Official Report (Hansard)

COMMITTEE FOR HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY

Health and Social Care (Reform) Bill

16 October 2008

Members present for all or part of the proceedings: 
Mrs Iris Robinson (Chairperson) 
Mr Thomas Buchanan 
Dr Kieran Deeny 
Mr Alex Easton 
Mr Tommy Gallagher 
Mr Sam Gardiner 
Mrs Carmel Hanna 
Mrs Claire McGill 
Ms Sue Ramsey

Witnesses: 
Mr Craig Allen ) 
Dr Michael McBride ) 
Mr Ivan McMaster ) Department of Health, Social Services and Public Safety 
Mr Bernard Mitchell )

The Chairperson (Mrs I Robinson):

I welcome Mr Bernard Mitchell, Mr Ivan McMaster and Mr Craig Allen from the Department of Health, Social Services and Public Safety, along with Dr Michael McBride, the Chief Medical Officer, to the Committee’s continuing clause-by-clause consideration of the Health and Social Care (Reform) Bill. They are here to explain the meaning of the clauses of the Bill, provide clarification and answer questions as required.

We will continue where we left off last week. Clause 12 establishes the regional agency for public health and social well-being. Before I invite the officials to explain the meaning of the clause, together with the corresponding schedule 2, I am conscious that we had a fairly detailed discussion about the merits of the proposed regional agency during last week’s meeting. I invite the officials to outline briefly the provisions in clause 12 and the corresponding schedule 2, after which members will have an opportunity to ask questions.

Mr Ivan McMaster (Department of Health, Social Services and Public Safety):

Clause 12 establishes a regional agency for public health and social well-being as a body corporate. As we discussed last week, that allows the organisation to do certain things on its own, such as regulate its own procedures and employ its own staff. Schedule 2 deals with the constitution and operation of the regional agency. Schedule 2 is almost an exact copy of schedule 1, which establishes the regional board. The one significant variation is that the regional agency’s board is granted permission to include a prescribed number of local elected representatives, the numbers of which will be determined by subordinate legislation.

Mr Easton:

I am not against a regional agency per se, but I am still not convinced of its merits as a stand-alone body that is separate from the proposed regional board. I see it as an extra layer of bureaucracy, the cost of which would be substantial at a time when we are expected to be making efficiency savings. I do not understand why it cannot be part of the regional board and still do just as good a job, if it is placed in the right context within the board, and if its funding is properly examined. I do not accept that it must be separate.

Will the regional agency make its decisions independently, or will it need the separate agreement of the regional board or the Department? I am confused about that. The money for the agency would be better spent if it were an internal organ of the regional board. I propose that clause 12 be subsumed into clause 6 so that there is a joint body, rather than two bodies.

Ms S Ramsey:

I partly understand what Alex is saying. We must be careful not to make any decisions on that issue for the time being. I am conscious that many people who responded to the consultation see the proposals for a regional board and a regional agency as a positive way ahead. I am not saying that those people are right or wrong. When we talk about front-line services and front-line service delivery, we are talking about the organisations that provide those services.

In its submission to the Committee, the Royal College of Nursing (RCN) argues that its proposed amendments to clauses 8(3) and 9(4)(1) would mean that:

“the relationship between RAPHSW on the one hand and the Regional Board and Local Commissioning Groups on the other will become one of strategic partnership rather than simply consultation and advice. This will, in turn, help to ensure that public health is firmly at the forefront of service design and delivery”.

I want to tease that issue out, because if we are saying that organisations such as the RCN are the experts in certain matters, we could be going against what they and other service providers want to aspire to in the Health Service.

Dr Deeny:

I have to take on board what Michael McBride said last week, namely, that if the agency is incorporated into the board, public health may well become the poor relation. My understanding — and I would like verification from the officials and the Chief Medical Officer — is that the local commissioning groups (LCGs) will have the clout to commission services locally and that an important part of their work will be to work alongside the regional agency.

Public health — and I have been in general practice for years — public education and health promotion are an important part of our future, so I would not like to think that the local commissioning groups would be working with part of a board that was treated like a poor relation.

In addition, we are concerned about bureaucracy, and if we are thinking about decreasing bureaucracy, I do not want people losing their jobs. I asked Bernard last week about staff numbers, and the figures 700, 400 and 250 were mentioned. Some people would say that 1,400 members of staff is a large number of people administering the Health Service from Belfast for a population of 1·7 million.

The answer, possibly, is to have fewer people in each of the bodies. To have 700 people in the Department seems to be a lot, when we have a population that is only the size of Yorkshire. I have come round to believing that the regional agency must be separate from the board because the local commissioning groups need to get top advice — and very important advice about public health and health promotion — from a body that is not treated as a poor relation. Will you confirm that that is the case and explain how they will work together?

Dr Michael McBride (Department of Health, Social Services and Public Safety):

That is the point that Tommy Gallagher made clearly about the locality level at last week’s Committee meeting. Staff from the board and the agency will support LCGs in delivering the service needs of local communities and populations, and in addressing the challenges of health inequalities in order that everyone is equally well.

More importantly, agency staff will focus on, and work with, other partnerships in local government, local authorities, local policing and in education, because it is not services that determine whether someone is healthy, but good education, life and employment opportunities, and the communities, environment and network around people that make them feel supported and as valued members of society. That is what keeps people healthy and well: loving families and supportive communities. The Department will give emphasis and profile to public health.

For once, we will not be saying one thing about public health and doing another, because we all talk the talk and say that it is important to address health inequalities so that everyone is equally well. However, if you ask me a question about the Department’s proportionate spend vis-à-vis health services compared with dealing with health inequalities, we spend less than 1% of our budget on addressing health inequalities and improving the health of the population with upstream interventions. That is the fact of the matter.

By creating a separate agency, the Department will be saying to the public of Northern Ireland that public health is an important issue. We will also ensure that that agency is a key and equal player in negotiating leverage over the totality of the budget for the board and the agency. At that grass-roots level, you will not see the join: they will work in partnership because they have to do that.

Dr Deeny:

You spoke about elected representatives on the agency. That is new to me. Will you elaborate?

Mr Bernard Mitchell (Department of Health, Social Services and Public Safety):

Two elected representatives are provided for on the board of the agency.

Dr Deeny:

Will they be councillors?

Mr Mitchell:

They will be district councillors.

Mr McMaster:

Paragraph 3(1)(f) of schedule 2 provides for:

“a prescribed number of members of district councils appointed by the Department in such manner as may be prescribed.”

Mrs Hanna:

I support the establishment of a separate agency for public health for the very reasons that have been outlined: addressing health inequalities, early intervention and prevention. However, I have raised concerns about the agency having teeth. It must be a real partnership, bottom-up as well as top-down. That is my only concern. I understand that, in the day-to-day running, the issue of public health could get lost if it is linked into the regional board.

However, I still need to be convinced that it will have teeth and will make a difference. It must not be a talking shop: it needs to have public-health professionals on board, and they must be able to make decisions.

Mr Mitchell:

We will provide a detailed framework — and I do not mean the framework document. We are doing specific work at present, following on from the Minister’s advice that he wishes to give consideration to joint sign-up. We are doing detailed work on the relationship between the board and the agency to ensure that the product of their work is an integrated commissioning plan, of which both have ownership, both approve and — as I said at last week’s meeting — which gives the agency not only direct input into the smaller amounts of money that it will commit but very significant influence over the £4 billion that the board spends in total. In that way, the agency can begin to shape the pattern of expenditure, target it, and achieve the outcomes in public health and social well-being that we want.

I have no difficulty whatsoever in assuring members that a clear, solid framework will emerge that will describe exactly how the two organisations will work in an integrated way to a common agenda.

Mrs Hanna:

That is fair enough. It is helpful that you have articulated that in detail.

Dr McBride:

That is at the root of Alex’s important appeal for absolute clarity about this — eye-watering clarity. As the discussion that we have just had illustrates, the difficulty is that such clarity is not outlined in the legislation. That is part of the challenge.

Sue asked about consultative responses: we have had an unprecedented response to this consultation exercise. From what we have heard, and from what people have told us, some 59% of all respondents support the development of a separate agency for public health; 20% were undecided —

Mr Mitchell:

If I may correct you, 59% of those who discussed the issue of the agency —

Dr McBride:

I am sorry: 59% of those who discussed the issue of the agency were in support of it; 20% were undecided; and another 21% of those who had discussed that issue were not supportive.

It is worth mentioning the bodies that were supportive: the Royal College of Physicians of Ireland; Royal College of Midwives UK Board for Northern Ireland; the Health Promotion Agency; the Northern Ireland Chief Environmental Health Officers Group; the Northern Ireland Association for Mental Health; the Institute of Public Health in Ireland; the British Dental Association; the British Psychological Society; and the Health Protection Agency in London.

Sue referred to a submission from the RCN: it emphasised the need to put public health at the centre. It qualified its response by saying that it needed to see more detail. That is entirely appropriate. The Committee also needs more information and discussion to ensure that it has all the details.

Mr Gardiner:

I support what Sue and Carmel have said, and I concur with their views. It is a little like the relationship between this Committee and the Department: we oversee what the Department and the Minister does. If we do not establish an independent agency to oversee what the board is doing, we allow the Minister and the Department to run the show as they see fit. However, we are here as elected public representatives. We are doing a good job, and I encourage and support the establishment of the agency.

Mr Buchanan:

My views are well known. I do not see the need to set up another agency. I take on board the positive aspects of setting up an agency and putting public health in the forefront, but I cannot see why that cannot be incorporated within the board. It should be one body rather than a separate agency that would need up to 400 staff to administer.

For example, across Northern Ireland, district policing partnerships and community safety partnerships were set up; they run in tandem and work is duplicated. There is no need for those two partnerships. We will be setting up a board and an agency, and there will be a duplication of work that is not required. I cannot see why the two bodies cannot be in the one board.

It was mentioned that the Committee may need more clarification to find out what the regional agency would do and what powers it would have. Perhaps the matter should be deferred. I cannot see why we need to set up another agency to run alongside the board. The work could be incorporated into one body that could do as good a job as a separate agency.

Dr McBride:

The important point is that there would be no more staff. Staff numbers would remain exactly the same whether there is to be a separate agency or a unified model. The efficiency savings will be realised, and there will be no more staff in either model.

To answer the question about why there should not be a single model: we have 20 years’ experience of a single model, albeit separated into four boards. We still have not seen the problems associated with health inequalities or improvements in healthcare being addressed successfully. Mr Buchanan is right to challenge our thinking on a unitary model. I do not know whether the unitary model will deliver anything different from what was delivered previously.

The Committee has met the community and voluntary sector, and it knows that, frequently, because of acute pressures and the issues about the financial balance of trusts, the projects that are working well at a local and community level are not being disseminated widely across Northern Ireland and implemented on the ground. Indeed, many of those organisations are surviving on short-term funding from year to year with end-of-year-slippage money from boards. Public health is not central and is not a major priority for boards at present. However, that is not because the boards do not want to do it; it is because they are distracted with more immediate and pressing issues, and they cannot get round to the longer term, more sustainable issue of building on a foundation of public health.

In a single organisation, the public-health agenda would disappear. The health-protection agenda, which we have not discussed, is important. Canada, post-SARS 2003, moved to establish an agency for public health for the sole reason that it recognised that a separate agency would give a higher profile to the health-protection challenges, whether those challenges might be healthcare-associated infections or multi-drug-resistant bacteria, such as listeria or tuberculosis, which are on the increase in our communities, or whether it might be a pandemic flu outbreak. It is about building resilience and capacity into the system so that public health is strong — and that is not only about health services.

Mr Mitchell:

The staff would be senior professional medical, nursing and allied health staff who currently work in the boards and have a significant input to the commissioning process. They also have a significant input into the public-health and well-being agenda.

Whether there is a unitary body or two bodies, those people’s work must still be done. In a single-body model, rather than those people working for the agency, they would work for the board because their jobs must still be done. Any savings that would be made would be fairly limited and would come primarily from the positions of chairperson, chief executive and a small number of directors’ posts that may be lost.

When working on the new organisations, we were careful not to replicate support services functions so that the agency would not be seen, for example, to set up its own human resources, finance and corporate services machinery. We envisage that the organisation will get those services from other parts of the system. That is why the somewhat anomalous situation exists, in which it appears that there are an additional 200 staff to run the new agency. That is not the case. If, tomorrow, there were to be no new agency, the bulk of those staff would belong to the new board because their work must still be done. Any savings would be made at the upper echelons and would not be that significant. I welcome the opportunity to explain that.

The Chairperson:

I am sorry, Sue. I want to invite Tommy to ask a question.

Mr Gallagher:

Will Sue get a chance to ask another question?

The Chairperson:

I will bring Sue back in at the end.

Ms S Ramsey:

Thank you.

Mr Gallagher:

I support the idea of there being two separate bodies. I am happy that we proceed on that basis. We must decide soon whether there will be one or two organisations.

A much stronger public-health message is needed. The best way to do that is with separate authorities. The problem with the public-health message is that several authorities seem to be responsible for it; the Health Promotion Agency and the trusts all carry out health promotion and such activities. We are worse off for that as regards hammering out a strong message on health promotion and public health. Therefore, I am happy that the two authorities be separate.

Will the situation continue in which trusts do essentially the same work? They are not mentioned in the Bill because they do not need to be. Are they empowered under the relevant legislation, t he Health and Personal Social Services ( Northern Ireland) Order 1991, to carry out a certain health-promotion function? If they still have that function under legislation, that will result in duplication of functions. Perhaps someone can throw some light on that matter.

Mr Mitchell:

This issue featured prominently during consultation. At its conclusion, many people cautioned against wholesale centralisation of trust staff who are currently based in local communities where they do work that is valued highly. We certainly got that message from the trusts. We also got it strongly from the community and voluntary sector, who said that we must be careful: if it ain’t broke, don’t fix it. They value the interaction by local trust staff. Their advice was not to pool all those functions managerially at a central point.

Our response was to limit the functions that are taken over by the new agency — those that relate to the work of the health action zones, for example — where we felt that we could bring improved partnership and better regional focus to the provision of those services. We seek to strike a balance, therefore, between what is brought into central management and what is left to local control. That was in direct response to views that we heard during consultation.

Dr McBride:

Tom Buchanan made an important point about ensuring that there is no duplication and used the example of community safety partnerships. We will try to ensure that staff in the health action zones and the Investing for Health partnerships work as one team.

Later in the legislation, we have placed a duty of public health and social well-being on trusts. That goes back to Dr Deeny’s important point: it is about ensuring that those who work in health and social care do not regard their primary role on the front line as treating the sick, such as patients with acute myocardial infarction or diabetes. Instead, it is about working proactively to ensure that someone who has had acute myocardial infarction, for example, is given advice about diets, exercise programmes and smoking cessation. It is important that the staff in trusts retain their patient focus.

We want a Health Service where all staff, regardless of whether we are cardiologists or work with people who live with diabetes, say that their target is to no longer have people arriving at clinics with illnesses such as diabetes. For that to happen, we all must address the problem of obesity.

The fundamental aim of the Bill is to realign health and social care and take it upstream. We must turn off the tap, because if we do not — as Derek Wanless stated — the Health Service will not be able to cope with the demographic changes in our population, the increase in life expectancy, people living with long-term conditions and the problems related to obesity and the diseases of modern society. Therefore, we must fundamentally change tack, move upstream and ensure that the majority of staff who work at the service end of health and social care regard that task as an important part of their job.

Mr Mitchell:

That is referred to in clause 21.

Ms S Ramsey:

Although I sympathise with what Alex and Tom are saying, investment is always made in acute care rather than community care. We must prevent illnesses; in my constituency, as with any other, the source of the problem must be tackled. If one organisation has control, the money will be lost, because it will be spent on treating illnesses rather tackling their source.

Mr Easton:

I do not agree that money would be lost if there were a single organisation — that will not happen if the correct structures exist. If the Committee agrees, I could withdraw my proposal and the issue could be discussed next week when we could be provided with information on the cost of establishing the new agency and more details on its structures.

The Chairperson:

I would suggest that we do not have a formal vote now. The risk is that the vote could go either way, and that could have significant implications for other parts of the Bill. I would prefer if we parked that proposal until we receive some clarification on costings and other points that were raised, including a better explanation on the points that Alex and Tom raised. I do not want to divide the Committee on the proposal.

Paragraph 7(3) of schedule 2 is wrongly drafted and, unless corrected, will result in a situation where RAPHSW committees have to comprise exclusively of regional board members. The words “regional board” should be replaced by “RAPHSW board”.

Mr McMaster:

Yes; that is on page 29 of the Bill and is a drafting error caused by cutting and pasting.

The Chairperson:

If the wording is not fixed now, we could be in trouble later.

We now move to clause 13, which details the functions of the regional agency for public health and social well-being. I invite Ivan to explain that clause.

Mr McMaster:

Clause 13 details the agency’s functions and provides clarification in relation to those. In very broad terms, clause 13(1) explains that the agency will have health-improvement and health-protection functions. Clauses 13(2) and 13(3) provide further details about those functions. Clause 13(2) refers to health improvement and to the agency’s requirement to take proactive steps to develop programmes and initiatives that will be targeted at improving the health and social well-being of the Northern Ireland public.

It should be noted that those are not solely targeted at health. Given our uniquely integrated service, those programmes and initiatives will also improve the social well-being of the public and will reduce health inequalities.

Clause 13(3) gives details of the agency’s envisaged health-protection functions that will protect the community — or any part of it — against communicable diseases. Currently, the main communicable diseases that are being dealt with are: measles; mumps; rubella; polio; tuberculosis; and hepatitis A, B and C.

Those functions will also deal with any other dangers to the health and social well-being of the public. Those wide-ranging duties are designed to cover anything that could be regarded as a danger. The power, therefore, is not limited at all, although it will often refer to more common dangers, such as environmental or public-health issues.

Clause 13(4) provides details of the areas in which the new agency will become involved in the exercising of those functions, such as undertaking research or providing laboratory, technical or clinical services. Clause 13(5) provides the Department with the power to alter the functions of the proposed new agency, either by adding or removing functions. That is a fairly new departure, and — in light of experience — the Department of Health, Social Services and Public Safety reserves the right to change those functions. Clause 29 will ensure that no Order that amends those functions will be made unless it is placed formally before, and debated in, the Assembly, so the Department will not be able to amend the functions without the Assembly’s approval.

Clause 13(6) states that the proposed new agency will be required to co-operate with other bodies. There is no limit on the bodies with which the agency must co-operate, and it is clear that the list is not even restricted to health- and social-care bodies. The agency will be required to co-operate with local councils in relation to environmental health functions and with such other bodies under any arrangement for joint working.

Clause 13(7) is a mirror image of clause 13(6), in that it requires any body referred to in that subsection to co-operate with the agency. Clause 13(8) is a technical inclusion that will provide the new agency with protection, because it will be compelled to provide information by clauses 13(6) and 13(7). Any provision of information will not be regarded as a breach of restrictions on the disclosure of information that might apply. However, the agency must note that that does not formally authorise the disclosure of information that contravenes the Data Protection Act 1998.

Dr Deeny:

Before the Committee considered the Bill, I was unclear about the proposed agency and its functions. However, I increasingly agree with my medical colleague Michael. I have spent 28 years of my life looking after the sick and treating diseases. More focus should be given to — and more finance should be provided for — disease prevention, as opposed to only the treatment of diseases. That is the future, particularly as the population is getting older, as Michael pointed out. If we have the resources, the time, the financial back-up and the support of an agency such as the one that is proposed, we would be able to prevent many diseases.

In the past, we waited until people became sick and then treated them. We are now trying to focus on preventing heart attacks, diabetes, strokes, and so forth, so I am increasingly seeing the benefits of the proposed agency.

Mrs McGill:

Disability Action made the point that clause 13(2)(b) needs to be expanded to better outline the health-promotion function. Is that a valid point?

Mr Mitchell:

Did it suggest a form of wording?

Mrs McGill:

I have not seen a form of wording, but it may be included in its substantive response.

Mr Mitchell:

Forgive me, but what was Disability Action’s concern?

Mrs McGill:

It felt that clause 13(2)(b) needs to be expanded to better outline the health-promotion function. It may have suggested a form of wording, but I do not have that information in front of me.

The Chairperson:

Disability Action’s opinion on this piece of legislation is that clause 13(2)(b) needs to be expanded to better outline the health-promotion function.

Mr Mitchell:

We will take that away and consider a form of wording.

Dr McBride:

We have not been restrictive at all. I am merely echoing the point that was made earlier about the health-protection or health-promotion function. The regional agency will be responsible for health and social well-being. We are happy to go away and consider any issues that you may have.

The Chairperson:

Disability Action:

“commends the comprehensiveness of clause 13(2)(a) but believes that 13(2)(b) should be expanded to better outline the Health promotion function.”

It is not a very detailed point, but perhaps you could consider it. Members are generally happy, but obviously there will be an impact, depending on whether there are one or two authorities.

Mr Buchanan:

The British Red Cross has suggested a form of wording to strengthen the clause. It suggests including the words “and risk reduction” after “health promotion”.

The Chairperson:

Bernard, we are happy to give you a copy of the responses from those organisations, and you can come back to us with responses to them.

Ms S Ramsey:

It would be useful if the Department were provided with a copy of those responses, because the Association of the British Pharmaceutical Industry has suggested that clause 13(4)(e) should be amended to read:

“make available to any other body, after consultation with the Assembly Committee for Health, Social Services and Public Safety, such persons, materials, information and facilities as are deemed appropriate.”

I know that we are nuisances, but the Committee should be included in clause 13.

The Chairperson:

We are simply protecting our backs. The devil is in the detail.

Mr McMaster:

May I just clarify that we are talking about clause 13(4)(e)? At the moment it reads:

“make available to any other body”.

Ms S Ramsey:

We are the real body.

Mr McMaster:

You are not simply “any other body”. [Laughter.]

The Chairperson:

We could not possibly comment on that.

Dr McBride:

I increasingly get the feeling that I am the Health Committee’s personal physician, and I am sure that Sue will not require smoking cessation services or anything else.

The Chairperson:

At this stage, I must rein everyone in and say that enough is enough.

We are generally happy, but we will come back to the issue of the two authorities next week when we get more detail on it.

Clause 14 relates to the regional support services organisation. Will you talk us through the clause together with the corresponding schedule 3. It is worth noting that the Central Services Agency had concerns about the title of the organisation and its acronym — RSSO.

Mr Mitchell:

Are you content for the Chief Medical Officer to leave at this point?

The Chairperson:

Of course. Thank you for your additional help on the issue of breast screening. I appreciate your speedy response to the matter.

(The Temporary Chairperson [Ms S Ramsey] in the Chair)

Mr McMaster:

Clause 14 creates a regional support services organisation as a body corporate — much like the organisations that we have been dealing with so far — and introduces schedule 3, which deals with the establishment of that organisation. Schedule 3 is somewhat different from schedules 1 and 2. It takes a different tack as the support services organisation will not provide services to the public. It is something of a new venture, so many of the provisions in relation to tenure of office and circumstances in which people can be removed or suspended from office, the appointment of committees, and so forth, will be provided through subordinate legislation, as set out in schedule 3. Initially, it is likely that that subordinate legislation will create an organisation that is a little different from the board and the agency. That is why schedule 3 differs from schedules 1 and 2.

Mr Easton:

I have no problem except for the new organisation’s acronym. Will you consider that? We do not want the organisation to be a laughing stock; it is a serious matter.

Mr Mitchell:

There is a proposal to change the name of the organisation to the “regional business services organisation”. We would be content to consider that.

Mr Easton:

That sounds better.

Mr McMaster:

It started life as a “common services organisation”, but the use of the word “common” is not suitable, because the organisation must provide services for more than one body. The technical term “common” cannot be used, because it might be required to provide a particular service for one of the bodies. That is how we arrived at the regional support services organisation. I am afraid that we were not really thinking about acronyms at the time.

Mr Gallagher:

Briefly, what services will the organisation provide?

Mr McMaster:

I will come to that.

The Temporary Chairperson:

The Committee agrees to come back to the title of the organisation at next week’s meeting. We will now move on to clause 15.

Mr McMaster:

Clause 15 sets out the services that the organisation — I will call it the regional support services organisation, for the moment — is to provide. Clause 15(1) gives a general description that the organisation is to provide:

“support services to other health and social care bodies in accordance with directions under subsection (4).”

Clause 15(2) broadly lists the services that need to be carried out on behalf of health and social care bodies. They are:

“(a) administrative support, advice and assistance;

(b) financial services;

(c) human resource, personnel and corporate services;

(d) training;

(e) the management and maintenance of buildings, equipment and land;

(f) information technology and information management;

(g) the procurement of goods and services;

(h) legal, medical, scientific or other professional services;

(i) contractual compliance, internal audit and fraud prevention.”

Those services are relevant to the contracts that boards currently hold with practitioners. Those are the services that the organisation is designed to provide.

Clause 15(3) requires the organisation to ensure that its arrangements for providing those services represent value for money for its customers and that they are provided in the most economic, efficient and effective way. To ensure that that is done, the organisation will be required to have those arrangements approved by the Department. It is implicit that, without such approval, the provision of the services to the bodies concerned cannot be commenced.

Clause 15(4) provides the Department with the power to control the flow of services to the new support services organisation by giving directions. The organisation will not take on everything from day one; there will be a drip-feeding of responsibilities. Some of the services will have to be provided by the organisations themselves, but, as time goes on, the services will be provided by the new support services organisation.

(The Chairperson [Mrs I Robinson] in the Chair)

This provision by direction gives a number of safeguards. It will ensure that health and social care bodies will use the organisation and not go elsewhere for their functions because that will be required under the directions. It will allow the Department to be satisfied that the organisation is properly equipped to carry out its functions, and it will enable a phased approach to be taken to the central provision of those functions. It will also ensure that health and social care bodies do not ask their organisations to carry out functions that are inappropriate. Anyone could ask this organisation to do something simply because it is too difficult or they do not like it — for example, the job of firing someone. This clause will prevent that type of action.

Clause 15(5) permits the regional support services organisation to charge its customers for the services that it provides. Clause 15(6) again provides the power for the Department to alter the functions of the new organisation and, similar to that provided by the proposed new agency, this will be done by an Order which will be brought before the Assembly. The Assembly would, therefore, have a say in that change — either adding to, or taking from, those functions.

Mrs McGill:

Clause 15(3)(a) is mentioned in the responses to the Committee. The Northern Health and Social Services Board asks that the word “equitable” be added after “economic” and before “efficient”, so that the clause would read:

“secure that those services are provided in the most economic, equitable, efficient and effective way”.

I support that. Is that possible?

Mr Mitchell:

I suppose that comes down to an assessment of what “equitable” means in the type of services that we are discussing. We are talking about supplies services, human resource functions, payroll functions and payments of accounts — operational, day-to-day transaction functions. That is largely what this new body is concerned with. The body’s customers are other health and social care bodies. When one asks if that works in an equitable way, all health and social care bodies are required to meet the obligations laid on them by section 75 of the Northern Ireland Act 1998, which informs how they do their business. It is difficult to give a commitment in legislation, given the nature of the services that the new organisation will provide. One wonders how it could be demonstrated that the type of service that I am talking about had been provided in an equitable way.

Mrs McGill:

I understand what you are saying, but every Health Service is supposed to be equitable in all aspects. I do not find that to be the case. It depends, in many instances, on where you live. I would like to see the word “equitable” included, and I wonder why the Northern Board has asked for that in its response. Whatever the service happens to be — and you have outlined the services — I think that it would be good to have the word “equitable” included.

Mr Mitchell:

I will take that away with me. We can think about the implications, but the new organisation’s support services will not be patient- or client-related.

The Chairperson:

I understand your point about responsibilities under section 75, and I wonder why the Northern Board insisted on making that response.

We will formally agree clause 15 later . We will now move on to clause 16, which deals with the patient and client council.

Mr McMaster:

Clause 16 establishes a new body to be known as the patient and client council, which will replace the four existing health and social services councils. Its function is explained in clause 17; however, it will deal primarily with patient and client representation in the new system. It introduces schedule 4, which deals with the status, membership and construction of the new body. Schedule 4 is almost the same as schedule 3, which is about the creation of the regional support services organisation. Details about appointments, tenure of office and the constitution of committees will be provided for in subordinate legislation, which will come before this Committee at some stage.

The Chairperson:

We will formally agree clause 16 and schedule 4 at a later stage. That brings the Committee to clause 17, which deals with the functions of the patient and client council. Will you briefly talk members through that clause, Ivan?

Mr McMaster:

Clause 17(1) sets out the four main functions of the proposed patient and client council, which include representing the interests of the public. That involves ascertaining the views of the public and ensuring that their views are conveyed accurately. It must be noted that they should be the public’s views and not those of the staff of the patient and client council.

Clause 17(1)(b) states that the patient and client council will have a role in “promoting involvement of the public”. That refers to the active role that the body must play in encouraging people to become involved in such things as consultation exercises and other processes that lead to decisions that may affect the public’s health and social well-being.

Clause 17(1)(c) explains the council’s role in providing assistance to individuals who seek help with complaints against health and social care bodies.

The council will also engage in “promoting the provision” of advice and information in relation to health and social care bodies. It should be noted that the intention contained in clause 17(1)(d) is not necessarily that the patient and client council prepares and issues advice but that it should proactively encourage and drive other bodies to get out information on appropriate matters.

Clause 17(1)(e) refers to “such other functions” as the Department would take a power to prescribe by regulations. That provides some flexibility to add other functions to the first four paragraphs that I have explained.

Clause 17(2) gives more detail about the issue of representing the public. Similarly, clause 17(3) provides further detail about the function of promoting the involvement of the public. Likewise, clause 17(4) gives more information about the function of providing assistance to individuals making complaints. Clause 17(5) requires the patient and client council to seek examples from any source of “best methods and practices” in order to promote the participation of the public in how health and social care is designed, commissioned and delivered.

Clause 17(6) reverts back to clause 17(2)(b), which requires the patient and client council to consult with the public. Clause 17(6) also requires the patient and client council to report publicly on any issues on which it has consulted.

Clause 17(7) defines “the public” as widely as people may wish to interpret it. The clause is simply there in order to clarify that “public” may refer to:

“individuals, a group or community of people and a section of the public”.

Clause 17(8) lists the bodies to which the provisions of clauses 17, 18 and 19 apply. Clause 18 deals with the duty to co-operate with the patient and client council, and clause 19 deals with public involvement and consultation. All the health and social care bodies that are referred to in the Bill are on that list, with the exception of the regional support services organisation and the Regulation and Quality Improvement Authority. That is mainly because those bodies do not provide services to the general public.

Clause 17(9) clarifies what is meant by the phrase, a body which is:

“responsible for health and social care”.

If the Committee wishes, I will deal with issues related to that.

Mrs McGill:

Disability Action is concerned that disabled people can be excluded from consultation, and it suggests adding the words “in an accessible way” to clause 17(2)(a), so that it would read:

“consult the public in an accessible way about matters relating to health and social care.”

Mr McMaster:

Like any public body, the patient and client council falls under the requirements of section 75 of the Northern Ireland Act 1998, and, therefore, it is bound to ensure that no member or part of the community is excluded from any consultation.

Mrs McGill:

I quoted what Disability Action said, and I do not want to ignore that. That organisation did not make that point because it believes that consultation is always accessible.

The Chairperson:

That issue is also raised by Disability Action’s second point.

Mrs McGill:

In its response to clause 17(4), Disability Action states:

“It needs to be clarified if this clause refers to reasonable adjustments under the Disability Discrimination Act or not.”

The Chairperson:

I presume that the officials will take those points away for consideration and that they will come back to the Committee when we get to the stage of formally agreeing the clause .

We will now move on to clause 18, which deals with the duty to co-operate with the patient and client council.

Mr McMaster:

Clause 18 is intended to place some sense of duty on the bodies to co-operate with the patient and client council in the carrying out of its functions and, for the first time, to put that requirement in statute. Up until now, there has been an almost tacit agreement that the bodies will co-operate with the patient and client council. Clause 18 puts that into statute.

Clause 18(1) places an onus on the health and social care bodies to co-operate. The Bill does not define “co-operate”; the definition is as broad or narrow as it can be taken. Clause 18(2) states:

“In particular, such a body must ¾

(a) consult the Patient and Client Council with respect to such matters, and on such occasions, as the body considers appropriate”.

We considered that the consultation should be on such matters as the patient and client council considered appropriate. To do that, however, would run the risk of tying the body up in consultation all the time, so it was felt that leaving it to the body to consult with the patient and client council as it considers appropriate was the right way to go. The patient and client council has the option of asking the Department to take action if it believes that the bodies are not playing the game.

Clause 18(2)(b) places a duty on the bodies to furnish to the council — in this case, the patient and client council — with such information that it considers necessary. It is considered that that provision of information would not tie up the body to the same extent that formal consultations would. Therefore, it should provide information that the patient and client council considers to be appropriate.

Clause 18(3) provides that, in order for the patient and client council to carry out its functions effectively, officers will need to have access to premises that are controlled by health and social care bodies and, indeed, certain other bodies. Clause 18(4) sets out the other types of premises that the patient and client council are entitled to enter, in addition to those of the health and social care bodies. Those are other buildings that belong to them, such as surgeries, pharmacies and opticians.

Clause 18(5) confirms a limitation on that right to enter. The right to enter is limited to allowing the patient and client council to carry out its functions. In other words, it cannot use that right to do anything it likes on those premises; it is limited to carrying out its functions of representing the interests of the public and promoting the public’s involvement in health.

Clause 18(6) explains that health and social care bodies must have regard to the views expressed by the patient and client council. The phrase “have regard to” means that those bodies must think strongly about those views, and only where there are strong reasons for doing otherwise should they not agree with the patient and client council.

Dr Deeny:

I prefer the expression “patient council” over “client council”; I do not like the word “client”. One need not be sick in order to be called a patient. I have 8,200 patients, not clients.

I am concerned about clause 18(1):

“A body to which this section applies must co-operate with the Patient and Client Council in the exercise by the Council of its functions.”

That is too general. What is meant by a “body”? Does that include, for example, the trusts, local commissioning groups, agencies, boards and, indeed, the Department?

Mr McMaster:

Yes, it does. Clause 17(8) states:

“This section and sections 18 and 19 apply to —

(a) the Department;

(b) the Regional Board;

(c) RAPHSW;

(d) HSC trusts; and

(e) special agencies.”

Dr Deeny:

They must all co-operate.

Clause 18(6) states:

“A body to which this section applies shall have regard to any views expressed by the Patient and Client Council”.

To “have regard to any views” is non-committal; I might have regard for your views, but then say to hell with them. I suggest that the phrase:

“and act on any views expressed”

should be inserted. There is no point in having regard to any views expressed — perhaps on behalf of the public and perhaps making suggestions about what healthcare the public requires — by the patient and client and council. Inserting the phrase that I suggested would mean that some action will be taken rather than merely listening to opinions.

The Chairperson:

Perhaps it should say “due” regard, which would mean that one could have input, even though that input may not be correct. Kieran’s suggestion implies that someone’s input should be acted on even if it is incorrect. “Due” regard would address that point but retain discretion.

Mr McMaster:

We will certainly consider that.

The Chairperson:

We will formally agree the clause later. We will move on to clause 19, which concerns public involvement and consultation.

Mr McMaster:

Clause 19 will apply to the same list of bodies. It is about public involvement in the planning and delivery of statutory services, and it places a duty on bodies to provide information, to research the population’s requirements and to encourage and assist people. In particular, health and social care bodies will be required to demonstrate, by producing a consultation scheme, how they intend to consult with the public about service provision. It will not be sufficient for such bodies to wait to be asked; they will have to publish information proactively about requirements and make that information known to the public. Users to whom care is provided will have to be proactively told about services and encouraged and assisted to use them appropriately. That obligation is about promoting cost-effectiveness in the health- and social-care system — for example, if the assistance required by patients can be provided cheaper by their consulting with pharmacists rather than with GPs, such means must be encouraged.

Given that prevention is better than cure, bodies will be required to encourage and assist people to help themselves mentally and physically, and to be aware of how to look after themselves, using diet, fitness and self-examination.

Clause 19(2) places a statutory duty on each body to produce a consultation scheme within nine months of the day appointed, and to send that consultation scheme to the Department, which will then examine the scheme and decide whether to approve it.

Mrs McGill:

Disability Action suggests that, in clause 19(1)(a), the words “in accessible formats” should be inserted so that it reads:

“to promulgate information, in accessible formats”.

Perhaps you could consider that when you are looking at the Disability Discrimination Act 2005.

The Chairperson:

Ivan, apart from that, we are in agreement. We will formally agree the clause later.

We will now move on to clause 20, which deals with public involvement and consultation schemes.

Mr McMaster:

The main function of clause 20 is to provide some detail on the consultation schemes. It specifies that the scheme must show clearly what arrangements the body will employ to canvas the views of the patient and client council and service users, or their representatives — including their carers — on matters specified in clause 20(2) relating to health and social care. Those matters are: the planning of how the services are to be provided — that is, the nature and delivery of the service; the development and consideration of change, however big or small, and the way in which those services are provided; and operational decisions around the delivery of that care, which will include such factors as surgery opening hours, for instance.

Clause 20(3) provides details on what a health and social care body to which this clause applies must do with the responses. It must have regard to those comments, and I appreciate that the Committee has concerns about the phrase “have regard to”. The body must also prepare a written statement that sums up all the comments received and sets out the body’s response to the comments.

Clause 20(4) states that the consultation scheme must provide that the body to which it is to apply will give adequate publicity to the statement. In other words, it is not enough for the body to make a mere statement; it must publicise the fact that it has made a statement on the issues raised.

The Chairperson:

We will formally agree the clause later. We now move on to clause 21, which deals with the duty on health and social care trusts in relation to improvement of health and social well-being.

Mr McMaster:

In general, the Bill bestows a number of functions on all the newly established bodies that directly or indirectly provide health and social care. Amid all the other competing priorities, it is important that the organisations do not lose sight of the overarching drive for improvements in health and social well-being.

Those duties already apply to the Department, because it has a general duty of care under clause 2 of the Bill. It also applies to the regional board, because it is charged with carrying out the Department’s general duties. It also applies to the regional agency, as is mentioned in clause 13(2)(a), which states that the agency is to develop and secure programmes designed to secure the improvement of health and well-being.

Clause 21 ensures that the overarching desire to secure such improvements is an integral part of the work of the trusts, despite any competing priorities that those trusts might have. It makes it clear that trusts, in the exercise of their functions, must also do this:

“with the aim of improving the health and social well-being of those for whom it provides”.

Bernard referred to clause 21 earlier.

Mrs McGill:

The Community Development and Health Network has asked that, in clause 21, the words:

“and reducing health inequalities between”

be inserted so that it would read:

“It is the duty of an HSC trust to exercise its functions with the aim of improving the health and social well-being of, and reducing health inequalities between, those for whom it provides, or may provide, health and social care.”

That goes back to the issue of inequalities that were previously discussed. Could that insertion be considered?

The Chairperson:

Would that be absorbed under section 75?

Mr McMaster:

Yes, but it is one of a number of responses that you have asked us to consider.

The Chairperson:

We will formally agree the clause later. We move on now to clause 22, which deals with public-private partnerships.

Mr McMaster:

Clause 22 provides for the Department, the regional board, the proposed regional agency, the regional support services organisation, special agencies and trusts to participate in public-private partnerships (PPPs) with companies to provide facilities or services to persons or bodies. That path is open to all those bodies and the clause is intended as a clarification not an advocation; it is more of a permissive power, and it simply sets out the provisions for that. We are establishing a number of new bodies, and clause 22 simply highlights the fact that public-private partnership is an avenue that is open to them.

The Chairperson:

The health and social services councils have some concerns. They:

“believe that this clause should include a reference to ensuring the long-term financial viability and value of any such public-private partnership before entering into it.”

All of us have a major concern about the long-term costs and that it should provide value for money. Perhaps you could take on board that this cannot be a short-term fix that will take a long time to pay back.

Mrs Hanna:

Will you clarify if this is a new arrangement? I am very sceptical of PPPs, and certainly will not be ticking the box on anything that increases their number. I do not think that PPPs should be in the Health Service at all, or at least, if they are, absolute best value for money must be demonstrated. Will you explain again what is happening?

Mr McMaster:

Trusts have some legislative provisions for PPPs, but I cannot honestly tell you which pieces of legislation they are. We are establishing a new structure, and the purpose of clause 22 is to make it clear that public-private partnerships are a viable option, and to which bodies that will be applied. At the moment, trusts can enter into those partnerships.

Mrs Hanna:

Does clause 22 clarify that they have the power to make that decision?

Mr McMaster:

It clarifies that not only trusts but other bodies have the power to enter into public-private partnerships.

Mrs Hanna:

Have they always had that power?

Mr McMaster:

They have always had that power.

Mrs Hanna:

I thought that the Department would have taken that decision.

Mr McMaster:

No; at the moment, there are some powers directly bestowed on the trusts to do that.

Mr Mitchell:

My understanding of clause 22 is that it eliminates any uncertainty. Those bodies listed have the legal right to enter into an appropriate private-finance arrangement, subject to passing those hurdles that the Chairperson mentioned. Any arrangement will have to be as a result of a business case, be best value for money and pass all those hurdles. There was no particular scheme in mind when this proposal was; it was proposed to avoid doubt. If the service needs to use a scheme such as this, it has to be quite clear to the bodies, and to the private sector with which they are dealing, that there is a legal basis for that partnership. That is the only reason that the clause is here.

Mrs Hanna:

There is concern about clause 22; may we leave it until next week? We are supposed to be making things clearer, but, as somebody who is opposed to PPPs, if I tick that box, I am saying that PPPs are fine. Tommy Gallagher is not here, and, if he were, he would also want to comment on clause 22.

The Chairperson:

We can agree on that next week. We will now move on to clause 23, which deals with schemes for the transfer of assets and liabilities.

Mr McMaster:

The simplest way of explaining clause 23 is that, in some cases, it requires the Department, and, in other cases, gives the Department the power to make schemes that provide for the transfer of assets and liabilities. That includes the transfer of staff from the bodies that are being dissolved and subsumed into the new organisations.

Clause 23(4) is important, because it extends the Department’s powers to make one or more schemes “at any time” for the transfer of designated assets or liabilities. Under Clause 23(2), the Department must have schemes in place into which it can transfer the assets and liabilities of the bodies that it dissolves now, whereas clause 23(4) provides for adjustments that we may have to make at some stage in the future. It confers the power, if needed in the future, to make further schemes for the transfer of designated assets to the health and social care bodies.

Schedule 5, which I will address with clause 23, contains further detail and clarification about those transfer schemes. Paragraph 2 of schedule 5 deals with the transfer of employed staff. Paragraph 2(2) states that the Transfer of Undertakings (Protection of Employment) Regulations 2006 — known as the TUPE regulations — will apply to transferring employees.

Paragraph 2(3) of schedule 5 states:

“The scheme shall —

(a) in relation to each transferee, identify the transferring employees (whether by name or otherwise);

(b) include provision securing pension protection for such employees;

(c) include provision for procedures designed to resolve any grievances of such employees arsing in relation to matters dealt with by the scheme; and

(d) include provision for the payment of compensation by the Department to any such employee who suffers loss or detriment in consequence of the scheme.”

Paragraph 2(4) of schedule 5 states:

“Before making the scheme the Department must consult —

(a) in the case of a scheme which identifies transferring employees by name, those employees”.

Paragraph 4 of schedule 5 deals with the completion of accounts and reports of dissolved bodies. Obviously, those bodies will not exist after April 2009 so their accounts must be completed by someone. The accounts of the four health and social services boards will be completed by the proposed new regional board. The Central Service Agency’s accounts will be completed by the regional support services organisation, or whatever it will be called in the future, and the Mental Health Commission’s reports will be completed by the RQIA. Paragraph 4 provides a continuation of those types of issues following the transfer of staff and assets.

The Chairperson:

We will formally agree clause 23 and schedule 5 later. We will move on to clause 24, which deals with the transfer of functions of the health and social services boards.

Mr McMaster:

Clause 24 provides for the transfer of functions of the existing health and social services boards. After the date of transfer, functions that relate to health-improvement functions or health protection will be exercisable by the agency.

The Chairperson:

We will formally agree clause 24 later. Ivan, will you explain the purpose of clause 25?

Mr McMaster:

Clause 25 provides for the transfer of functions from the Mental Health Commission to the RQIA.

The Chairperson:

We will formally agree clause 25 later. Will you explain the purpose of clause 26?

Mr McMaster:

Clause 26 provides for the transfer of functions from the Central Services Agency to the new regional support services organisation. However, clause 26(3) states:

“The Department may by order provide that subsection (1) is not to apply to any specified function.”

The Chairperson:

We will formally agree clause 26 later. We will move on to clause 27, which provides for the amendment of statutory and other references to dissolved bodies.

Mr McMaster:

Clause 27 deals with any references in legislation to the bodies that are being dissolved. Throughout legislation there are numerous mentions to the health and social services boards, and the other bodies that are being dissolved. Therefore, clause 27 grants generic provision for those references to be construed as references to the new bodies.

Clause 27(2) states:

“In relation to any time after the transfer date, any reference in any statutory provision or document to a Health and Social Services Board (whether general or particular) shall —

(a) in relation to any function transferred by section 24(1), be construed as a reference to RAPHSW;

(b) in relation to any function transferred by section 24(2), be construed as a reference to the Regional Board.”

The same applies for references to the Central Services Agency and the Mental Health Commission for Northern Ireland. The clause provides for a generic way of correcting those references rather than our having to amend every single one.

The Chairperson:

We will formally agree clause 27 later. We will now move on to clause 28, which deals with the dissolution of special agencies.

Mr McMaster:

Under clause 28, two special agencies are being dissolved — the Health Promotion Agency and the Northern Ireland Regional Medical Physics Agency. Those agencies were established under the Health and Personal Social Services (Special Agencies) ( Northern Ireland) Order 1990. However, when we were formulating the Bill, we discovered that the provisions of that Order were defective and did not contain a power that allowed us to transfer the assets and liabilities of those special agencies; the agencies could be wound up, but we could not do anything with their assets or liabilities. Therefore, clause 28 is an amendment to that Order that allows us the capacity to make that transfer.

The Chairperson:

We will formally agree clause 28 later. We will now move on to clause 29, which deals with orders, regulations, guidance and directions.

Mr McMaster:

Clause 29 outlines what sort of procedure should be used in respect of the subordinate legislation Orders, regulations and directions. For example, clause 29(1) relates to instances when the functions of the regional agency or the regional support services organisation are altered, or when an Order is made that allows a Department to do something that will give full effect to the Bill. Such Orders cannot be made until they are laid before, and approved by resolution of, the Assembly. In general, regulations are made through negative resolution and will, at some stage, come before the Committee. Therefore, clause 29 outlines a technical procedure that allows such Orders to be made.

The Chairperson:

You have mentioned regulations being made subject to negative resolution; was any consideration given to affirmative resolution in relation to clause 29(2)?

Mr McMaster:

At the moment, the provision is for negative resolution.

Clause 24(4) relates to instances when the functions of the health and social services boards will not be split as is specified in the Bill, and clause 26(3) relates to instances when the functions of the Central Services Agency will not be as directed in the Bill. The Bill states that the functions of the health and social services boards will, generally, be split between the regional agency and the regional board and that, broadly, the functions of the Central Services Agency will go to the regional support services organisation. Those regulations relate to instances when the contrary would apply. As the Bill is drafted, that would be done by negative resolution.

The Chairperson:

Will you humour me and tease out when it might be regulations as opposed to Orders — can you explain that to me, please?

Mr McMaster:

No, I cannot. [Laughter.]

The Chairperson:

Good grief.

Mr McMaster:

That is the draftsman in me. They are both pieces of subordinate legislation that confer different powers. I will come back with clarity on that for you next week, if you wish.

The Chairperson:

Yes, please do that. We will leave that until next week. We will now move on to clause 30, which relates to further provision.

Mr McMaster:

Clause 30 is a general provision in the Bill. It allows the Department to make, by subordinate legislation, any provisions that it feels are necessary to give effect to the Bill. It provides for instances when it is found that something has, accidentally, been left out of the Bill. Rather than producing a piece of primary legislation to provide for something that has been missed out when the Bill was formulated, it allows us to provide for that by subordinate legislation. Such subordinate legislation will still come before the Committee; it is simply a quicker method of ensuring that what we want to happen will happen on time. It has been included just in case we have forgotten bits and pieces, which we all do.

The Chairperson:

Yes; we are all human, we can err. We will formally agree clause 30 later. We will now move on to clause 31, which relates to interpretation.

Mr McMaster:

Clause 31 contains a list of definitions for terms that are used in the Bill.

The Chairperson:

That is straightforward. We will formally agree clause 31 later. We will now move on to clause 32, which deals with minor and consequential amendments.

Mr McMaster:

Clause 32 simply introduces schedule 6, which lists a considerable number of amendments that are consequential to the changes that are being made. It mainly involves the names of organisations, and so on.

The Chairperson:

We will formally agree clause 32 later. We will move on to clause 33, which deals with repeals.

Mr McMaster:

Clause 33 introduces schedule 7, which deals with legislation that must be repealed. As I said at an earlier meeting, we are not repealing legislation in general, but some specific provisions must be repealed, such as those that establish the boards, the Central Services Agency and the health and social services councils.

The Chairperson:

We will formally agree clause 33 later. We will move on to clause 34, which deals with commencement.

Mr McMaster:

Clause 34 details when the various provisions of the Bill will come into operation. Those listed at clause 34(1) will come into effect immediately upon Royal Assent. They include: the duties and powers to make schemes in relation to the transfer of assets; the insertions into the Health and Personal Social Services (Special Agencies) ( Northern Ireland) Order 1990; and technical provisions that allow for the making of Orders and regulations, and so on. Those provisions need to be in effect from day one.

Subsection 34(2) states:

“The following provisions come into operation on Royal Assent insofar as they confer power to make regulations or orders —”

It goes on to list those provisions. All other provisions will require a commencement Order, which is subordinate legislation that will come before the Committee. The Order will simply state that the provisions will come into effect on a particular date. It may be that the target date for the establishment of the new structures —1 April 2009 — cannot be met, so that provision allows for some flexibility.

The Chairperson:

We will formally agree clause 34 later. Clause 35 deals with the short title, which is self-explanatory. We can all grasp that, so there should be no need for any questions. We will formally agree the clause at a later meeting.

We now move on to the remaining schedules. We have already dealt with schedule 5, which covers the transfer of assets, and so on. Schedule 6 deals with minor and consequential amendments.

Mr McMaster:

There are a couple of technical changes to schedule 6. Again, there were drafting errors — perhaps I should not call them that; our draftsmen would not particularly like it. At page 53, line 39, paragraph 18(1) provides for an amendment to sections 51(1) and 51(2) of the Health and Personal Social Services Act ( Northern Ireland) 2001. It reads:

“in subsections (1) and (2) for ‘or the Agency’ substitute ‘, the Regional Board or RAPHSW’;”.

That line deals with the Central Services Agency, and it should read the “regional support services organisation”. That is a mistake. It does not reflect any change in policy; it should always have mentioned the regional support services organisation, or whatever name it will be given in future.

The Chairperson:

That is everything except for schedule 7, which deals with repeals.

Mr McMaster:

That schedule simply lists the legislation that we are repealing.

The Chairperson:

I do not think that, at this stage, we will start the formal clause-by-clause scrutiny — I see the relief on members’ faces. I thank Ivan, Craig and Bernard for their much-appreciated help in explaining the Bill so clearly. A number of issues were queried, and DV, I hope that we will get more clarification on them. We can then begin to agree each of the clauses and schedules formally. Thank you for your attendance.