Official Report (Hansard)

COMMITTEE FOR HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY

Health and Social Care (Reform) Bill

25 September 2008

Members present for all or part of the proceedings: 
Mrs Iris Robinson (Chairperson) 
Mrs Michelle O’Neill (Deputy Chairperson) 
Dr Kieran Deeny 
Mr Alex Easton 
Mr Tommy Gallagher 
Mr Sam Gardiner 
Mrs Carmel Hanna 
Ms Claire McGill

Witnesses: 
Mr Richard Dixon ) Eastern Health and Social Services Council

The Chairperson (Mrs I Robinson):

I welcome Richard Dixon, who is well known to the Committee as the chief officer of the Eastern Health and Social Services Council. I invite Richard to make a presentation, after which I will invite members to ask questions.

Mr Richard Dixon (Eastern Health and Social Services Council):

I thank the Chairperson and members for inviting the health and social services councils to present their views on the Health and Social Care (Reform) Bill to the Committee. My presentation is based on the response to the four councils’ consultation, which is a consensus view reached by the councils after careful consideration of the proposals, particularly the proposed establishment of a patient and client council.

In general, the four councils are supportive of the proposals. We believe that the new structures will offer the people of Northern Ireland a much-improved system of accountability and involvement.

We welcome a structure that has a clear line of management responsibility from the Minister and the Department, through the commissioning board, and to the providing trusts. The accountability of trusts to the regional health and social care board is a key strength of the proposed structures. The previous arrangement, in which commissioners and providers were jointly accountable to the Department but in which providers were not clearly accountable to the commissioners, was not ideal. Customers want a simple transparent system in which they can see how, where and by whom decisions are made. The proposed new structures will deliver that.

Over many years, the health and social services councils have represented patients and the public within the health and social care system. Therefore, we welcome the priority that the legislation gives to engagement with patients and the public. We welcome the creation of the patient and client council. We also welcome the representative nature of the new bodies, particularly the local commissioning groups. Above all, we welcome the new duties in the legislation on engagement with patients and the public, which are applicable to all the health and social care organisations.

I will now comment on our response to the proposed creation of the regional health and social care board and the regional agency for public health and social well-being. Our concern for a simple, clear and accountable structure is reflected in the comments that we made in our response to the proposed creation of those two bodies. Although we strongly support the creation of local commissioning groups and the delegation to them of significant commissioning responsibilities, we wanted it to be clear that they operate under the direction of, and are fully accountable to, the regional health and social care board.

Underlying central authority will help to ensure equity in the allocation of resources and access to services, will guard against the risk of a postcode lottery in Northern Ireland and will ensure that regional, as well as local, interests are taken fully into account. A regional authority will benefit those in small and dispersed communities, such as those who live with a rare condition who may — and I emphasise “may” — fall below the radar of local commissioners and their priorities. For a similar reason, we said that the regional agency for public health and social well-being should be accountable to the regional board. We were concerned that a separation of the public-health functions in that manner would lead to silo thinking — a territoriality among organisations that could work against the best interests of patients and the public.

However, we are comforted by the Minister’s recognition of those concerns in his response to the consultation and by his commitment to the production of a framework document that makes abundantly clear the respective functions and interrelationship of the new health and social care organisations.

The proposals for the patient and client council are in line with the views expressed by all four health and social services councils throughout the planning process. We welcome the clarity of the proposed patient and client council’s functions, the place it will be given in the new structures, its independence and the duty placed on all health and social care organisations to engage with it, which is enshrined in the legislation.

The issue of most concern to members of health and social services councils in the development and delivery of the patient and client council is how local representation will be preserved and maintained. Regardless of how that is worked out in secondary legislation and in implementation, members of health and social services councils will want an organisation that is clearly rooted in local communities and which equitably hears the local voice. Notwithstanding that, the members of health and social services councils recognise the importance of having a single co-ordinated organisation to formulate and express diverse local views and, consequently, welcome the broad consensus of opinion, in response to the consultation, that the patient and client council should be a single body rather than five local and autonomous groupings.

In conclusion, the collective view of the health and social services councils is that they are able to support the structures that are set out because they are, in principle at least, capable of delivering fully accountable services and seeking the involvement of patients and the public in all their functions.

Dr Deeny:

Thank you for the presentation, Richard. I have worked in the Health Service for many years and am very interested in this issue. Are you in favour of one patient and client council or one patient and client council that has five offices?

Mr Dixon:

We are in favour of one patient and client council that has five local offices.

Dr Deeny:

As with any consumer council, the patient and client council is a patients’ advocate. How many members will a patient and client council have? How much clout will it have to stand up for patients? I assume that the five offices will be in the confines of the five trusts; how many people will be employed in those five offices? As a GP, people visit me to discuss health issues. For example, someone rang me at lunchtime with a complaint. Should people who complain be directed to one of the five offices, which will then refer them to the patient and client council?

Mr Dixon:

There are a number of issues there, and I will try to take them in turn. Matters relating to membership and structures are currently under debate and discussion.

We imagine that there will be a regional patient and client council, which will have a membership of at least 15 people. However, it will be difficult to balance the need for the council to be representative with the need for it to be a board of governors that looks after an independent organisation. The members of the four health and social services councils currently work on a voluntary basis. We have no executive functions, and we are looked after by the boards, hence I am called an officer rather than an executive. Nevertheless, we anticipate that the regional patient and client council may have a similar make-up, and there will be a genuine attempt to ensure that it is representative of local groups. We are unsure about the size and composition of the local groupings in each of the trusts and local commissioning groups areas, but we may be less constrained, provided we have the freedom to recruit people that the patient and client council regards as appropriate or representative of an area and provided a clear link is created between it and the regional body.

We imagine that regional body members will be paid. The local groups may remain voluntary, and that would provide more latitude, but there would have to be an absolute link between those local groups and the regional body.

We imagine that the patient and client council will have five offices that will deliver three core functions for their respective areas. Those functions are: advocacy for individuals with complaints; liaison; and working, and maintaining a relationship, with the local trust, the local commissioning group and other relevant bodies, including the voluntary and community sector. Furthermore, the offices will actively engage with communities. It is reflected in our response that representation will be contained within committee membership, but it is always augmented, whether by a local commissioning group or a patient and client council, by an active ongoing programme of engagement with communities. The officers will go out and meet people and bring back their views, as well as take in the views of members of local committees.

Access requires work, because, with the best will in the world, even with five local offices, they will not be accessible or local to everyone in that patch. We hope that serious consideration will be given to ideas such as accessible clinics for advocates, access to the Internet and to new technologies to a greater extent than was ever the case with the health and social services councils. You are correct to point out that access is of primary importance.

Lastly, the powers of the patient and client council are greatly augmented by the Bill. A duty is placed on all health and social care organisations to engage with the patient and client council and to listen to what it has to say and to have due regard for it. That is a significant additional power that gives the patient and client council influence to a greater extent than the health and social services councils now have.

The requirement that all health and social care organisations produce consultation and engagement strategies will address how they are communicating and working with the people whom we serve. Those strategies will be approved by the Department of Health, Social Services and Public Safety only after consultation with the patient and client council. Again, that is another significant additional power.

Mr Gallagher:

Richard, you spoke about people working for the patient and client council, but most of its members will be unpaid. Is that correct? If so, it will be important for members who take time off work to receive appropriate remuneration, as they are making a valuable input into council discussions, formulation of plans, and so on.

In your submission, your response to clause 8(2) of the Health and Social Care (Reform) Bill is that the regional board’s functions do not include any reference to balance of regional, strategic commissioning and locally responsive commissioning.

It is important for that issue to receive a good deal of attention as the Bill progresses, because the public have many questions about disparity. People in the west, for example, ask why home helps there are paid at a different rate than in other areas and why, across all the trusts and boards, some areas provide vulnerable groups with more support than others. It has always been difficult to obtain accurate information about such variations, and figures must emerge to identify how much money has been allocated to different areas.

Is that what you were getting at? If so, have you any ideas about how to improve that situation, because the subject has been discussed in Committee and no answers have been forthcoming. How could more balanced commissioning be achieved?

Mr Dixon:

The theme of the councils’ response was to make a clear statement on the need for central leadership and direction that will, and should, provide equity across Northern Ireland. In saying that, we do not wish to detract from the important local agenda that requires local responsiveness. We clearly stated our support for those structures that involve locally elected representatives, engage with communities and decide what people in the area need and want.

However, any proposals should arrive at a central point at which someone makes a decision. Among the duties of that individual should be to ensure equity of access, so that a person in Strabane will have the same experience of a service as a person in Newtownards. That is the business of decision-making; it is why a central authority is necessary, and it is the underlying theme of our response. Until now, such an authority has not existed.

We stated in our response that the fragmented nature of the planning and delivery of care through multiple organisations in the old system was a disadvantage and should not be replicated in the new structures.

Mrs McGill:

Thank you, Richard, for mentioning Strabane; I am grateful to you for doing so. I want to put on record that I welcome that and the fact that equality of service, provision, and so forth, that has not existed thus far, will happen.

The Chairperson:

That was a fairly simple and straightforward comment. Members have no further questions. Thank you, Richard, for taking the time to meet the Committee and for your presentation.