Official Report (Hansard)

Session: 2007/2008

Date: 29 May 2008

COMMITTEE FOR
HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY

OFFICIAL REPORT
(Hansard)

Response to the Bamford Review

(Minister of Health, Social Services and Public Safety)

29 May 2008

Members present for all or part of the proceedings: 
Mrs Iris Robinson (Chairperson) 
Mrs Michelle O’Neill (Deputy Chairperson) 
Mr Thomas Buchanan 
Rev Dr Robert Coulter 
Dr Kieran Deeny 
Mr Alex Easton 
Mr Tommy Gallagher 
Mr John McCallister 
Mrs Claire McGill 
Ms Sue Ramsey

Witnesses: 
Mr Michael McGimpsey ) Minister of Health, Social Services & Public Safety 
Mr Martin Bell ) Department of Health, Social Services & Public Safety 
Ms Maureen McCartney )

The Chairperson (Mrs I Robinson):
I welcome the Minister and his officials. The first evidence session on the Bamford Review will followed by another on the reform of health and social care structures under the review of public administration for which the Committee will go into closed session. As the first session is open, members of the public are entitled to remain.

I extend a warm welcome to you, Minister, and to your officials. With you this afternoon are Ms Maureen McCartney from the Bamford response unit and Mr Martin Bell from the investing for health unit. Minister, I invite you to make a short presentation on the Bamford Review, after which members will put questions to you. Approximately 40 minutes will be allowed for that.

The Minister of Health, Social Services and Public Safety (Mr McGimpsey):
Thank you. We are all familiar with the background to the Bamford Review and the resulting reports. The review’s report, ‘A Vision of a Comprehensive Child and Adolescent Mental Health Service’, was published approximately 18 months ago, and the Department immediately accepted in full all of its recommendations. Following the review, we have produced an exhaustive response, covering the review’s 10 detailed reports, with some 650 recommendations. Our response document ‘Delivering the Bamford Vision’ accepts the broad thrust of the review’s recommendations, shows how change, in line with the recommendations, has begun, and recognises the major challenges ahead. It sets out proposals to progress the recommendations over the next 10 to 15 years.

As I stated in my recent letter to the Committee, the document is not a detailed response to every single recommendation; however, it gives a broad strategic endorsement to the service and the legislative reforms that the review advocated. It describes the existing structures that will be put in place across Government, and how the health-and-social-care sector can drive forward the Bamford vision. It gives more specific commitments on what we want to achieve in the next three years, given the financial allocations that we secured for services in the comprehensive spending review.

Our proposed overall vision is for person-centred, seamless, community-based services that are informed by the views of service-users and carers. It makes early intervention a key priority in protecting and promoting people’s mental health. My Department led the response, and there was input from other relevant Departments. That response reflects the review’s work on human rights, equality of opportunity, social inclusion and on wider services that are needed, such as education, training and employment, housing, transport and leisure, as well as health-and-social-care issues.

Owing to the cross-departmental nature of the review’s findings, I established an interdepartmental ministerial group, which met for the first time in the autumn of 2007 and is supported by a corresponding interdepartmental officials group. A wide range of work in the health-and-social-care sector must be progressed and I, therefore, propose to set up a task force.

The Bamford monitoring group, as proposed in the document, is intended to provide a challenge function. The current Board for Mental Health and Learning Disability has a challenge function as part of its remit; however, my Department’s proposals seek to widen the range of stakeholders who participate in the challenge process. The proposed group will be required to form links with the wider stakeholder network. At least annually, it will report formally to me, as the Minister, on any Bamford-related issues — not only those that relate to health and social care.

I propose that the patient-client council be tasked with establishing and supporting the monitoring group, which will replace the board of experts when the terms of office of its current members and chairperson expire midway through 2009. The consultation questionnaire will include a specific question on the proposal to establish a monitoring group.

Legislation is another key strand to emanate from the Bamford Review, which recommended that mental health legislation and new capacity legislation be developed within a common framework of human rights principles. I propose that a legislative framework document be produced to provide a statement of the human rights principles that will govern the drafting and enactment of legislation on mental health and mental capacity. Those principles will, subsequently, be included in the two separate, but interrelated, pieces of legislation.

The three key steps to implementing Bamford’s recommendations on legislation are: developing the overarching framework, on which we will consult over the summer; amending, or replacing, the Mental Health ( Northern Ireland) Order 1986, to come into operation by 2011; and introducing new capacity legislation to come into effect by 2014.

As members know, there are major financial implications. The review found that investment in mental health and learning disability in Northern Ireland, particularly in community-based services, has not kept pace with the rest of the UK. My Department managed to secure an additional £44 million over the next three years to invest in those services, and that money will secure a solid foundation for the necessary reforms and modernisation. However, the review envisages a programme of reform that will last for between 10 and 15 years, and substantial additional funding will, therefore, be required in future spending rounds.

The Executive discussed the response document on Thursday 22 May 2008, and cleared its issue for public consultation. I intend that the public consultation exercise will be proactive and will last from July 2008 to the end of September 2008. The summer is not an ideal time for consultation, but we must press ahead to reach agreement on the immediate actions to be taken, and on the establishment of the task force, which will concentrate on longer-term work in the health and social care sector. Over the consultation period, the Department plans to target some events specifically at the users of services and carers, and an easy-read version of the response will be produced.

I am happy for members to comment or ask questions.

The Chairperson:
Minister, thank you so much for your presentation. I want to draw attention to one issue. Professor Roy McClelland and his panel have just expressed their views on the way forward following the Bamford Review, including the consultation exercise. Professor McClelland is particularly concerned that the consultation is to take place over the summer months, because that scheduling removes from the equation parents whose children have special needs. As the children are not at school, the families may be away on holiday and feel that they are, therefore, at a disadvantage.

You mentioned the possibility of holding major events. Will those include meetings with parents to discuss respite, service provision and the postcode lottery, whereby children in some areas receive help but those in other areas receive none? I would like your comments on that, because Professor McClelland’s concern is still fresh in our minds.

The Minister of Health, Social Services and Public Safety:
I am aware that Professor McClelland has some concerns, and we will address those to the best of our ability. It is not an ideal time, but the consultation process will continue until the end of September 2008. Although it is compressed because of the holidays, adequate time exists, and I am hopeful that, towards the end of September, we will know more about the type of responses.

We will hold events to enable individuals and groups to meet and to make their key points on the issues that you talked about, including the postcode lottery and the important issue of respite care.

Ms Maureen McCartney:
Many voluntary organisations, carer organisations and organisations representing service users were involved in the Bamford Review. We have kept in touch with several of those — including Mencap, Positive Futures and CAUSE — about organising events during the consultation period. We want to meet such groups, and the families involved with them, to talk about the document and to hear their views.

The Chairperson:
It is a large part of the mental-health issue; so thank you for the reassurance.

Mr McCallister:
Minister, as you are aware, the Committee heard earlier from members of the Board for Mental Health and Learning Disability. They welcomed the extra money that has been secured. However, they did have some concerns, one of which was about the strategy on flourishing mental health. Although it is a good strategy, they were concerned about its delivery, and what effect it will have on the ground.

Furthermore, there were concerns about learning disability, lifestyle issues, and how we can focus on getting other Government Departments involved. You mentioned the ministerial inter-departmental group, and an officials group. Can you ensure that other Departments face up to their responsibilities in tackling the massive issue of mental health? Everyone wants that issue resolved. Pressure must be kept on other Departments, including DEL and DSD, to get the support that will help to revive the services that are needed in communities.

The Minister of Health, Social Services and Public Safety:
I am aware of the concerns raised by Roy McClelland and the board, which is exactly what they are there to do. As you are aware, under direct rule, two unsuccessful attempts were made to find a director for mental health. It was proposed that I should make another attempt. I felt that a different approach was required, which resulted in the Board for Mental Health and Learning Disability. The board’s role is to advocate and champion the sector, and to challenge, which is exactly what it does. I welcome its comments.

The document ‘Delivering the Bamford Vision’, which is currently being debated, is out for consultation. We will be guided, to a large extent, by the responses that we receive. When the consultation finishes, we will finalise and implement our plans.

The interdepartmental Bamford implementation group involves other Ministers; therefore, it has their imprimatur. Departmental officials also work together. Clearly, mental-health and learning-disability issues are not simply a health-and-social-care function. Such issues are cross-cutting, and impact on education, employment and learning, housing, social development, and so on. Therefore, all Departments have a role, and all Ministers are enthusiastic.

There will be a resource implication, but the group will be guided by the responses to the consultation, as we put together a plan for delivering Bamford’s recommendations over the next 10 to 15 years.

Ms O’Neill:
I am glad that the outcome of the consultation will guide your decisions. During the previous presentation, legislative reform issues were raised. Witnesses expressed concern about the length of the process and whether the two separate pieces of legislation would marry up. Although I am aware that it is a major piece of legislative reform, will you clarify why the process is so lengthy, given that the Scottish process was shorter?

The document does not place sufficient focus on learning disability. The Board for Mental Health and Learning Disability feels that the document treats learning disability as a poor relation: there are no cross-departmental targets or joined-up thinking. Furthermore, the Bamford Review recommended the establishment of a regional forum for people with learning disability to promote local advocacy — again, the document overlooks that recommendation. Joanne McDonald, a lady with a learning disability, spoke very well to the Committee. She is an excellent advocate for people with learning disabilities, and she shared those concerns.

Although I note your earlier comments about the subsequent release of further information about delivery, there is concern about the lack of clarity and detail on the establishment of a timeline for delivery for the next 10 to 15 years.

The Minister of Health, Social Services and Public Safety:
We must strike a balance between deciding to go with our own ideas and being open to input by consultation. After hearing other people’s views, we will establish a timeline. Learning disability is included in the Bamford Review, and we will ensure that it is included in the plan. We have outlined our targets on long-term stays in learning-disability hospitals and other institutions.

The Assembly has a process for legislative reform, and I want to conduct that process as urgently as possible. First, we must decide on the detail, and, subsequently, construct a plan for delivery. Although 2014 seems a long distance in the future, we will aim to complete the process more quickly. However, we must adhere to processes and consultations.

We will establish a monitoring group that will include a wide range of stakeholders. That group is, essentially, a different name for the regional forum that Michelle mentioned. The monitoring group is included in the proposals, and, through consultation, we will examine ways to strengthen that group. I am well aware of the need for an advocacy role; Joanne McDonald has made that point to me, on numerous occasions. The reason I invited her to join the Board for Mental Health and Learning Disability was the points that she makes routinely and so well.

Ms O’Neill:
Will users and carers be included on the monitoring group?

The Minister of Health, Social Services and Public Safety:
Yes.

Dr Deeny:
The previous session was interesting. Minister, you said that you will set up a taskforce. The eminent team from the Board for Mental Health and Learning Disability felt that separate taskforces for learning disability and for mental health — or at least a sub-taskforce — may be necessary. Will you outline your views on that matter?

Having worked as a primary care professional in the community for many years, I am concerned about community support being regarded as a panacea. Community support can be a solution to many problems if it is properly resourced. ‘Delivering the Bamford Vision’ — the Executive’s draft response to the Bamford Review — states that more people will receive care in their own home, with admittance to hospitals an extraordinary outcome. However, there are little or no resources in the community for child and adolescent mental health. There are major deficiencies in resources for prenatal, perinatal and postnatal community care. Northern Ireland also has an increasing elderly population with dementia, Alzheimer’s disease, and so on.

Will you put some meat on the bones of the workforce planning study? I have seen examples of people who have been overwhelmed by work that they have been asked to carry out and whose physical health has suffered as a consequence. It would be wonderful to be able to provide all of that care in the community. However, to do that, community services must be provided with the necessary financial and personnel resources. I appreciate that it is still early days, Minister, but how are you going to implement Bamford without putting the fear of God into community health workers, and leaving them to pick up the pieces? As John McCallister mentioned, I presume that other Departments will provide help. The Department of Education, the Department for Regional Development and the Department for Social Development could all help to finance vital resources in our communities.

The Minister of Health, Social Services and Public Safety:
You are correct; workforce planning is a key element. The central thrust of Bamford is care in the community and that people should not be left in, or put into, institutions as happened in the past. However, the community must be provided with the necessary resources. You are absolutely correct; workforce planning is vital to this process because people cannot be retained in the community without the support that they require. A workforce study is underway and we will implement a clear human resource and workforce plan. That is sine qua non, and a central thrust, of the Bamford Review.

There will not be two separate taskforces. However, the taskforce will stream through mental health, learning disability and child and adolescent mental health services, in addition to other areas that the taskforce deems necessary. I am not being pejorative and saying that people will have to work in a straitjacket. We are keen that the taskforce will perform the job that we envisage for it. We will allow the taskforce to branch out and there will be work streams in mental health, learning disability and child and adolescent mental health services.

Mr Easton:
How much of the Bamford Review can be implemented with the resources that you were given in the Budget? How many individuals will comprise the monitoring group? Have other Departments, such as Education, co-operated by providing resources to help you to roll out the recommendations of the Bamford Review?

The Minister of Health, Social Services and Public Safety:
There has been one meeting of the ministerial group and it was pre-budget. We will have another meeting and I will ask those questions. However, in such discussions, “limited resources” is a standard response.

My Department works closely with the Department of Education. We must also work closely with the Department for Social Development. Supported housing is central to shifting the emphasis to community, rather than institutional, support, as Dr Deeny mentioned.

I do not have a fixed number in mind for membership of the monitoring group. I will consider the consultation and assess who should be in that group. I do not want to rule anyone out by saying that there should be 10, 15 or 20 members

We want to be flexible on the number, and to make sure that we are getting the right sort of mix and the right sort of input.

The new money provided in response to the Bamford Review consists of a total of £44 million, by year three, on a step-by-step basis. That includes £27 million for mental-health services by year three, and £17 million for learning disability services by year three, allowing certain steps to be taken in line with the recommendations of the Bamford Review. Those are: provision of an additional 200 multi-professional staff or community mental-health teams; a 10% reduction in mental-health hospital admissions, and of those resident in mental-health hospitals; a 13-week maximum wait for some psychotherapy services by 2009. With regard to learning disability, the steps to be taken are: a reduction of 25% in those resident in learning-disability hospitals, ensuring that, by March 2009, no child is resident; the provision of an extra 200 residential respite packages; and improved transition services through alternatives to day care.

As I said in my opening remarks, we are making a good solid start to dealing with the recommendations of the Bamford Review. The resource implications are considerable, and we have some way to go, but we are making a solid start on the first three years.

Ms S Ramsey:
I welcome the Minister and his team: I see it is a big team. I congratulate you and your Department for getting us this far on implementing the recommendations of the Bamford Review. If a direct-rule Minister were dealing with health, we would still be doing a lot of running around on this issue, so I congratulate you on that. I know that your response to the Bamford Review is out for consultation; however, it has many targets. Those are probably still in draft form, and it might be useful if the Committee had sight of how they will be implemented, so that we can go a bit deeper in scrutinising them.

One target states that, by 2014, our aim is that no one will have a hospital as their permanent address. That target may be stated in the paper, but I would like to see how it is going to be achieved. It might be useful if the Committee were given an indication of that. Another target aims to reduce the overall suicide rate by 15% by 2011. It strikes me that this Committee carried out an inquiry into suicide and self-harm, and I would like to know — as, I am sure, would the rest of the Committee: in fact, the matter was raised last week — whether you accept the recommendations of the Committee, whether you will implement those recommendations, and how you hope to achieve that target.

The issue of community and voluntary sector involvement was covered in previous questions. At what stage is the independent review of autism services, which was started in September 2007? We need an update, because it is now almost a year down the line. Although that review of autism services is ongoing, there is a cry from people in the community and the professional field concerning the issue of autism and associated illness. The point that Alex Eastwood made is probably the crucial one; although the Executive has made that response to the Bamford Review — and it is supposed to be a joined up approach to the issues raised in the review — can you put your hand on your heart and tell us that the money will be there to deliver the actions detailed in the response? Can you put your hand on your heart and tell us that the recommendations that you propose will be implemented? I do not know if they will be.

I do not want to sound flippant, but the Bamford Review was seen to be the be-all and end-all on the issue of mental health, and other issues. However, time and time again, we are being told, as a Committee and as individual elected representatives, that there is no money when it gets to the ground. Tell us — or make suggestions to us as a Committee, working hand-in- glove with you — what we need to ask of other Departments. In the presentation earlier, Joanne highlighted the difficulties concerning benefits faced by carers and families. Although that is not directly your responsibility, tell us if we need to raise it with other Committees.

Let the Committee work with you. It would make a change if we were to work hand-in-glove with the Minister. The goodwill is there, but unless you can prove otherwise, I do not believe that the money and resources exist to implement the Bamford Review as it currently sits.

The Minister of Health, Social Services and Public Safety:
You are aware of the debate that took place concerning the Budget. I secured extra money for the Health budget, and I said that that was as good as it gets. I accepted that; however, I made the point that the Budget did not provide enough money to run the Health Service as it stands. There is a financial deficit in funding for social services. I have illustrated the amount of money that is available for mental health and learning disability for the next three years. At the end of that three-year period, another bidding process will take place, and money will be needed. Implementation of the Bamford Review will require more resources. That depends on the resources that are available and on how the matter breaks.

I cannot provide any guarantees on money — no one can do that. Not a single person in Government is able to say that the money will definitely be available, but, in common with everyone around the table, I have an ambition that the Bamford Review be implemented in an acceptable time frame. There are resource implications, and, where it is my responsibility, I will bid hard for the resources. I am sure that others will do the same in years to come.

I outlined what the Department is able to do about the implementation of the Bamford Review. That is funded by moneys for additional services that will be provided on top of the current Budget provision of around £187 million to go into mental health and learning disability. With the trusts, we are currently in a process of determining how the trusts will deliver those services. I am considering that, and I will be ready to share that with the Committee, and the Assembly, in due course. That is still some way off; the trusts must get an understanding of their allocation and of their requirement for other service frameworks. I agree that implementation and delivery are of key importance. I shall share the information with the Committee immediately I am in a position to do so, and I shall look for any support possible.

I shall ask Martin Bell to speak about the suicide rate because he is involved with the Protect Life strategy, and that is why he has attended the meeting. Maureen McCartney looks after issues to do with mental health and learning disability, and she can talk somewhat on the Protect Life strategy.

As I said in my response to the Committee’s report on the inquiry into the prevention of suicide, it is a hugely important piece of work, and I welcome it. I will provide a detailed response in due course. I received the report only on Thursday, and one working day was not enough to provide the sort of comprehensive response that the report merited. That will come.

Certain aspects of it resonated: for example the recommendation for the establishment of a suicide prevention director. That mirrors what is happening in the Irish Republic, and it is a good idea. Along with others around the table, I have spent years working with groups on the ground. Funding is an issue, and being able to have a three-year funding package, which the report recommends, would make life easier for the various groups that are involved. I fully endorse that recommendation, and the three-year CSR period gives me an opportunity to consider and respond to that. Martin will provide an update on that.

The autism review began in September 2007, and it is now complete. I will examine it between now and July 2008. It has been some nine months since the review began, and we are ready to publish and go forward with it. I have not read it, but much work has gone into it.

Ms S Ramsey:
I know that we are pushed for time. I started off by congratulating you, Minister, because your involvement with mental health has brought us to this point. How can you convince me, so that I can convince others, of the commitment of Ministers, when only one meeting of the ministerial group took place prior to the Budget?

Have officials or Ministers made a commitment that the recommendations in the Bamford Review will be implemented?

The Minister of Health, Social Services and Public Safety:

I inadvertently said that the £187 million was for the mental health and learning disability sectors — it is not, it is for mental health only. I just want to clarify that in case someone wrote that down.

Ms S Ramsey:
We always write down what you say. [Laughter.]

The Minister of Health, Social Services and Public Safety:

I know, and you believe it all.

A commitment has been made, which the Ministers demonstrated by the officials by joining the group — I did not have to twist anyone’s arm to join. Our response to the Bamford Review will determine what is expected of each Department, which is when people will prove their bona fides.

Undoubtedly, the Bamford Review is part of everyone’s priorities — it is an Executive priority, and the document was accepted, without a murmur, last week by the Executive. You are correct that the implementation of the recommendations in the Bamford Review will be dependent on having sufficient resources to ensure that we can do everything that we want to do.

The Chairperson:
Martin, you wanted to speak about the suicide strategy, the meaning of which I do not want to be lost in the debate.

Mr Martin Bell (Department of Health, Social Services and Public Safety):
We have confirmed that the ministerial co-ordination group will meet on 23 June, and we intend to bring a paper to that meeting for further consideration. As the motion suggested, we are trying to get onto the next available Executive agenda — before the summer recess if that is feasible. Therefore, we are moving full steam ahead.

Given that there has been an increase of over 70% in the number of recorded suicides in 2005 and 2006, it will be challenging to achieve a 15% reduction by 2011. Hopefully, the 17% reduction in deaths by suicide in 2007 is the first result of the work done at grass-root and community level to turn that tide. The suicide strategy has 62 actions, which are split into short, medium and long term priorities. It recognises that suicide is a long-term problem that will not be fixed overnight and will take a lot of work. However, the commitment from the ministerial co-ordination group, the allocation of the Department’s budget and the ongoing attention that all recent Ministers with responsibility for health have given suicide — particularly the current Minister — will help to address the problem. The right structures must be in place, and the suggested suicide directorate in the structures that were announced by the Minister recently is one way to ensure that attention is kept on the suicide.

The Minister of Health, Social Services and Public Safety:
I welcome your offer to lobby and am glad to accept it.

Mr Gallagher:
I thank the Minister and his staff for the presentation. Furthermore, I acknowledge the Department’s response to the challenges in the Bamford review and welcome the paper that went through the Executive.

Kieran Deeny raised a point about the workforce. I welcome the workforce planning study, which will be available by March 2009. The witnesses from the Mental Health and Learning Disability Board mentioned the staff shortages and the resultant problems. They said that a workforce strategy was required — some people may think it is a fine distinction but it is, nevertheless, an important one because of some of the problems that exist in, for example, respite-care facilities, which can take many years of campaigning to secure. I can think of one example — and I am sure that there are others — where the capital funding has been made available, the work has been done and yet there is no staff.

At this stage, the responsibility lies with the trusts, and they must place advertisements for the staff. Although a facility may be fitted out, no staff will be available. A strategy would be the better way to tackle such problems. A respite-care facility in Dungannon is in that position at the moment. My concern is that the summer will come and go, and still no staff will be in place. The facility may not be open by October, and, at that stage, trusts or others with responsibility may then say that, as the planning study will be ready in another few months, they should wait for that. Do you have a view on that? Can you recommend that, where gaps exist, the appointment of staff should not be delayed by waiting for the outcome of planning studies?

The Minister of Health, Social Services and Public Safety:
As far as that matter in question is concerned, the workforce planning and the study are under way. Workforce and training issues are being carefully monitored. For example, around 500 nurses per annum graduate. They — overwhelmingly — want to work in adult nursing, but, currently, our real need is for mental-health and learning-disability nurses. We have a shortfall of about 400 such nurses, and that is reflected in your remarks and Kieran Deeny’s earlier point about the key to delivery and implementation being available staff. There is also a shortage of children’s nurses and midwives. At the moment, we are skewing nursing training as best we can towards mental health and learning disability, among other disciplines. Hopefully, we will be able to address those shortfalls. We plan, but, by its very nature, planning is always carried out in advance. I understand that, around 15 or 20 years ago, it was decided that there were too many nurses, so the number of trainee nurses was cut. However, eight years later, huge numbers of nurses were needed here. As a result, several hundred nurses have been recruited from overseas, for example, from the Philippines and South Africa. Workforce planning is not just for this year and next year, but for the whole cycle.

The Chairperson:
Every Member who wished to ask a question has had an opportunity to do so, so I will now conclude this session. I thank you for your answers, and I hope that, in the not-too-distant future, mental-health services will be delivered in the way we want them delivered.

I was rather taken aback today during our meeting with the Children’s Commissioner, Patricia Lewsley, whose role is to highlight children’s issues and needs. She has indicated that she has been trying to see you since last September to discuss issues that arose in the Bamford Review, but that she has not as yet had a meeting with you. Perhaps you could comment on that?

The Minister of Health, Social Services and Public Safety:
I had a meeting with Patricia Lewsley last week.

The Chairperson:
She indicated in today’s Committee meeting that she had been trying to meet you since last September.

The Minister of Health, Social Services and Public Safety:
Certainly her diary and my diary are reasonably full, to put it mildly, but I have no problems with meeting her. Yes, she plays an important role, and I bump into her routinely in the course of my work. I will certainly take that matter up when I go back to my office, and I will make sure —

The Chairperson:
She indicated that there were a lot of cancellations by your office. I feel that we must give due respect to her and her role as Children’s Commissioner. It was a bit of a shock to learn that she had not had a meeting with you. I take your word for it that you have seen her now, but she indicated that, right up until today, there was no real formal, face-to-face meeting with you.

The Minister of Health, Social Services and Public Safety:
All I can say is that I met her last week.

The Chairperson:
I thank you Minister, and your officials, for your attendance. We now move into closed session.

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