North/South Ministerial Council: Food Safety and Health

TOP

Mr Speaker:

I have received notice from the Minister of Health, Social Services and Public Safety that she wishes to make a statement on the meeting of the North/ South Ministerial Council in its food safety and health sectoral format, held on 27 February 2002 in Dublin.

Go raibh maith agat, a Cheann Comhairle. Ba mhaith liom tuairisc a thabhairt don Tionól faoin Chomhairle Aireachta Thuaidh/Theas a tháinig le chéile mar chruinniú earnáileach i mBaile Átha Cliath Dé Céadaoin 27 Feabhra 2002. Bhí gnóthaí a bhain le cur chun cinn shábháilteacht bia agus le comhoibriú ar cheisteanna sláinte faoi chaibidil ag an chruinniú.

I ndiaidh domh féin agus don Uasal James Leslie, Aire sóisearach in Oifig an Chéad-Aire agus an LeasChéad-Aire, bheith ainmnithe ag an Chéad-Aire agus ag an LeasChéad- Aire, d’freastail muid ar an Chomhairle a tháinig le chéile den cheathrú huair mar chruinniú den Earnáil Sábháilteachta Bia agus den Earnáil Sláinte. Bhí an tUasal Micheál Martin, an tAire a bhfuil cúram na Roinne Sláinte agus Leanaí air, agus a chomhghleacaí an Dr Thomas Moffatt, Aire Stáit a bhfuil cúram Sábháilteachta Bia agus Daoine Scothaosta air, ag feidhmiú ar son Rialtas na hÉireann.

Tá an ráiteas seo, a cheadaigh an tUasal James Leslie, á thabhairt ar a shon chomh maith.

Fuair an Chomhairle tuarascáil chuimsitheach ar an dul chun cinn i riarachán agus in obair an Bhoird um Chur Chun Cinn Sábháilteachta Bia.

Thug an Chomhairle dá haire dul chun cinn an bhoird agus é ag ullmhú plean ilbhliantúil trí bliana a bheas á chur faoi bhráid na Comhairle lena cheadú ag an chéad chruinniú eile i mí an Mheithimh, agus fosta ábhar thuarascáil bhliantúil agus cuntais an Bhoird um Chur Chun Cinn Sábháilteachta Bia don bhliain 1999-2000. Thug an Chomhairle dá haire fosta an dul chun cinn i gcuid réimsí eile, lena n-áirítear naisc idir saotharlanna a fhorbairt agus comhaltachtaí taighde a dhámhachtain. Cheadaigh an Chomhairle go gceapfaí beirt bhall bhreise ar an Choiste Chomhairleach Eolaíochta agus go nglacfaí leis na scálaí leasaithe tuarastail don chéad ghrúpa de 20 ball foirne a fostaíodh.

Chuir feidhmeannaigh ón Roinn Sláinte agus Leanaí taispeántas i láthair na Comhairle faoi fhorbairt na straitéis sláinte ‘Cáilíocht agus Cothoime’, a seoladh i mí na Samhna seo caite.

Fuair an Chomhairle tuarascálacha breise faoin dul chun cinn i ngach ceann de na cúig réimse comhoibrithe san earnáil sláinte. I measc na dtosaíochtaí a aimsíodh le haghaidh comhoibriú bhí seirbhísí taismí agus éigeandála, pleanáil le haghaidh olléigeandálaí, comhoibriú ar threalamh ardteicneolaíochta, taighde ar ailse, agus cur chun cinn sláinte.

Sa réimse seirbhísí taismí agus éigeandálaí, thacaigh an Chomhairle leis an chomhoibriú leanúnach trasteorann sna seirbhísí ospidéal atá á mhaoirsiú ag Grúpa na Seirbhísí Ospidéal Réigiúnach Thuaidh/Theas. Thug an Chomhairle dá haire fosta an comhoibriú ar conas seirbhísí trasphlandála orgán a fhorbairt ar bhonn uile-oileáin; tá sé beartaithe ag na feidhmeannaigh faoi seach eolas a mhalartú le linn dóibh seirbhísí duán a athbhreithniú sa Tuaisceart agus sa Deisceart.

Sa réimse pleanáil le haghaidh olléigeandálaí thacaigh an Chomhairle leis an dul chun cinn go dtí seo i bhforbairt clár de chúrsaí pleanála trasteorann le haghaidh éigeandálaí, freagairtí comhpháirteacha ar thaismí bóthair agus an dul chun cinn i gcuid nithe eile. Thacaigh an Chomhairle fosta leis na réimsí breise oibre a d’aimsigh meithleacha a bhí ag obair ar nithe eile ar nós prótacail chumarsáide.

Maidir le comhoibriú i ngnóthaí ardteicneolaíochta, cheadaigh an Chomhairle moladh go mbunófaí scéim iniúchta fisice radaiteiripe Thuaidh/Theas le comhoibriú a chur chun cinn idir ionaid radaiteiripe sa Tuaisceart agus sa Deisceart. Thug an Chomhairle dá haire fosta go bhfuiltear ag forbairt creata ar bhonn leanúnach le measúnú a dhéanamh ar fheidhmiú tomagrafaíochta astaithe posatrón ar bhonn uile-oileáin agus go bhfuil ceardlann/seimineár faoi na forbairtí is déanaí san ardteicneolaíocht á heagrú ag an ghrúpa comhpháirteach um theicneolaíocht sláinte.

Thug an Chomhairle dá haire go bhfuiltear ag leanúint den chomhoibriú sa taighde ar ailse mar chuid den chomhaontú trípháirteach a chuimsíonn an Institiúid Náisiúnta Ailse sna Stáit Aontaithe Mheiriceá agus na Ranna Sláinte sa Tuaisceart agus sa Deisceart. Thug an Chomhairle dá haire go háirithe an obair atá ar siúl ag grúpa na gclárlann comhthaighde agus é ag leagan amach tosaíochtaí le haghaidh taighde comhoibritheach agus ag caighdeánú bhailiú sonraí.

I dtaca le cur chun cinn sláinte, thug an Chomhairle dá haire an dul chun cinn go dtí seo i dtionscnaimh éagsúla a ceapadh leis an tsláinte a chur chun cinn. Orthu sin bhí meastóireacht ar an fheachtas faoi aigéad fólach, tionscnaimh in éadan chaitheamh tobac, tionscnamh faoi chothú, agus tionscnamh uile-oileáin le sláinte san áit oibre a fhorbairt.

D’aontaigh an Chomhairle go mbeadh an chéad chruinniú eile san fhoirm earnáileach seo aici sa Tuaisceart i mí an Mheithimh 2002.

D’aontaigh an Chomhairle ar théacs na teachtaireachta a eisíodh i ndiaidh an chruinnithe. Cuireadh cóip den teachtaireacht i Leabharlann an Tionóil.

I want to report to the Assembly on the meeting of the North/South Ministerial Council held in sectoral format in Dublin on Wednesday 27 February 2002. The meeting considered matters relating to food safety promotion and co-operation on health issues.

Following nomination by the First Minister and the Deputy First Minister, Mr James Leslie, junior Minister in the Office of the First Minister and the Deputy First Minister, and I attended the fourth meeting of the Council in the food safety and health sectors. Mr Micheál Martin, the Minister responsible for the Department of Health and Children, and his colleague Dr Thomas Moffatt, Minister of State with responsibility for food safety and older people in the Department, represented the Irish Government. This statement has been approved by Mr James Leslie and is also made on his behalf.

The Council received a comprehensive progress report on the administration and work of the Food Safety Promotion Board (FSPB). The Council noted the board’s progress on the preparation of a three-year multi-annual plan, which will be submitted for approval to the next Council meeting in June, and the FSPB’s annual report and accounts for 1999-2000.

The Council also noted progress in several other areas, including the development of laboratory linkages and the awarding of research fellowships. It approved the appointment of an additional two members to the scientific advisory committee and revised remuneration scales for the initial tranche of 20 staff.

The Council received a presentation from officials in the Department of Health and Children on the development of the health strategy, ‘Quality and Fairness – A Health System for You’, which was launched last November.

The Council received further reports on progress made in each of the five areas of co-operation in health. The priorities identified for co-operation include accident and emergency services, planning for major emergencies, high-technology equipment, cancer research and health promotion.

With regard to accident and emergency services, the Council endorsed the continuing cross-border hospital co-operation overseen by the North/South regional hospital services group. It also noted co-operation on assessing the potential for the development of organ transplantation services on an all-Ireland basis, and that respective officials plan to exchange information during the reviews of renal services, North and South.

The Council endorsed the progress to date on the development of a programme of cross-border emergency planning courses, joint responses to road traffic accidents and several other matters. It also endorsed further areas of work identified by the working groups on issues such as communication protocols.

In relation to co-operation on high technology, it approved a proposal to establish a North/South radiotherapy physics audit scheme to develop collaboration between the respective radiotherapy centres. It also noted that a framework for assessing the operation of positron emission tomography on an all-island basis is still being developed and that a joint workshop seminar on emerging high- technology development is being organised by the joint health technology group.

The Council noted ongoing co-operation on cancer research as part of the tripartite agreement, which includes the National Cancer Institute in the USA and the Health Departments, North and South. In particular, it also noted the work carried out by the joint research registries group on the setting out of priorities for collaborative research and the standardisation of data collection.

With regard to health promotion, the Council noted progress to date on a range of health promotion initiatives, including the evaluation of the folic acid campaign, anti-smoking initiatives, nutrition and the development of an all-island workplace health initiative.

The Council agreed that its next meeting in these sectoral formats would take place in the North in June 2002. It agreed the text of the communiqué issued following the meeting, and a copy of that has been placed in the Library.

The Chairperson of the Committee for Health, Social Services and Public Safety (Dr Hendron): I welcome the Minister’s positive statement. I was particularly interested to hear about the co-operation on accident and emergency and cancer services. The Committee’s recent report on cancer services in Northern Ireland highlighted the need for further investment. The co-operation on cancer research under the tripartite agreement with Dublin, Belfast and Washington is important for attracting the best cancer specialists and maintaining the world-leading cancer research currently being undertaken in Belfast. The co-operation between the ambulance services is welcome, and the Assembly will have a debate on the Ambulance Service later today.

What is the framework for assessing the operation of positron emission tomography (PET) on an all-Ireland basis? The Minister played a significant role in getting high technology into the Royal Victoria Hospital, although it will take some time to establish.

I thank the Member for his welcome to the statement, which strikes a positive note on ongoing work. The framework for assessing the operation of PET technology on an all-island basis is in development. People are familiar with CAT (computer-assisted testing) and MRI (magnetic resonance imaging) scans. PET technology is a major new development in medical imaging, and I want to see everyone benefiting from advances in modern technology, particularly imaging. I am content that the joint health technology group should examine the feasibility of PET technology. The development of PET clinical scanning services is a highly appropriate area for North/South co-operation.

Strand two of the Belfast Agreement speaks of

Can the Minister tell the House what precise mutual benefit there is in the development of an all-island workplace health initiative? It is not clear to me what that would be.

Given that the Member’s Colleague Sir Reg Empey expressed his willingness to have an all- island initiative, he will be able to give the Member even more detail on the matter than I can.

With regard to health promotion, it has been found that considerable savings can be made in economies of scale in ventures such as the folic acid public awareness campaign and other television campaigns. Rather than reinventing the wheel in two different parts of the island, we can co-operate by using work that has already been developed in one area and, therefore, share the cost. One area bears the cost of developing the awareness campaigns, and the other contributes to, or pays for, the cost of television advertising. That has been useful. In progressing such work, some people may be further forward than others. That allows us to learn about, and share, best practice. All those aspects will be progressed in the discussions.

In addition, Members will be aware that consideration is being given to the appointment of dedicated programme managers for the Health Promotion Agency in the North and the Health Promotion Unit in the South. That will progress the work programme on an all-island basis. The work being done here by the ministerial group on public health, and the work being undertaken by the Department of Enterprise, Trade and Investment on the occupational health forum, will feed into the considerations on the work being undertaken on workplace health on an all-island basis.

Go raibh maith agat, a Cheann Comhairle. I too welcome the Minister’s statement. I wish to return to a point made by the Chairperson of the Committee for Health, Social Services and Public Safety. Given that cancer services were debated in the House last week, and that today the situation facing the Ambulance Service will be debated, can the Minister tell the House how those two areas of co-operation are being developed? In addition, can the Minister update the House on the validation of qualifications for health professionals on the island, which was also the subject of a debate in the House?

If I do not answer all the Member’s questions now, I will write to her.

With regard to cancer services, the Department has established links with the National Cancer Institute in the United States and the Department of Health and Children in Dublin to create a cancer consortium. The North/South Ministerial Council allows for ministerial oversight of the work that is being progressed through those arrangements. The arrangements afford world-class links to our research community, and the enthusiastic involvement of the National Cancer Institute is in part a response to the quality of the research that is already being carried out here. Through the consortium, the research and development office here has secured two jointly funded three-year epidemiology fellowships, which are linked to the Belfast and Southern cancer registries.

The close co-operation and collaboration of the registries will, for the first time, make data available on the incidence of cancer throughout the island of Ireland. The consortium is also fostering an exchange programme among the three partners, as well as a major clinical trials initiative. That will enable cancer patients throughout the island of Ireland to participate in clinical trials. The consortium also allows us to take part in international conferences. One such conference will take place in the Royal Victoria Hospital in October 2002.

The feasibility study on the all-island helicopter service has been jointly commissioned, and a report is expected in June 2002.

Work is also being undertaken on the response to road traffic accidents. That will include work on ambulance and hospital services in border areas to ensure maximum co-operation to the benefit of all patients in those areas.

I am afraid I have forgotten the final point.

I welcome co-operation in all areas of food safety and health. The Minister may have already answered my question about accident and emergency services. Members have mentioned the provision of an all-Ireland air ambulance, and the Minister has just mentioned it.

Will the excellent co-operation and businesslike manner in which the North/South meetings have taken place be able to continue, given the unnecessary, offensive and stupid remarks about our cross-border neighbours made by David Trimble at the weekend?

I am not clear that the second question related much to the Minister’s statement, but the Minister may wish to respond to the first question.

With regard to the first point, the advertisement inviting tenders for a feasibility study on the costs and benefits of an all-Ireland helicopter emergency medical service (HEMS) was placed in national newspapers, North and South, during the week ending 26 January 2002. Fifteen tenders have been received, and they will be evaluated. The aim is for the evaluation exercise to start in mid-March, and it will be completed by the end of June 2002.

The North/South Ministerial Council has overcome barriers and difficulties to date, and I am sure that it will continue to do so.

Health and Personal Social Services Bill: Second Stage

TOP

The Minister of Health, Social Services and Public Safety (Ms de Brún):

Go raibh maith agat, a Cheann Comhairle. Molaim go dtugtar a Dhara Céim don Bhille Sláinte agus Seirbhísí Pearsanta Sóisialta.

Tá dhá aidhm ag an Bhille measardha goirid seo. Ar an chéad dul síos, soláthróidh sé cúram altranais saor in aisce i ngach cás tríd chúram altranais saor in aisce a chur ar fáil dóibh sin atá i dtithe altranais. Tríd an bheart thábhachtach seo, má cheadaíonn an Tionól é, is ar bhealach níos cothroime a mhaoineofar cúram fadtéarma feasta. Ó mhí Dheireadh Fómhair 2002 caithfear le cónaitheoirí thithe altranais ar an dóigh chéanna leo sin atá faoi chúram ina dtithe féin. Soláthrófar seirbhísí sláinte de réir riachtanais agus beidh siad saor in aisce nuair a bheas siad á soláthar; ní bheidh siad ag brath ar acmhainneacht chun íoctha.

Sa dara háit, tríd an Bhille seo beifear in ann comhlacht áitiúil nua a bhunú le tacú le forás gairmiúil an altranais agus an chnáimhseachais anseo — an Chomhairle Chleachtais agus Oideachais don Altranas agus don Chnáimhseachas. Imríonn corradh le 20,000 altra cláraithe agus tuairim is 5,000 ball foirne tacaíochta ról barrthábhachtach agus iad ag soláthar cúram sláinte agus sóisialta do dhaoine anseo. Oibríonn siad i gcuid mhór rólanna agus suíomh, lena n-áirítear na hearnálacha deonacha agus neamhspleácha. Is é aidhm na gairme, a oibríonn i dtimpeallacht chúram sláinte atá ag síorathrú, cúram ardcháilíochta a sholáthar go seasta; cúram a fhorbraítear agus a thugtar cothrom chun dáta ar mhaithe le hothair agus le húsáideoirí seirbhíse. Leis seo a bhaint amach, caithfidh na struchtúir a bheith ann le tacú leis an ghairm, go háirithe sna heochair-réimsí seo leanas: dea-chleachtas, oideachas leanúnach agus foghlaim saoil, agus scoth feidhmiúcháin.

I beg to move

The aim of this short Bill is twofold. First, it will provide for nursing care to be free in all settings by extending free nursing care to people in nursing homes. This important step will, with the Assembly’s consent, make the funding of long-term care fairer.

From October 2002, nursing home residents will be treated in the same way as those who are cared for in their own homes. Any nursing care that they require will be provided according to need and free at the point of delivery, not on the basis of ability to pay.

Secondly, the Bill will enable the establishment of a new local body — the Northern Ireland Practice and Education Council for Nursing and Midwifery (NIPEC) — to support the professional development of nursing and midwifery. Over 20,000 registered nurses and an estimated 5,000 support staff play a vital role in the delivery of health and social care to people here. They work in a wide variety of roles and care settings, including the voluntary and independent sectors. The aim of the profession, working in a constantly changing healthcare environment, is to strive to provide consistent, high-quality care that is updated and developed for the benefit of patients and service users. To achieve this goal, it is essential to have structures in place that support the profession, particularly in the key areas of best practice, continuing education and lifelong learning, and excellence in performance.

In the debate on care for the elderly on 27 February 2001, I provided an overview of how England, Wales and Scotland had separately responded to the report of the Royal Commission on Long Term Care for the Elderly, and I gave an indication of my intentions in this regard. More recently, in the debate on 21 January 2002 on care in the community, I was able to report progress on a range of significant initiatives that I have taken over the past year. I remarked on the interim findings of the community care review, on work undertaken by my Department on carers, and on the imminent introduction of legislation to help support carers better.

I also anticipated the legislation that would be needed to transfer residents with income support preserved rights to care management by health and personal social services in April 2002, together with the resources to fund their care. Furthermore, next month I will introduce a three- month disregard on the value of a resident’s former home when he or she permanently enters a care home. I referred to this proposal in the debate on 27 February 2001. These changes to the charging rules for residential and nursing home care are evidence of my commitment to making long-term care for older people more responsive to individual circumstances and fairer for anyone who needs continuing help and support from health and personal social services.

Health and social services were given priority in the Budget statement of Monday 3 December 2001 on the Executive’s revised allocation proposals for 2002-03. This will enable the Department of Health, Social Services and Public Safety to tackle some of the current serious problems in the community and hospital sectors. Additional funding will be allocated to community care in the next financial year. In particular, £4·5 million will be provided for the introduction of free nursing care from October 2002, subject to the successful passage of the Bill.

It is estimated that there are approximately 2,000 residents currently paying the full cost, or most of the cost, of nursing home care. Those residents will benefit initially from the introduction of free nursing care. In order to qualify, residents will be required to have an appropriate assessment of their nursing care needs. The assessment process will be fair and easy to understand, and will involve the minimum of bureaucracy.

I asked the chief nursing officer to set up a group to advise me on an appropriate assessment process. This group of health professionals is involved in the development of an assessment tool, which will be ready by October 2002. The development process will include the preparation of associated guidance for, and the training of, nurse assessors to carry out assessments.

With regard to the measures required to provide free nursing care, the Bill will provide that the cost of time spent by a registered nurse in giving nursing care to residents of care homes will not be subject to charges for that care. Nursing care, for this purpose, is tightly defined as

Therefore, from next October the cost of nursing care will be removed from the nursing home residents means test. The means test will then apply only to personal care costs and accommodation costs.

When Members resolved, at the end of the debate on care for the elderly on 27 February 2001, that the Executive should implement the recommendations of the Royal Commission on Long Term Care for the Elderly in full, they laid particular emphasis on the provision of free personal care.

I brought the Assembly’s resolution to the attention of the Executive on 3 May 2001. The Executive decided that an interdepartmental group should be established to examine the costs and implications of introducing free personal care here, drawing on the findings of the Scottish care development group. That interdepartmental group has been established, and its work is continuing. It is to report its findings to the Executive by the end of June 2002. The Executive will then consider if free personal care is affordable and if it should be implemented here.

I now turn to the proposed creation of the Northern Ireland Practice and Education Council for Nursing and Midwifery (NIPEC). Although individual organisations that deliver healthcare will support the development of their own nursing and midwifery staff, the creation of the new body will facilitate a much needed mechanism to develop consistency in the standards for achieving best practice, education and performance in nursing and midwifery. The new local body will also be able to support the work of the new four-country nursing and midwifery regulatory body — the Nursing and Midwifery Council — and will work locally on its behalf.

In addition, NIPEC will work alongside other local professional bodies to take forward multi-professional initiatives. In the development of the proposals for the establishment of NIPEC, a consultation paper was issued in August 2000 to a wide range of individuals, groups and organisations. Responses to the consultation, and subsequent meetings held with a range of stakeholders, indicated broad support for the proposals, particularly from the profession locally.

The establishment of the new body is an important step forward for the largest group of staff within health and social services. NIPEC will make a significant contribution to the development of nursing and midwifery, ultimately improving the quality of care provided for patients in hospitals and for service users in the community.

The Bill provides for a body corporate to be known as the Northern Ireland Practice and Education Council for Nursing and Midwifery, which shall have the duty to promote high standards of practice among nurses and midwives and in their education and training. It shall also promote the professional development of nurses and midwives. A schedule to the Bill provides for the proper governance and control of the new body.

Members will have points to raise, and I will try to answer as many as I can when winding up the debate. If I cannot respond to a particular matter today, I will write to the Member concerned.

The Chairperson of the Committee for Health, Social Services and Public Safety (Dr Hendron): I welcome the introduction of the Health and Personal Social Services Bill. The Bill has two provisions, the first of which covers free nursing care, as the Minister stated. The other provision covers the establishment of the Northern Ireland Practice and Education Council for Nursing and Midwifery (NIPEC).

We have learnt that the Bill will provide for free nursing care for elderly people who live in nursing homes. The measure will cost approximately £9 million each year. The introduction of the measure has been deferred to the end of October 2002 due to lack of money in the Department’s budget allocation.

Currently the cost of nursing care for residents of a nursing home is included in the cost of their place in that home. If they are treated as residents of a nursing home, they may have to pay for their care. If the community nursing service treats them in their own home, or if they are treated in hospital, their care will be supplied free. That raises the question of equity of treatment, an aspect that the Minister has sought to address in the Bill. Residents of nursing homes who are in need of care and their families will welcome the revision.

The Committee for Health, Social Services and Public Safety will wish to explore the provision during its deliberations in the Committee Stage. Members will consider how it compares with similar action being taken in England, Scotland and Wales.

The other provision contained in the Bill establishes NIPEC. I welcome any measure that supports the effective professional development of nurses, midwives and health visitors, and improves the quality of care provided to patients by those professionals.

However, I am concerned that the proposal will create a new non-departmental public body in addition to the Nursing and Midwifery Council, due to come into existence in April. Members of the Committee for Health, Social Services and Public Safety will be interested to hear from the Department on the rationale for the new body. The Committee looks forward to considering the provisions of the Bill during the Committee Stage.

I will try to be as brief as possible — even briefer than the Chairperson of the Committee for Health, Social Services and Public Safety.

I welcome the Bill. I also welcome the opportunity that the Committee will have to discuss it in greater detail. However, I have one or two concerns about the issues, which I hope will be addressed.

Although every Member of the Assembly welcomes free nursing care, there were concerns some months ago regarding homes in England. Some of them were abusing free nursing care and were taking part of the money. It was not being properly distributed and was not, therefore, going directly to the people who needed it. Although I am not suggesting that that would happen in homes in Northern Ireland, I have some concerns. What action does the Department intend to take to ensure that that problem does not arise here?

Free nursing care for the elderly is welcome. However, there are major concerns that nursing homes are grossly underfunded. I am aware that an extra £3·5 million is being provided for nursing homes in this year’s Budget. However, that must run alongside free nursing care. It is all right to provide free nursing care, but if nursing homes across the Province are closing, that is a matter of grave concern. What is the Department’s long-term strategy for dealing with the gross underfunding of nursing homes? I welcome the Bill, and I look forward to examining it closely in the Committee.

Go raibh maith agat, a Cheann Comhairle. Like other Members, I will also attempt to be brief. I welcome the vision of the Bill and the commitment of the Minister. I commend the Minister for taking the Assembly’s arguments back to the Executive on the need to introduce free nursing care. Members are aware that that is a start. I appeal to the Minister to take the argument to the Executive that there is a need to look at the provision of free personal care for the elderly.

I do not want to sound negative. A start has been made, and we are on the right road. I also welcome the idea of setting up the new body for nurses and midwives. However, I, like the Committee Chairperson, look forward to the detailed scrutiny of the Bill by the Committee. I commend the Bill to the Assembly.

I too welcome the Minister’s statement. Free nursing care for the elderly is an issue that I am familiar with, and I have wanted to see it brought to a successful conclusion. Some time ago, Mr Nigel Dodds and I brought the issue to the Floor of the House. We had the unanimous support of the Assembly at that time. This morning’s statement represents real progress. It is a positive aspect of having a local Administration and a local Minister to make decisions. No doubt the Assembly will have to study the ins and outs of the provision in detail.

I also welcome the fact that a group has been set up to examine the issue of free personal care. That issue has been another area of concern, given the division between nursing care and personal care. I am delighted to hear the Minister say that the group has been set up. She has had more success in setting up a cross-party group than I have had. I wish her good luck, and more power to her elbow. I hope that when the group reports to the Executive in June, the Executive will be receptive and see the need for free personal care along with nursing care.

This is a big subject. The Assembly must do what it can. It has the opportunity to look after Northern Ireland’s elderly people, who have been crying out for a long time. That is just one aspect of the issue. There are many others. I fully support the Bill and look forward to a successful conclusion.

I thank Members for the interest that they have shown in the debate on the Bill. I will deal with a couple of the points that they have raised.

There is no overall increase in the number of non- departmental public bodies (NDPBs) within my Department. Although the Northern Ireland Practice and Education Council for Nursing and Midwifery (NIPEC) is to be established as an NDPB, an existing one, the National Board for Nursing, Midwifery and Health Visiting for Northern Ireland, is to be stood down on 31 March 2002. Therefore, there will be no overall increase in the number of NDPBs associated with nursing and midwifery. I am sure that, as the Chairperson of the Committee for Health, Social Services and Public Safety said, they will want to pursue that point further at Committee Stage.

NIPEC’s role is to promote the development of nursing and midwifery in the areas of best practice, post- registration education and performance. With regard to best practice and practice development, NIPEC will gather information on evidence-based best practice, review how it can best be applied and disseminate details to health and social care commissioners and providers. That will help to enhance the standards of nursing and midwifery care of patients throughout the service and to develop consistently high standards of care of patients and other service users.

NIPEC will be involved in quality assuring the standard of nursing and midwifery education. It will contribute to ensuring that nurses and midwives are appropriately trained before they treat and care for patients. NIPEC will also be able to assist organisations to improve the performance of nursing and midwifery teams and the quality of nursing care of patients in general. It will be a source of advice and will be able to assist organisations in that area directly. By supporting the development of the nursing and midwifery professions, NIPEC will help to improve the care provided to service users and the wider community.

On free nursing care, I note the points raised by Mr Berry about the difficulties facing nursing homes. Indeed, as he said, that is why I put extra money in the Budget proposals to address that. However, that is a subject for another day and not specifically related to this legislation.

Ms Ramsey and Mr McCarthy mentioned free personal care. My Department has previously estimated the annual cost of providing free personal care for people in nursing and residential care homes here to be around £25 million. However, the interdepartmental group on personal care, which will advise on the costs and implications of providing free personal care, is expected to refine that estimate as part of its work. The group expects to report its findings to the Executive by the end of June this year and will seek to take full advantage of work that has already been done on free personal care in Scotland.

If I have not fully covered any area that has been raised in the debate, I will write to the Members involved. I thank Members for their interest in the debate.

Carers and Direct Payments Bill: Further Consideration Stage

TOP

Mr Speaker:

I draw the attention of the House to the fact that the short title of the Bill was the Personal Social Services (Amendment) Bill before it was amended at Consideration Stage on 4 March 2002.

That concludes the Further Consideration Stage of the Carers and Direct Payments Bill. The Bill stands referred to the Speaker.

Ambulance Service

TOP

Mr Fee:

I beg to move

I am pleased to be able to raise what is an important issue not just for people in rural border areas, such as my constituency, but right across Northern Ireland. The motion was laid before the Business Committee in October 2001, so there is no particular significance in its timing.

I appreciate that the Minister has initiated a consultation exercise on her plans to implement a newly- revised Ambulance Service. I want to take the opportunity to impress upon her the urgency of proper resources, organisation and support for the service. People’s lives and welfare are at stake, and the service is currently in complete disarray.

I preface my next remarks with the hope that no one thinks that I am criticising in any way the personnel at the coalface who provide ambulance cover and care services for patients. It is remarkable that they manage to sustain the service given so many organisational and administrative failings across four board areas.

The context of the motion is simple. The old target for responding to emergency incidents was inside 21 minutes. I live in Crossmaglen, and it is impossible to get there from Daisy Hill Hospital in that time. I know men and women who have driven emergency vehicles and tried their damnedest to get to road traffic accidents or cardiac and other emergencies in the required time, but it is physically impossible. That goes for a large part of my Newry and Armagh constituency, from the Ballsmill area through Glasdrummond to Creggan, Crossmaglen, round to Cullyhanna and on bad days even to Newtownhamilton. There are between 10,000 and 15,000 people who are permanently outside the safe response time for accident and emergency vehicles. I am sure that the situation is the same in the Augher/Clogher valley and in parts of Fermanagh and the Glens of Antrim. Until recently, it applied to substantial parts of the Mournes area. Many people are, therefore, without the basic emergency medical cover recommended by the old Operational Research Consultants standards, and those people will be even further disadvantaged by the strategic review of the Ambulance Service and the new implementation strategy.

Resources will be discussed later in the debate. However, although they are important, resources are not the key issue. The strategic review of the Ambulance Service published in 2000 recommended that 50% of all 999 calls could be reached in under eight minutes. That could be achieved by improving the availability of accident and emergency ambulances, and no additional resources were required.

That is what this is all about. Currently the service is so poorly organised and strapped by bureaucracy that even with existing resources the necessary service and response times are not achieved. The general public is probably not aware that the Ambulance Service in Northern Ireland is not classified as an emergency service, and neither is it treated or funded as such. Were the Fire Authority to ask for money to provide a service or the police to ask for money for training or new personnel or whatever, it would come from central funding, and there would be no quibbling. That funding is ring-fenced.

The Ambulance Service does not work that way. It has no single budget or single source of finance. It must sell the boards the number of miles travelled, the numbers of incidents dealt with and journeys made. It is impossible to manage a service in that way. If a core budget is not guaranteed year-on-year, and administered by a central authority, staff cannot be properly trained, the estate cannot be properly managed, and the fleet cannot be properly developed. If I ask the Minister to take any action as a result of this debate, it will be to look at the funding arrangements for the Ambulance Service and to put it on a par with the other emergency services, so that it can prepare, plan and manage the service.

I now make a plea for my own area. The original strategy published in 2000 recommended that an additional 20 ambulance centres be established. In the Minister’s revised implementation programme, that figure was reduced to nine, in addition to the two that have already been developed. That will leave a substantial part of the North of Ireland without the necessary cover, and it will continue to leave substantial parts of areas such as south Armagh beyond the eight-minute response times. Sections of the community in Fermanagh, Armagh, Antrim and Down will be left outside safe response times for the foreseeable future. Surely that is not what the Minister or the Department intends. It is certainly not what communities need or want.

Why was no meeting held anywhere in Newry, Armagh or south Armagh as part of the consultation exercise? Why, at the meeting held in Banbridge, was there no mention of any additional ambulance centres for the broad swathe of land around the border?

This process has been ongoing since the review of ambulance services was commissioned by John McFall in October 1998. The review was published in 2000, and the implementation document was then produced. That document is out for consultation at the moment. Ambulance services exist to respond to immediate life-threatening situations. If parts of the problem can be clearly identified and solved before the review is finished, I ask the Minister to do that.

There are problems with the fleet, and I ask the Minister to renew her bids for money to upgrade it. There are also problems with the dispatch and communication systems. Until the review is complete, will the Minister ensure that all software, hardware and technology is properly tested in a Northern Ireland context? England had months of poorly recorded or missed 999-calls. I hope that the preparatory work has begun, but I do not see many signs of that.

Ambulance staff and paramedics are misused. We must address a system that allows highly trained people with well-equipped ambulances to provide, for want of a better term, a taxi service. People must be brought to day-care and outpatient services, but the resources of the ambulance and accident and emergency services should not be drained by a job that others could do.

In going through some papers for today’s debate, I was shocked to realise that there is no guarantee of a trained paramedic in any ambulance dispatched. It is shocking that our accident and emergency services might dispatch an ambulance without a paramedic to a road traffic accident or to someone with an ectopic pregnancy or someone having a heart attack. We must address that urgently before we deal with anything else.

I beg to move the following amendment: Insert after "rural areas":

Go raibh maith agat, a Cheann Comhairle. Ba mhaith liom tacaíocht a thabhairt do rún John Fee agus cúpla pointe eile a chur san áireamh fosta.

I commend John Fee on tabling the motion, and I would like to add to it. I attest to the experiences of people living in rural areas, such as County Armagh, which Mr Fee also outlined. I am aware of the particular difficulties experienced by people living in areas of pronounced rurality such as County Tyrone, south Derry and County Fermanagh with regard to ambulance provision. They often have to make their way to hospital in private vehicles or neighbours' vehicles. People living in rural areas such as Cranagh on the Tyrone/Derry border also share that fear and anxiety when trying to access essential health services, and, unfortunately, the response times are not being met.

I share concerns about the downward revision of the targets set by the Department and the Minister. Everyone would like to see improved response times and improvements in survival rates, and that is at the heart of the overall ambulance review.

In tabling the amendment, my Colleague, Ms Ramsey, and I wish to draw attention to the most fundamental issue of all - resources. We are highlighting the link between Ambulance Service improvement and the adequate provision of resources. The Minister has often stated publicly that it will be a long haul to remedy past funding failures. There is a recognised lack of capacity in the Health Service. We must put that capacity back into the service and, specifically, into the Ambulance Service.

We need a commitment to long-term planning arrangements. Last night, the key message from the chief executive, Mr Lindsey, and the chairman, Mr Bradley, of the Western Health and Social Services Board was that there is a need for certainty about future funding levels.

While I welcome the Minister of Health, Social Services and Public Safety's presence today, I would also like to have seen Mr P Robinson attend. In order to have joined- up government, the Department of Health, Social Services and Public Safety, the Department for Regional Development and other Departments must work closely together. Rurality and poor roads infrastructure go hand in hand - they are virtually synonymous. The combined efforts of Executive Ministers are required to address that problem, and I hope that Mr Robinson will join those Ministers in making the case for greater funding and for greater emphasis to be placed on improving rural roads infrastructure. Those issues are central to the overall problem that has been highlighted in the motion.

To achieve more effective and efficient ambulance provision, cross-border co-operation must be strengthened - in fact, the border must simply disappear. People living in parts of the North can access hospitals in Sligo and Cavan more easily than they can access hospitals in a more northerly location. Therefore, while I agree with virtually all of Mr Fee's sentiments, I would like the Executive to match that vision with resources.

TOP

Next >>