, developed the nursing needs assessment tool. Prof McCormack is well known for his expertise in the development of assessment tools. The tool was commissioned by the working group established by the Minister and chaired by the chief nursing officer, Judith Hill.

The terms of reference were to review what was available in England, Scotland and Wales and to look at what was available in Northern Ireland. Then, those tools were to be measured against the national service frameworks. A tool was to be developed for Northern Ireland to determine the nursing needs of people who need continuing care in a nursing home setting. That was done.

Once the tool was developed, we piloted it in seven sites across Northern Ireland. We asked all the trusts if they wanted to participate. Seven replied positively, and between them those trusts represented all four health board areas. The assessment tool was used to assess the nursing needs of people who require nursing home care.

The Chairperson: Is there much difference between this assessment tool and the original one in England? Have there been many changes made in order to accommodate Northern Ireland?

Ms Smyth: Changes were made to the tool after the pilot exercise. There were originally 22 assessment domains in the tool. The tool is based on professional judgement; it is not a box-ticking exercise. One must take biographical information from the patients, assess their need under each of the domains and determine how the nursing care is going to meet those needs. It then asks whether that nursing care has to be met directly by a registered nurse or through care supervised by a registered nurse, or whether it is directive, where the nurse teaches someone else to do it.

The review amalgamated two of the domains. It also amended the risk assessment, where assessors were asked whether the patient's condition was stable and predictable or unstable and unpredictable. The nurses felt that some of the clients whom they assessed fell somewhere in the middle of that; it was not black and white. So, that was amended. Some of the language was also amended because the nurses felt it was not user-friendly and that those who were being assessed, or their carers, would not understand some of the terminology. After the pilot exercise, the review made minimal changes to the structure and content of the tool.

The Chairperson: On other aspects, such as the fast-track review and the payments system, we will be using the Welsh system - is that right, Mr Deazley?

Mr Deazley: I must also point out to Committee members that, as stated in the covering letter to the Department's consultation document, the assessment tool is capable of identifying nursing care needs at three separate dependency levels - low, medium and high. That is not a comment on how the nursing care will be paid for; it has been decided that there will be one single rate for nursing care.

However, the nursing tool will still be a major help in the care planning process. It will help care planners to decide where nursing care is best delivered. The fact that a person needs nursing care does not mean that it will best be delivered in a nursing home. The detailed output from the tool will go a long way to assisting that care planning process.

The Chairperson: I assume that there was agreement on the part of the various professionals and trusts involved in this exercise?

Ms Smyth: Yes. The pilot exercise was successful and the comments received about the tool and its ability and suitability to assess people's needs were positive.

Mr Deazley: The Minister has decided that we will apply a single rate for each person who is assessed as needing nursing care in a nursing home. The actual amount has not yet been decided. We have written to the trusts today asking them to survey in detail the number of people who fully or partly self-fund their care in nursing homes. We can then put forward proposals to the Minister on the weekly amount that will be paid towards nursing case.

The Chairperson: Will it be at least £85?

Mr Deazley: It will be no less than £85 a week.

The Chairperson: It is certainly not "free nursing care". I appreciate that you are using a particular definition.

Mr Deazley: We could call it "a contribution towards residents' nursing costs in a nursing home".

The Chairperson: The other matter was the appeal mechanism.

Mr Deazley: I am not sure if Members have had time to look at the documents. I have included a very early version of the departmental directions that will issue along with the other guidance.

The first two paragraphs are as they will appear in the final version. They set out the legislation under which we are issuing the directions to the trusts - article 17(1) of the Health and Personal Social Services (Northern Ireland) Order 1972 - and the action required of boards and trusts to commence health and personal social services payments.

I have outlined what will be included in the directions. There will be a brief outline of the legislation under which nursing care is being introduced, detail on implementation, and directions to go out to the trusts identifying every nursing home resident who makes a contribution towards their nursing care and who will, therefore, be entitled to some contribution from the Department of Health, Social Services and Public Safety.

We will require trusts to inform those residents of their right to a nursing care assessment. The trusts will be required to seek the consent of those residents for an assessment to be carried out. Nursing care assessments are entirely voluntary and cannot be imposed on residents.

The directions will describe the assessment and review process, which will be set out in detail. If a resident is not satisfied with the first assessment, he or she is entitled to a review assessment by another nurse within one week. If that is not satisfactory, a review panel must be set up and the case heard within a further two weeks. The process will take three weeks from start to finish.

The experience of the review and appeal procedure in England has almost totally revolved around the three tiers: when people are assessed as being in the lower group, the appeals are to get them into the second group, and when they are in the second group, the appeals are to get them into the top group.

In our case, if nursing care need is assessed, people will automatically be entitled to £85, or to whatever contribution they currently make to the cost of their care.

The Chairperson: Are you saying that the fast-track appeal takes three years?

Mr Deazley: No, I am referring to the three tiers. The main volume of appeals in England is due to their three-tiered system. It is not that people have been assessed as not needing nursing care, but rather that the assessment has placed them at the lower level or the intermediate level, and people are inclined to appeal when money is involved.

The Chairperson: Mr Deazley has set out for the Committee the areas to be covered in the departmental directions and guidance, which will be referred to the Committee for consideration. There are different headings, including legislation, implementation and identification. Is the Committee happy with the departmental directions? Has everyone had time to look at them?

Mr Berry: I am concerned about the directions on information. You say that trusts will be required to inform residents. If the matter is left to the trusts, they might inform only the home's owners, not the residents. How can we be sure that all residents and their families or carers will be informed, as well as the home?

Mr Deazley: There are two points. First, the consent of the resident - or their family or carer - to an assessment must be sought. It is a voluntary process. Secondly, it is feasible that someone who is funding their own care will not want social services to be involved. In order to obtain clear consent, the assessments and all other matters are carried out directly with the individual, or, where the individual is incapable of making decisions, with their family, their carer or an appointee. That will be clearly specified in the directions.

The Chairperson: As there are no other queries, I assume that the Committee is happy with the directions. The various headings are detailed. Requiring trusts to identify all nursing home residents who are funding their own care in nursing homes is terribly important.

We have covered information, advocacy and short-term placement. Is the Committee happy, or are there other questions?

Mr Deazley: The identification process has already started. The Department issued the survey request today.

The Chairperson: That goes right across Northern Ireland. Is the Department sending it directly to the trusts, or will it go via the boards?

Mr Deazley: We are dealing directly with the trusts.

The Chairperson: That will be quicker. The Committee wants to clear up clause 1 and the other clauses today. If my Colleagues have nothing further to add, we will move on to that.

The Chairperson: Members will be aware that we have a potential amendment to clause 1 in the briefing paper, which can be considered in the context of the evidence given by the officials. Before concluding consideration of clause 1, the Committee will wish to formally record its views on personal care in the context of the introduction of free nursing care as outlined in the Bill.

Members will be aware of the views expressed by witnesses on the introduction of financial assistance for nursing care for self-funding residents of nursing homes. Many witnesses called for the approach to personal care taken in Scotland to be adopted here. If resources were available now, the Committee would wish to see free care covering the nursing and personal care needs of residents. However, the working group on personal care has not yet reported to the Executive on the outcome of its investigation. A decision is not due to be made until late June 2002, and we do not know what position the Executive will take. However, the estimated cost of free personal care is in excess of £25 million a year, in addition to the £9 million a year cost of free nursing care.

If the Committee were to recommend free personal care now, the money would have to come from the block grant allocation at a time when the pressures on funding for key health, education, transport and regional development priorities are preventing many desperately needed projects from being funded. It would mean making hard decisions on how the health budget should be spent.

However, clause 1 is essentially about equity and correcting an anomaly faced by some 2,000 self-funding residents of nursing homes who have been put at a distinct disadvantage. In comparison, nursing care is supplied free, as a health service, to a person in his or her own home or to a resident in a residential care home, if it is supplied externally by a trust via the community nursing service. Adopting clause 1 should be seen as a first, necessary step to meeting basic equity of provision. It will ensure that we will be able to provide similar benefits to those already provided in England and Wales. Although it is limited in its intent, the Committee welcomes the aim of the clause.

The Committee and the Assembly may wish to reconsider free personal care and the conclusions of the Royal Commission on Long Term Care for the Elderly in the future. We will then be able to learn from the Executive's examination of personal care and the experiences of the Scottish Parliament. We will be better able to gauge the benefits and costs of introducing free personal care.

Do members have any further comments to make before we vote on clause 1?

Question, That the Committee is content with the clause, put and agreed to.