COMMITTEE FOR HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY
Health and Social Care (Reform) Bill
02 October 2008
Members present for all or part of the proceedings:
Mrs Michelle O’Neill (Deputy Chairperson)
Mr Thomas Buchanan
Dr Kieran Deeny
Mr Alex Easton
Mr Tommy Gallagher
Mr Sam Gardiner
Mrs Carmel Hanna
Mr John McCallister
Mrs Claire McGill
Ms Sue Ramsey
Witnesses:
Mr Craig Allen ) Department of Health, Social Services and Public Safety
Mr Ivan McMaster )
Mr Bernard Mitchell )
The Deputy Chairperson (Mrs M O’Neill):
The Committee will now begin its clause-by-clause scrutiny of the Health and Social Care (Reform) Bill. I welcome Ivan McMaster, Bernard Mitchell and Craig Allen, who are here to give meaning to each clause, provide clarification, and to answer any questions. At the Committee meeting on 11 September, information was distributed, including a copy of the Bill, explanatory notes, submissions for the Committee’s consultation, together with a table that brings together comments received by the Committee in relation to each clause.
The Committee has a number of options in relation to each clause. Before choosing an option, I will invite officials to outline briefly the purpose and meaning of the clause. Members may wish to seek clarification about the clause as we proceed. Members will take account of the views expressed in the written submissions and the oral evidence. Following discussions with the officials on each clause, the Committee must decide if it is content with the clause as drafted, or, agree the potential for amendment, in which case the Department must be requested to consider its position and report to the Committee. Where amendment is considered appropriate, the Committee must then invite the Department to indicate whether it is willing to undertake the drafting of such an amendment. By choosing that option, we effectively defer the consideration of the clause.
I invite the officials to outline the meaning of the clause and then we will take members’ questions.
Mr Ivan McMaster (Department of Health, Social Services and Public Safety):
I will set this out for you as briefly as I can. Clause 1 deals with the generality of the restructuring of the organisations. That is dealt with at the beginning of the Bill in an attempt to aid the reader, set out the bodies that are to be dissolved, the names and acronyms used, and, hopefully, get those things out of the way. Subsection (1) deals with the four bodies that are to be dissolved. Those bodies were created by primary legislation and therefore, have to be dissolved by a similar means. Two special agencies — the Health Promotion Agency and the Regional Medical Physics Agency — are also being dissolved; however; those were set up under subordinate legislation and will be similarly dissolved. The subordinate legislation dealing with those two bodies will come before the Committee at some stage later in the process. Fur the purposes of this Bill, the four bodies that will be dissolved are those listed in clause 1.
Subsection (2) provides for a change in name for a number of bodies. The Regulation and Improvement Authority was established in 2003, and the Order that established the authority said that it should be known as such. In practice, however, the organisation has always been referred to as the Regulation and Quality Improvement Authority. “Quality” is clearly part of its remit, and the opportunity has now been taken to regularise that situation and legally amend the title to its commonly referred name.
Moreover, health and social services trusts are now to be known as health and social care trusts. That reflects recent thinking that the term “and personal social services” should be replaced with the term “social care”. Indeed, some Committee members may be aware that, since they were established in April 2007, the new trusts have been branded as health and social care trusts. However, strictly speaking and legally, they are still health and social services trusts, so the opportunity has now been taken to regularise that matter as well. Similarly, to provide some uniformity, the special health and social services agencies are to be called special health and social care agencies.
Finally, clause 1(5) gives a definition of health and social care bodies. Its purpose is simply to list those bodies that are being referred to when the term “health and social care bodies” is used in the Bill — that includes the bodies that are being created, as well as the special agencies, the RQIA and the trusts. It provides a generic phrase, and when the Bill refers to a health and social-care body that is not one of those listed in this subsection it will say so. Essentially, when the term “health and social care bodies” is used, it refers to all those bodies listed under subsection (5).
The Deputy Chairperson:
In the previous evidence session, we heard from representatives of the allied health professions. I am not sure whether this issue is directly relevant to clause 1, but they mentioned their concerns about representation and support services for allied health professionals in the Department. Is that issue in any way relevant to clause 1, or is the Department considering it at a different level?
Mr Bernard Mitchell (Department of Health, Social Services and Public Safety):
I do not believe that it is; I think that that is a separate issue.
Ms S Ramsey:
I know that we are starting clause-by-clause scrutiny, but I have a general question to ask. The proposals in the Bill were put out to consultation, and many general responses were received. In the light of those consultation responses, does the Department or the Minister have any proposed amendments to the Bill? Sometimes, a Committee can do a great deal of work on a Bill only to arrive at the same conclusion as the Minister. Therefore, it may be useful to know whether the Minister has any proposed amendments as a result of the consultation.
Mr Mitchell:
There is none at this point.
Mr McMaster:
As we go through the Bill, I will draw members’ attention to a couple of proposed amendments, but they are to amend printing errors and the like. However, no substantive amendments have been proposed at this stage. When we come to the relevant clauses, we will point out the changes that will have to be made. For example, in one instance, there is a reference to the “regional agency” rather than to the “regional board”. That is simply a printing mistake, or a mistake on our part. We will bring those proposed amendments to the Committee’s attention when we reach the relevant clause, if that is OK. However, there are no proposed amendments to this particular clause.
Mr Gardiner:
Clause 1(2)(a) and (b) will rename the Northern Ireland Health and Personal Social Services Regulation and Improvement Authority the Health and Social Care Regulation and Quality Improvement Authority, and states that it will thereafter be referred to as the RQIA. Anyone who reads the Bill will be misled by references to the RQIA — they will not know what it means if the term “Health and Social Care” is removed from its title. The organisation’s role hinges on health and social care, yet the Bill refers to it only as the “RQIA”.
Mr Mitchell:
Do you propose that the term should be prefaced by the words “Health and Social Care”?
Mr Gardiner:
Yes, it should be spelt out properly.
Mr Buchanan:
Clause 1(5)(b) states:
“the Regional Agency for Public Health and Social Well-being, established under section 12 and referred to in this Act as ‘RAPHSW’;”.
I am not convinced that that body should be set up. I do not really see the need for it, and I will be proposing an amendment to say that we are not convinced that such a body should be set up.
Mr Mitchell:
It would be fair to say that, in the consultation responses, several respondents raised the issue of the respective roles and responsibilities of the proposed regional agency and regional board. They stressed the importance of being clear about the nature of those relationships. They felt that the lines of accountability and responsibility for the two bodies should be clear, and that they should work to a common agenda.
It is also fair to say that there was significant support for the concept of a regional agency, on the grounds that it was seen to offer a tangible sign of an intention to bring a renewed focus to the issue of public health and social well-being. Many people responded positively to the proposal from that perspective, and they felt that it was an issue that had to be addressed. They wanted a focus on health inequalities.
Mr Buchanan:
That may be so, but to me, it is another body that has been set up to consult or to give guidance to the regional board. I do not see the need for it. It is another layer that will have to be paid for out of the health budget. The issues that it would be set up to address could be dealt with by the regional board.
The Deputy Chairperson:
Clause 1(5) merely describes the organisations that comprise the health and social care bodies, Thomas. Clause 12(1) establishes the regional agency. Your argument may be more valid when we get to clause 12.
Mr Buchanan:
I am simply putting a marker down today. I do not feel that there is a need for a regional agency.
Mr McMaster:
Clause 12 establishes the regional agency. Clause 12(1) states:
“There shall be a body corporate”.
Clause 1 sets out the definition of the regional agency and provides an acronym for it. If it is subsequently decided that the regional agency should not be created under clause 12, the reference to it in clause will be also be removed.
Mr Gallagher:
It is worth noting that we have already approved a clause, as Tom is aware, that dissolves the health and social services boards. This is a proposal, as part of a process of rationalisation, for a single board to replace the four boards that are to be dissolved. Is that correct?
Mr McMaster:
That is correct.
The Deputy Chairperson:
Are you happy enough to leave the matter until we get to clause 12, Thomas?
Mr Buchanan:
That is fair enough, but I have put a marker down. I am not happy with such a body’s being set up.
Mr Mitchell:
Chairperson, are you content that we do not respond further to that issue today?
The Deputy Chairperson:
I think so, yes. The Committee must decide whether it wants more time to consider that position or wants to agree the clause as it stands.
Mrs McGill:
There are concerns about the setting-up of the regional agency. We have had a presentation from one set of witnesses in particular. Those witnesses articulated their concerns about the increase in bureaucracy that the legislation will create. Your suggestion, Chairperson, that we seek clarification on the nature of the regional agency and obtain some more information may be valuable at this stage. We should all be clear —
The Deputy Chairperson:
Are you suggesting that the officials should try to explain the situation or that we should refer the clause for further consideration?
Mrs McGill:
I am listening to Tom’s concerns and to what the officials have said about returning with some more information. I am not clear about the process. If we agree clause 1, does it just go ahead? One member has said that he has put down a marker. It may be valuable to know exactly what added value the regional agency will give to the structures.
I remember that, shortly after I became a member of the Committee, I raised some concerns about the number of proposed new bodies. We have already heard today some concerns about the linkages between them and about each body’s particular authority. I agree with the concerns that have been expressed.
The Deputy Chairperson:
I fully understand your point, but clause 12 deals with the establishment of a regional agency for public health and social well-being. When addressing that clause we will have the opportunity to fully debate the ins and outs of how that agency will operate in practice.
Mr Gallagher:
All the groups that gave evidence in Committee this afternoon supported the establishment of one regional health and social care board to replace the four current health and social services boards. It seems to me that the Bill will enact the measures that those witnesses supported. None of those groups questioned the establishment of single regional board. That has not been raised as an issue in any of the submissions that have been made to the Committee.
Ms S Ramsey:
Claire McGill and Thomas Buchanan make a valid point. I partly agree with Tommy Gallagher, in that no one involved in the consultation has opposed the establishment of a regional board, but, in reading the Bill, it seems as if it abolishes the four health and social services boards but establishes three more organisations. Claire’s point is that more information is needed, because, although the Bill appears to abolish the four boards and establish one regional board, it also establishes a regional agency for public health and social well-being and a regional support services organisation (RSSO).
Mrs Hanna:
Tom Buchanan’s proposal is a radical shift from the course that we have been taking so far, and it almost represents a return to the drawing board. We all have concerns about how the new bodies will work together, but we have been expressing those concerns all along. We have never said that any of those bodies should not be established; we merely queried the methods of communication among them and where the decisions would be taken, and we sought to ensure that the new bodies would not be top-heavy. We received no clarification, so this is probably the first time that anyone has questioned the number of bodies. If we are to discuss a reduction in the number of bodies to be established under the legislation, that is a bit like going back to the drawing board.
It is not that we should not discuss the number of bodies, but it has not been mentioned before. Several issues concerning the bodies have been discussed, but no one has questioned the need for any of the bodies, except, perhaps, for the RSSO, which will subsume the Central Services Agency. We heard about concerns around that at a late stage. However, it represents a shift if we are now to question whether one or more of the elements should be removed. As I said, it is a bit like going back to the drawing board.
Mr Buchanan:
With respect, it is not a shift. If you remember, I raised the issue in the House during the Bill’s Second Stage. I stated then that I did not see the need for the establishment of a regional agency alongside a regional board, and the Minister responded to my concerns. It is not a new issue. It may be the first time that it has received open discussion in Committee, but it is something that I have raised in the House prior to today’s meeting.
Mr Mitchell:
Some very strong arguments exist in support of the creation and development of the regional agency. We welcome the chance to explore those with the Committee, and to go through the arguments in detail. We are quite happy to address the points that have been made about duplication and value for money — we can answer them. We are content to return and discuss those issues, and we shall bring some public-health expertise with us to try to inform that discussion.
The Deputy Chairperson:
Are you suggesting that we refer clause 1 for further consideration and return to it at a later date?
Mr Mitchell:
We can address those points when we come to discuss clause 12, which if amended, as my colleague has said, would alter clause 1.
Mr McMaster:
When we come to clause 12, which proposes the establishment of the regional agency for public health and social well-being, the Committee will either vote on whether the clause should be agreed to or propose an amendment to it. If the Committee proposes an amendment to clause 12, it must also propose to an amendment to clause 1. In other words, if we decide not to set up the regional agency, the reference to it in clause 1(5)(b) must be removed. That is based on the assumption that every other clause will be accepted. However, if the Committee agrees that a clause should be agreed to, it will be withdrawn.
Clause 1 provides some clarification about the organisations that will be dissolved and details the names of the new health and social-care bodies.
Mrs McGill:
I understand Carmel’s point that what Tom Buchanan suggests represents a complete change and that we are going back to the drawing board. However, that is not my position. Some concern was expressed about the establishment of a regional agency. When Mr Mitchell said that he will return with further information, I said that that will be valuable. That remains my position.
Mrs Hanna:
When I said “back to the drawing board”, I meant that we as a Committee must have further discussions on the issue. The issue may have been raised at Second Stage, but it was not raised in Committee until now.
Mr McMaster:
Clause 2 sets out the Department’s overarching duty for the provision of health and social care in Northern Ireland, as well some specific requirements.
The clause largely replicates article 4 of the Health and Personal Social Services ( Northern Ireland) Order 1972, which states that the Ministry of the time had an overall and overarching duty for the provision of health and social services. However, given that the Bill is designed to provide a clear narrative of the major review of structures, it was considered that the Department’s overarching duties should be restated in the Health and Social care (Reform) Bill. There were concerns that it was not enough to spell out the Department’s overarching duty in high-level terms.
Clause 2(3)(a), therefore, provides some further detail about the Department’s overarching duties. It is the first time that the Department’s unavoidable requirements have been placed on statue.
It states that Department must:
“develop policies to secure the improvement of the health and social well-being of, and to reduce health inequalities between, people in Northern Ireland;”.
If the Department does not adhere to those requirements, someone could question its actions and say that it was in breach of its statutory requirements. That is the first time that that requirement has been spelt out in legislation. However, the duties listed should not be regarded as exclusive.
Clause 2(3) begins: “In particular, the Department must—”. The requirements that follow are areas of high-level focus. However, that does not mean that the Department cannot perform other duties.
Clause 2(3)(h) specifies that the Department must:
“monitor and hold to account the Regional Board, RAPHSW, RSSO and HSC trusts in the discharge of their functions;”.
Clause 2(3)(i) provides that the Department must:
“make and maintain effective arrangements to secure the monitoring and holding to account of the other health and social care bodies in the discharge of their functions;”,
because some of them are also held to account by other bodies.
Clause 2(3)(c) outlines the Department’s duty to:
“allocate financial resources available for health and social care, having regard to the need to use such resources in the most economic, efficient, and effective way;”.
The clauses place firm, clear duties on the Department.
Clause 2(4) states:
“The Department shall discharge its duty under this section so as to secure the effective co-ordination of health and social care.”
The clause ensures that health and social care go together. We cannot distinguish between those two issues; they are inextricably linked. The clause makes provision for effective co-ordination because it is an important issue.
The Deputy Chairperson:
If members have no questions, I propose that the Committee move through a number of clauses and come back to agree them, rather than agree them one by one.
Mr McMaster:
Clause 3 concerns the Department’s general power. I want to distinguish between this clause and clause 2: a duty is inescapable, whereas a power is something that the Department can exercise if it considers it necessary. Clause 3 provides a general power for the Department to do almost anything that it wants in order to discharge and secure its general duty. The duty is very broad in the first place. This clause, therefore, provides very broad power for the Department to do anything in its power in order to improve the health and well-being of people in Northern Ireland — anything legal, I should say.
Clearly, there are other actions that are not specified in the clause. However, clause 3(1)(b) states that the Department may:
“do anything else which is calculated to facilitate, or is conducive or incidental to, the discharge of that duty.”
Paragraph (b) will simply give the Department the power to step outside its remit. The Department will normally secure the provision of those duties, from the regional board or elsewhere, but the wording does not stop the Department from providing them itself. If the Department finds that something is not being provided, it can employ someone directly to do it. It is a very broad power, but it also, more or less, a restatement of the general power given in the 1972 Order.
Clause 4 places a statutory obligation on the Department to determine, regularly, priorities and objectives for the provision of health and social care. The Department has done that in the past, although it was never a statutory requirement as it will be when the Bill becomes law. The Department can revise those priorities and objectives. Before doing that, however, it must, generally speaking, consult with the bodies in question.
The Department believes it right and proper that if it is setting objectives for bodies, it should consult with them. However, subsection (3) releases the Department from that obligation and provides for the doomsday scenario — for example, during the outbreak of a disease — when urgent action is required and there is no time for consultation. In such a case, the Department must demonstrate why the matter was so urgent that it did not consult. In the normal case of events, however, it must consult with the bodies on setting priorities and objectives.
Mr Buchanan:
The safeguard is that the Department must explain why it took an urgent decision.
Mr McMaster:
Indeed. This Committee, or anyone else, could ask the Department why it did not consult. The general requirement for the Department is to consult, but the Department realises that it must explain why it considered a matter so urgent that it did not consult.
The Deputy Chairperson:
The British Medical Association (BMA) has called for retrospective consultations in such cases. Would that be beneficial?
Mr Mitchell:
What did the BMA (NI) mean by that?
The Deputy Chairperson:
The BMA said that meaningful consultation must be at the core of an issue. It also said that it would like the Department’s emergency decisions to be subject to retrospective consultation.
Mr McMaster:
That might be difficult in some cases.
Mr Mitchell:
Given the nature of the service that is provided in health and social care, action without consultation would occur only in extremis, when an immediate risk called for immediate action.
In fact, action would be expected, and failure to act would, rightly, be criticised. The BMA (NI), and, subsequently, anyone else, can challenge why certain action was taken in a particular set of circumstances and criticise or take legal redress if it considers that an individual has acted outside his or her authority.
Mr Easton:
To pick up on what Tom Buchanan said, I am slightly concerned that clause 4(3) could be open to abuse, in that the Department could take action without consultation. I accept the concept of a doomsday scenario, but I would like a bit more beef on what constitutes the doomsday scenario that would permit such action. I would hate to agree to clause 4, only for a silly situation to arise that becomes an excuse for taking such action. A list of doomsday scenarios would be helpful.
Mr McMaster:
It quickly comes to mind that there could be a national emergency or an outbreak of some highly infectious disease.
Mr Easton:
Are there any other scenarios beyond those two?
Mr Mitchell:
I would avoid using the word “doomsday”, because it implies that such a scenario is unlikely. Given the nature of health and social care, it is not unusual for situations to arise in which a Minister feels that he or she must intervene, either because there is an issue of public concern or a risk to patients, carers or staff. The scenario may be linked to an outbreak of illness or a failure of infrastructure that means that a service can no longer be provided in a particular building. That is not a fanciful situation; in my experience, when a boiler house blew up at 3.00 am and there was no power to a particular building, immediate action was required. The word “doomsday” paints a misleading picture; it is not that uncommon, given the nature of the profession, for the Department to have the right to intervene in the public interest and in the interest of patients, clients or staff.
Dr Deeny:
In clause 4(3), perhaps the word “extreme” could be inserted before “urgency”. As a doctor, I know that the discovery of an animal with rabies on the island would be an extreme situation. GPs receive not only urgent referrals but “red flag” referrals, because some cases are more than urgent. Perhaps “urgency” is not a sufficiently strong word and could be preceded by “extreme”.
Mr Gardiner:
I can imagine instances of extreme urgency, but surely there would be enough time to inform the Committee. Rather than have the Department take a decision and leave us high and dry, we would have an opportunity to have an input.
Mr Mitchell:
That may be an option, but I am not being fanciful when I say that there would be circumstances in which something happened during a holiday period, at night, on a Friday evening or in the early hours of a Sunday morning that required a response there and then. To ask for total commitment to prior discussion would be to tie the hands of the Minister of the day in a situation that demanded his or her response. How that is defined is another issue, but the underlying need is important for patients and clients.
Mr Gallagher:
We must all accept that Departments cannot be compelled to come before the relevant Committee before making every decision — that is simply a fact of life in any democracy. Everyone knows that unexpected events will happen but not what they will be. Kieran probably came up with the best solution when he suggested the phrase “extreme urgency”. We will just have to leave it at that.
A matter has cropped up. Do not misunderstand me; we do not always agree with the Department. It might have been at the outbreak of clostridium difficile, and the Minister and officials came to the Committee immediately to ensure that members were briefed. This place also has an Executive. Therefore, there are safeguards. As Kieran said, we must leave the matter there and hope that it will work.
Mrs Hanna:
Briefly, Deputy Chairperson, we can all understand that, in some circumstances, there is not time to consult the Committee. However, it might be appropriate for there to be a report and review afterwards, rather than consultation, so that people understand why it happened, what expenditure was involved, et cetera. Perhaps, that would be more sensible.
The Deputy Chairperson:
I suggest, therefore, that the word “extreme” is included — “the extreme urgency of the matter ”. Also, Carmel’s suggestion that there should be a report and review immediately after the decision —
Mrs Hanna:
As soon as possible afterwards.
Mr McMaster:
In cases in which no consultation had taken place, the report and review could be carried out afterwards.
Mrs Hanna:
It is a bit difficult to undertake retrospective consultation.
Mr McMaster:
I understand that. Sometimes, it would be difficult.
The Deputy Chairperson:
Are you happy to consider that suggestion?
Mr McMaster:
Yes.
Clause 5 provides a statutory requirement on the Department to produce a document which is to be known as a “framework document” for health and social-care bodies. To clarify, it will apply not only to bodies that are created under the Bill, but also to special agencies, trusts and the RQIA. It will clearly specify to each body what is expected of it and the procedures that it must follow to perform certain functions.
The clause sets out what the document should include: the body’s main priorities and objectives and the process that it must employ to determine any other priorities and objectives that it might have, because it is recognised that organisations might also have certain internal targets. The document will also prescribe the matters for which the individual body is responsible. The Department will be required to set out roles and responsibilities for each of the bodies. That sort of clarity is considered to be essential for performance-managing the organisation. The document will set out the manner in which each of the bodies is to discharge its functions and conduct its working relationship with the Department and, indeed, other bodies in the health-and-social-care family.
As has been said by Committee members, effective operation of proposed new structures will not depend on that legislation or even on subordinate legislation. It will depend on what happens on the ground. The document will go some way towards setting guidelines. Those matters must be included. However, subsection (2) states that it can also contain:
“(a) such guidance relating to the carrying out by each health and social care body of its functions, and
(b) such other material pertaining to the body or its functions”
as the Department considers appropriate.”
The provision requires the Department to keep the document under review and to revise it as and when necessary. Certainly, parts of the document will be reviewed fairly regularly.
Subsection (4) requires that the Department to ensure that the framework document is “best calculated to promote” health and social care. That relationship refers back to the Department’s general duty to promote health and social care. It must ensure that the document has a purpose and that it is not merely bureaucratic gobbledygook. Its purpose is, generally, the promotion of health and social care.
Subsection (5) covers consultation. The Department should consult with each body in respect to its functions and may consult with any other bodies that it considers appropriate. That could be the BMA, the Royal College of Nursing, or any other individual who has a particular expertise. The subsection does not limit the Department’s consultation powers or compel the Department to consult with each body.
Subsection (6) says that each health and social care body must have regard to the framework document. That means that the body will follow the document’s instructions unless there is a compelling and exceptional reason not to do so. That is a broad outline of clause 5.
Dr Deeny:
When will the Committee see the framework document?
Mr Mitchell:
The Department is required to make it available before April 2009. We intend to complete a substantive draft by the end of November. At the moment, there is no plan to bring that to the Committee. That is our current timetable.
The Deputy Chairperson:
A response to our consultation suggested that the wording “may consult” in clause 5(5)(b) is too weak. One suggestion is to replace that phrase with “must consult with stakeholders” drawn up in conjunction with the Committee for Health, Social Services and Public Safety. What is your opinion on that amendment?
Mr Mitchell:
That it is the difficulty with the rigidity of the process. An extremely lengthy list of folk would have an interest in a high-level framework document.
The Deputy Chairperson:
Even if the legislation said “must consult with stakeholders”?
Mr Mitchell:
Every individual reasonably considers himself or herself a stakeholder in health and social care.
Mr McMaster:
I am concerned about the definition of the term “stakeholders”. How broad should it be?
The Deputy Chairperson:
Do members have any views on that matter?
Mr Buchanan:
The phrase “may consult” is weak; it leaves it open-ended and suggests that the Department can decide whether to bother consulting. Use of the word “must” will compel the Department to consult.
The Deputy Chairperson:
Could we change the word “may” in clause 5(5)(b) to “must”?
Mr McMaster:
That still leaves a way out. If the Department does not consider consultation to be appropriate, the compulsion to consult is almost irrelevant.
Mrs Hanna:
There is no problem with agreeing the framework. However, it is difficult to envisage how the document will come together because there is so little detail. I am unsure whether there is anything we can do about that. However, there are several gaps in the legislation, and the framework does not flesh it out. I do not know if there is any way around that. To some extent, I think that was Kieran’s point.
Dr Deeny:
Subsection (2) states:
“The framework document may contain”.
That is ambiguous. Furthermore, 5(5)(b) says that the Department.
“may consult any other bodies or persons the Department considers appropriate.”
We must examine the framework document, and we should, perhaps, substitute the word “must” for the word “may” in clause 5(5)(b).
It should not be the Department’s prerogative to decide whom it is appropriate to consult: that leaves uncertainty. The appropriate people should be consulted.
Mr Mitchell:
To provide a flavour of the document, I would like to outline in more detail what it might contain.
The initial section of our work is concerned with the financial and planning cycle. That is not about determining the amount of money that is allocated to an individual place each year, rather it is about how the process of a planning and financial cycle would work. That part of the document will highlight the performance and financial-management issues that need to be addressed. It will set out how priorities and targets will be established and monitored and how resources will be distributed, monitored and performance-managed by the Department. It will show how efficiencies, value for money, regulatory and probity will be reviewed and secured. That opening section is about how the cycle of planning, finance and performance works at a high level.
The second section is concerned with the issues of governance, accountability, internal controls, standards and risk management at a high level. That section also explains how standards would be managed across the health and social care sector, how they would be issued and where the responsibility would lie for the monitoring of those standards. That section also explains the regulation of standards that derive from a regulatory basis.
The priorities and objectives of each body in carrying out its functions will be outlined, not on a year-by-year basis, but their roles and responsibilities will be outlined on a substantive rolling basis. It will outline the issues for which a body is responsible, how it would be expected to discharge those functions and the arrangements for the provision of information to the Department.
As we work on the document and begin to flesh it out, that is how we think it will look. The end of document will outline how it will be regularly reviewed to ensure that it is kept up to date. I hope that that information helps the Committee to get a feel for what the document will look like.
Mr Gardiner:
The difficulty that was mentioned could be overcome if the word “may” were replaced with “will” in clause 5(5)(b). It would say that the Department will:
“consult any other bodies or persons the Department considers appropriate”.
That would get over the difficulty. The responsibility for who would be contacted would still lie with the Department, but that wording would mean that the Department will, rather than may, consult with those it deems necessary.
Mrs Hanna:
That would be helpful. It is difficult because the Bill is so important, and we are going through it line-by-line. Our timing is not consistent with some of the development in the Bill, so we are working in the dark. I appreciate that some of the information is a broad frame, but it would be helpful to have it fleshed out.
Mr Mitchell:
We will do our best.
The Deputy Chairperson:
You are happy to consider that.
Mr McMaster:
Clause 6 is fairly self-explanatory. It gives the Department the power to issue general or specific directions to the regional board, the agency and the regional support services organisation in carrying out their functions. Directions are a legal requirement; if someone were not doing something correctly, the Department could issue a direction telling them that they have to do it correctly. Subsection (4) states:
“It is the duty of a body to comply with any directions given to it under subsection (1).”
It is not envisaged that that power would be used on an everyday basis. It would be used when a body, despite negotiation and reference to the framework document, still does not comply. As a last resort, the Department would take the stance of formally directing the body to do something. Given that the Department has an overarching duty of care, it is important that that power is ultimate. If a body is not performing, it should be directed to do so, and bodies will be required to comply with that direction.
You may wonder why only the regional board, the regional agency and the regional support services organisation are mentioned in clause 6(1).
There is legislation in existence that established bodies such as the trusts, the special agencies and the RQIA. The power to give direction is already in the pieces of legislation that established those bodies. Therefore, we are simply taking the power in relation to bodies that we are creating anew in this Bill.
One body missing from that clause is the patient and client council. We felt that it was inappropriate for the Department to direct the operations of a body whose primary purpose is representing patients. We will give it objectives and targets to meet rather than specifically directing it in the performance of its duties. For that reason, it has been omitted from this clause.
Mr Gallagher:
I have noticed that the ambulance trust is also included in the clause.
Mr McMaster:
The legislation establishes the trusts and grants powers of general direction. It includes the ambulance trust.
Mr Gallagher:
My apologies.
Mr Easton:
Clause 6(3)(b) states:
“because of the urgency of the matter, it is necessary to act… without that consultation.”
I accept that there could be a time when that will have to occur. However, to beef it up and to keep me happy, could we again put “extreme” before “urgency”?
Mr McMaster:
Whatever resolution we make in relation to the initial “urgency,” I believe that we should consider the same with the “extreme.” The Department will report retrospectively if that is felt suitable. We can consider that along with the other one.
The Deputy Chairperson:
Are there any other questions?
Mr Gallagher:
It has come up before, but the acronym RAPHSW recorded in 6(1)(b) is dreadful. Could we perhaps replace that with RPA so that it makes sense to people?
Mr Buchanan:
Indeed, it does not make sense.
Mr Gardiner:
I raised that point at a previous Committee meeting held at Muckamore Abbey Hospital. My idea was that we should spell out exactly what we are speaking of or trying to speak of, rather than using than abbreviation.
Mr Mitchell:
The creation of the names was an extremely difficult process. We spent an inordinate amount of time trying to develop them and there are considerable sensitivities surrounding them.
The very long name for the regional agency has actually worked, in so far as there was a grave concern that the social well-being agenda was not being addressed, and that it would be a medically driven process. The Department applied that principle throughout the process to ensure that we were comprehensive and inclusive.
I know that representations have been made to the Committee on the name of the regional support services organisation and I await the Committee’s view on that. In relation to the other bodies, the names are in common parlance within the service now and have — colloquially — been shortened to “the agency” and “the board”. As a result, people now understand what those bodies are.
It does give the Department an issue in designing a logo. However, I can only caution the Committee that there was very grave difficulty in reaching the names that we did and there has been a degree of acceptance of those names, leaving aside what has been said to you in relation to the RSSO.
Mr Gardiner:
Could the process be revisited again?
Mrs Hanna:
I take that on board. However, Mr Gardiner’s point must also be taken on board for the sake of the public. A name of a body with a long acronym must clearly state what that organisation is. It is fine for people who work within the Health Service, but when it is that length, I do not think that it can be remembered unless it is written out.
Mr Mitchell:
Publications such as ‘The Belfast Telegraph’ refer to “the agency” and “the board” and it will quickly become understood to be that. Trying to come up with an alternative that is not seen to be siding with one part of an agenda or another is quite difficult.