Session 2008/2009

First Report

Committee for Health, Social Services and Public Safety

Report on the Health and Social Care (Reform) Bill (NIA 21/07)

TOGETHER WITH THE MINUTES OF PROCEEDINGS, MINUTES OF EVIDENCE
AND WRITTEN SUBMISSIONS RELATING TO THE REPORT

Ordered by The Committee for Health, Social Services and Public Safety
to be printed 13 November 2008

Report: 10/08/09R (Committee for Health, Social Services and Public Safety)

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Membership and Powers

The Committee for Health, Social Services and Public Safety is a Statutory Departmental Committee established in accordance with paragraphs 8 and 9 of the Belfast Agreement, section 29 of the Northern Ireland Act 1998 and under Standing Order 46.

The Committee has power to:

Consider and advise on Departmental budgets and annual plans in the context of the overall budget allocation;
Consider relevant secondary legislation and take the Committee stage of primary legislation;
Call for persons and papers;
Initiate inquiries and make reports; and
Consider and advise on any matters brought to the Committee by the Minister for Health, Social Services and Public Safety

The Committee has 11 members including a Chairperson and Deputy Chairperson and a quorum of 5.

The membership of the Committee is as follows:

Mrs Iris Robinson MP (Chairperson)
Mrs Michelle O’Neill (Deputy Chairperson)

Mr Thomas Buchanan       Mrs Carmel Hanna
Dr Kieran Deeny               Mr John Mccallister
Mr Alex Easton                 Mrs Claire McGill¹
Mr Tommy Gallagher        Ms Sue Ramsey
Mr Sam Gardiner²

¹ with effect from 20 May 2008 Mrs Claire McGill replaced Ms Carál Ní Chuilín.
² with effect from 15 September 2008 Mr Sam Gardiner replaced Rev Dr Robert Coulter.

Executive Summary

Introduction

Consideration of the Bill

Clause by clause consideration of the Bill

Appendix 1

Minutes of Proceedings

Appendix 2

Minutes of Evidence

Appendix 3

Written Submissions

Appendix 4

Written Evidence and other Correspondence considered by the Committee

Appendix 5

List of Witnesses

Executive Summary

1. The stated purpose of the Bill is ‘to provide the legislative framework within which the proposed new health and social care structures can operate’. Prior to the introduction of the Bill the Committee heard evidence from a number of the organisations likely to be affected by the provisions. Following its introduction a total of 30 organisations responded to the Committee request for written evidence. The Committee took further evidence from a number of key organisations before undertaking a formal clause by clause scrutiny of the Bill.

2. During the clause by clause consideration the Committee raised a number of concerns with the Department including issues highlighted in the oral and written evidence to the Committee. The Committee agreed that it was content with clauses 2 and 3, clause 7, clauses 10 to 12, clauses 15 to 17, clause 19, clauses 22 to 35, and schedules 1, 3, 4 and 7.

3. The Department agreed to a proposal from the Committee to change the name of the ‘Regional Support Services Organisation’ to the ‘Regional Business Services Organisation’ in clause 14 and throughout the Bill. The Department agreed that the acronym “RAPHSW” be replaced with the term “Regional Agency” in clause 1 and throughout the Bill.

4. The Department accepted a number of amendments proposed by the Committee to clauses relating to consultation. It accepted amendments to clauses 4 and 6 relating to the requirement of the Department to consult in relation to its power to determine priorities and objectives and to issue directions. The Department agreed to strengthen the consultation provision in clause 5 on the production of a framework document for all health and social care bodies and the provision in clause 9 about consultation to be undertaken by the Local Commissioning Groups. The Committee welcomed the proposal by the Department to amend clause 8 to provide for joint sign-off of the commissioning plan by the Regional Board and the Regional Agency.

5. The Committee was divided on the merits of a separate regional agency for public health and social well-being set out in clause 12. Most members supported the proposed agency arguing that a much stronger public-health message is needed. A number of members argued that setting up a separate agency would create another layer of bureaucracy and that its functions could be dealt with by the regional board. The Department accepted drafting amendments to clause 13 relating to the functions of the regional agency.

6. The Department accepted an amendment to clauses 18 to strengthen the duty on health and social care bodies to take account of the views of the Patient and Client Council and an amendment to clause 20 about taking account of comments submitted in response to a consultation. The Department accepted an amendment to clause 21 to place a duty on trusts to exercise their functions with the aim of reducing health inequalities. The Committee had concerns around the principle of public-private partnerships and suggested the inclusion of a reference to ensuring the long term financial viability and value of any public-private partnership schemes. Following consideration the Committee agreed the clause as drafted. The Committee questioned the procedures for making subordinate legislation set out in clause 29 and after consideration agreed to the clause as drafted. The Department accepted a minor correction to schedule 2 and advised the Committee of drafting amendments to be made to schedules 2, 5 and 6.

Introduction

1. The Health and Social Care (Reform) Bill (NIA 21/07) (the Bill) was referred to the Committee for consideration in accordance with Standing Order 33(1) on completion of the Second Stage of the Bill on Tuesday 1 July 2008.

2. The Minister for Health, Social Services and Public Safety (the Minister) made the following statement under section 9 of the Northern Ireland Act 1998:

“In my view the Health and Social Care (Reform) Bill would be within the legislative competence of the Northern Ireland Assembly.”

3. The Explanatory and Financial Memorandum states that ‘the rationale behind the reform of the health and social care system is to put in place structures which are patient-led, patient-centred and responsive to the needs of patients, clients and carers as well as being more effective and efficient (releasing resources for investment in front line health and social care).’ The stated purpose of the Bill is ‘to provide the legislative framework within which the proposed new health and social care structures can operate.’

4. During the period covered by this Report, the Committee considered the Bill and related issues at ten meetings. The relevant extracts from the Minutes of Proceedings for these meetings are included at Appendix 1.

5. The Committee had before it the Health and Social Care (Reform) Bill (NIA 21/07) and the Explanatory and Financial Memorandum that accompanied the Bill.

6. On referral of the Bill to the Committee after Second Stage, the Committee wrote on 4 July 2008 to key stakeholders and inserted advertisements in the Belfast Telegraph, Irish News and News Letter seeking written evidence on the Bill by 22 August 2008.

7. A total of 30 organisations responded to the request for written evidence and a copy of the submissions received by the Committee is included at Appendix 3.

8. Prior to the introduction of the Bill the Committee was briefed by the Minister on 6 March 2008 about the proposals for the reform of the health and social care system. The Committee took evidence from the Health Promotion Agency on 22 May 2008 and evidence from the Institute for Public Health and the Northern Ireland Local Government Association on 19 June 2008 about the proposals. The Committee took evidence from the Mental Health Commission on 3 July 2008. Following the referral of the Bill for Committee Stage the Committee took evidence from Departmental officials on 11 September 2008 about the policy behind the Bill and its general provisions. The Committee took evidence from the Central Services Agency on 18 September 2008; from the Health and Social Services Boards, the Health and Social Services Councils, and the Regulation and Quality Improvement Authority on 25 September 2008; from the Royal College of Nursing, the British Medical Association (NI), and the Allied Health Professions Federation on 2 October 2008. The Minutes of Evidence are included at Appendix 2.

9. The Committee began its clause by clause scrutiny of the Bill on 2 October 2008 and concluded this on 6 November 2008 – see Appendix 2.

Extension of Committee stage of the Bill

10. On 3 November 2008, the Assembly agreed to extend the Committee Stage of the Bill to 5 December 2008.

Report on the Health and Social Care (Reform) Bill

11. At its meeting on 13 November 2008, the Committee agreed its report on the Bill and agreed that it should be printed.

Consideration of the Bill

12. The Department issued its ‘Proposals for Health and Social Care Reform’ for consultation on 18 February 2008 with a closing date for submissions of 12 May 2008. Following this consultation period, and prior to the introduction of the Bill, the Committee took evidence from a number of organisations. The Committee took evidence from the Health Promotion Agency and the Institute of Public Health in Ireland on 22 May 2008 and 19 June 2008 respectively. The Health Promotion Agency argued that public health and health improvement are complex issues that require collaboration and partnership working and that “current structures do not easily facilitate those partnerships or local working”. The Health Promotion Agency described the current restructuring proposals as offering “a major opportunity for change” and argued that “any proposed new organisations should make public health, particularly health improvement, a priority”.

13. The Institute of Public Health welcomed the proposed regional public health agency as “a major opportunity to bring together the different aspects of public health and to give public health a much stronger voice”. The Institute stated that “the agency must be multi-sectoral. Public health is not about just the health service, … but about other areas such as housing, education, agriculture, transport and rurality. This organisation must be outward looking and forward looking. There is here a fantastic opportunity to create in Northern Ireland something that is truly world class”. The Institute argued that “there must be strong links between the [regional health and social care] board and the proposed regional public health agency, but it is not clear how those links would be taken forward”. The Institute also called for the regional public health agency to have a stronger function relating to research and information.

14. The Northern Ireland Local Government Association (NILGA), in evidence to the Committee on 19 June 2008, welcomed “the proposals for a much stronger and closer role for local government” and said it would mean that “the local community will have ownership of the services, feel more involved, have better feedback, and enjoy an improved sense of well-being”. NILGA called for local government to be seen as “an organisation that, in conjunction with partners, can deliver health improvement. It has responsibilities for environmental health, heath improvement through the provision of leisure and open spaces, community development, good relations, economic development, and so forth”. NILGA also recognised that capacity building for local councilors needed to be addressed and that council members working on health bodies must be properly supported and briefed in their work. NILGA was strongly supportive of the proposal for a regional public health agency.

15. The Bill provides for the dissolution of the Mental Health Commission and the transfer of its functions to the Regulation and Quality Improvement Authority. The Committee took evidence from the Mental Health Commission on 3 July 2008. The Commission argued that it should be retained as a separate organisation but, recognising that this was unlikely, made a number of suggestions about how its functions, particularly those relating to the Mental Health (Northern Ireland) Order 1986, should be delivered within the Regulation and Quality Improvement Authority. The Committee took evidence from the Regulation and Quality Improvement Authority on 25 September 2008 when it reported that “over the summer we took a strategic approach on an operational level to discuss and plan how the services will come together, if the legislation comes into effect from 1 April 2009”. The Regulation and Quality Improvement Authority reported that the Authority and the Mental Health Commission established a project board to develop an action plan and full agreement has been reached on how the work in the action plan will be taken forward.

16. Departmental officials briefed the Committee on 11 September 2008 on the general provisions in the Bill. The Committee recognised the tight timescale to deliver the proposed changes by 1 April 2009 and noted that the purpose of the Bill is to provide a legislative framework for the proposed new healthcare structures. The officials explained that

“The Bill seeks, either in the body of the document itself or by securing the powers to make subordinate legislation, to establish parameters within which each of those health and social care bodies will be permitted to operate; what is expected of them; and the necessary governance and accountability arrangements that would support the effective delivery of health and social care in Northern Ireland.”

17. The officials reported on the outcome of the consultation and stated that there was broad support for the thrust of the proposals. They said that there was much support for the establishment of a regional board and a regional agency for public health and social well-being and indicated that the name of the regional agency “was chosen to try to get across the message that the agency will adopt a comprehensive approach to the public health and social well-being of the entire population”. They indicated that comment on the regional support services organisation was limited while there was “overwhelming support” for the proposed patient and client council model.

18. Officials reported that among the concerns raised during the consultation were the relationship between the regional board and the regional agency, representation of the voluntary and community sector, and the level of social care representation on the local commissioning groups. The Committee questioned the inclusion in the Bill of a provision relating to public-private partnerships and the officials explained that legal clarification on the issue was needed and stated that “It is simply a permissive provision, and it provides the legal clarity that a PPP scheme can be used if it is required and is judged appropriate in individual cases.” In response to a question about deficiencies in performance management identified in the Appleby Report the officials explained that a proposed definitive framework for performance management was being prepared and would be published shortly.

19. The Committee took evidence from the Central Services Agency on 18 September 2008. The Agency outlined its current role and indicated that its replacement by the proposed Regional Support Services Organisation would represent a natural progression with the new organisation providing a wider range of services. Among the additional functions which will move to the new body are the health and personal social services superannuation scheme, some payment functions relating to GPs, with ICT and IT services transferring in the medium term and, in the longer term, accounts services and human resources and recruitment are areas under consideration. The Central Services Agency made a case that the name of the new body should be changed to the ‘Regional Business Services Organisation’ to better reflect the business and business-support functions it will provide.

20. The Committee took evidence from the Health and Social Services Boards on 25 September 2008. The Boards welcomed the general thrust of the proposals and particularly the enhanced profile for public health and well-being. The Boards recognised that “there is a particular challenge in bringing together [those] different interfaces, particularly those between the regional health and social care board and the regional agency for public health and social well-being”. The Boards stressed the importance of the Framework Document under Clause 5 in providing the checks and balances on accountability between the various bodies.

21. The Committee also took evidence from the Health and Social Services Councils on 25 September 2008. The Councils welcomed the clear line of management responsibility in the structures from the Minister and the Department, through the commissioning board, and to the providing trusts. They stated that “the accountability of trusts to the regional health and social care board is a key strength of the proposed structures”. The Councils welcomed the creation of the patient and client council and recognised “the importance of having a single co-ordinated organisation to formulate and express diverse local views”. However, they also had some concerns about how local representation will be preserved and maintained.

22. The Councils argued that the regional agency for public health and social well-being should be accountable to the regional board. They acknowledged that concerns about the separation of functions between the two bodies had been addressed by the Minister’s “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”.

23. The Royal College of Nursing, in evidence to the Committee on 2 October 2008, supported “the Minister’s stated intention to put the public-health agenda at the heart of the health and social care system”. They shared the concern echoed by others that “how the local commissioning groups, the regional health and social care board and the regional agency for public health and social well-being work together is central to the delivery of those objectives”. They called for the language in the Bill to be strengthened and that “all plans should be signed off jointly by the local commissioning groups, the board and the agency. In that way no one body has primacy over the others. We believe that that will provide checks and balances that will help to ensure that good local decisions are made”.

24. The RCN welcomed the involvement of local voices in the commissioning of services but had some concerns about the weight that will be given to the local representatives and professionals involved. It stated “if commissioning is to be truly local, an agreed level of authority must sit with local commissioning groups; otherwise, groups will be relegated to no more that debating chambers”.

25. The British Medical Association (NI), in evidence to the Committee on 2 October 2008, strongly welcomed the establishment of a regional health and social care board and the slimming down of the Department but stressed that this reduction in bureaucracy must produce savings which will be released into front-line patient care. The BMA welcomed the creation of a new regional support services organisation but had concerns about the size of the organisation and particularly how it will be structured. The BMA also welcomed in principle the establishment of a regional agency for public health and social well-being but was “slightly concerned about the lack of clarity on how the organisations will communicate with one another”.

26. The BMA expressed major concerns about the top-down approach to managing commissioning and argued that “an opportunity will be lost if we create local commissioning groups, but ignore the potential for further development at a community level”. The BMA questioned whether the proposed local commissioning groups with populations of 300,000 would be so very different from the existing health boards and argued for structures to operate at a level of 50,000 patients or fewer. They recognised that under the proposed structure this is not precluded but would wish to see it encouraged. The BMA also expressed opposition to the inclusion of elected local representatives on the local commissioning groups arguing that if they are included “the scrutiny and accountability of local councils may be eroded”.

27. In evidence to the Committee on 2 October 2008 the Allied Health Professions Federation, while welcoming the creation of a single regional health and social care board, had reservations about the representation of allied health professions on the board. The Federation also welcomed “the emphasis that the regional agency for public health and social well-being will place on health promotion and protection”. The Federation expressed some concerns about the proposed commissioning arrangements. These included the need for the allied health professional on each local commissioning group to have access to adequate support and advice structures and the need for clarification on the extent of the financial controls. The Federation argued that “care is also needed to ensure that there is no duplication between the regional board’s role and that of the LCGs. … … Regional commissioning must have a local flavour – localities must have an input into what is commissioned regionally”.

Clause by clause consideration of the Bill

28. The Committee undertook its clause by clause scrutiny of the Bill on 2, 9, 16, 23 October and 6 November 2008 – see Minutes of Evidence in Appendix 2.

Clause 1 – Restructuring of administration of health and social care

29. The Committee raised two concerns relating to this clause. The first related to the use of the acronym “RQIA” in subsection (2)(b) and throughout the Bill to refer to the Health and Social Care Regulation and Quality Improvement Authority. The Committee suggested that “Health and Social Care RQIA” be used. However, following consideration the Department did not accept the proposal arguing that

“as the purpose of an acronym is to provide a shortened version of the full name, “Health and Social Care RQIA” is not felt to be appropriate. In addition, “RQIA” is a recognised and accepted acronym for the organisation and therefore it is considered that it should remain.”

After further consideration the Committee agreed to the use of ‘RQIA’.

30. The second concern related to the use of the acronym “RAPHSW” in subsection (5)(b) and throughout the Bill which the Committee considered cumbersome and unwieldy. Following consideration the Department proposed that “Regional Agency” be substituted for “RAPHSW”. The Committee agreed to clause 1 as drafted subject to the proposed amendment to subsection (5)(b).

Proposed amendment, clause 1(5)(b), “leave out ‘RAPHSW’ and insert ‘the Regional Agency’.

Clause 2 – Department’s general duty

31. The Committee agreed to clause 2 as drafted.

Clause 3 – Department’s general power

32. The Committee agreed to clause 3 as drafted.

Clause 4 – Department’s priorities and objectives

33. The Committee noted that clause 4 will make it a statutory requirement for the Department to determine its priorities and objectives for the provision of health and social care. The Department can revise those priorities and objectives but before doing so it must consult with such bodies or persons as it thinks appropriate. The Committee had concerns that section (3) releases the Department from the obligation to consult “where because of the urgency of the matter” it is necessary to act without consultation. The Committee proposed that the provision be modified by the inclusion of the word “extreme” before “urgency” and that where no consultation takes place a report will be submitted to the health and social care body concerned. Following consideration the Department did not accept the proposed inclusion of the word “extreme” arguing that

“this creates a difficulty in attempting to define and justify what type of situation is “urgent” as compared to one that is “extremely urgent”. In addition, the use of the term “extremely urgent” would mean that the Department would be required to consult in instances where the circumstances were just “urgent” and this would appear to defeat the purpose of the provision”.

After further consideration the Committee accepted section (3) as drafted.

34. The Department accepted the need for a report to be submitted to the health and social care body concerned where because of the urgency of the matter no consultation takes place and agreed to amend the clause accordingly. The Committee agreed to clause 4 as drafted subject to the proposed amendment to section (3).

Proposed amendment, clause 4(3), “leave out subsection (3) and insert:

(3) Where the Department is of the opinion that because of the urgency of the matter it is necessary to act under subsection (1) without consultation—

(a) subsection (2) does not apply; but

(b) the Department must as soon as reasonably practical give notice to such bodies as it thinks appropriate of the grounds on which the Department formed that opinion.”

Clause 5 – The framework document

35. The Committee noted that clause 5 provides a statutory requirement on the Department to produce a ‘framework document’ for all health and social care bodies. This is intended to clearly specify to each body what is expected of it and the procedures it must follow to perform certain functions. The Department is required to keep the document under review and to revise it as and when necessary. The clause also provides that the Department should consult with each body in respect of its functions and may consult with any other bodies that it considers appropriate. The Committee was concerned that the provision in subsection (5)(b) that the Department “may consult any other bodies or persons the Department considers appropriate” was too weak and proposed that ‘may consult’ should be replaced by ‘will consult’. Following consideration the Department accepted the proposal and agreed to amend the clause. The Committee agreed to clause 5 as drafted subject to the proposed amendment to subsection (5)(b).

Proposed amendment, clause 5(5)(b), “leave out ‘may’ and insert ‘’will’.

Clause 6 – Power of Department to give directions to certain bodies

36. The Committee noted that clause 6 will give the Department power to issue general or specific directions to the regional board, the regional agency and the regional support services organisation in carrying out their functions. The Committee had concerns that subsection (3)(a), similar to the provision in clause 4(3), enables the Department in cases of urgency to issue a direction without first consulting the health and social care body concerned. The Committee proposed similar amendments as in clause 4, that is, to insert ‘extreme’ before ‘urgency’ and to report retrospectively where action is taken without consultation. Following consideration the Department did not accept the proposal to insert the word “extreme” before the word “urgency” but did accept the need for a report to be submitted to the health and social care body concerned where because of the urgency of the matter no consultation takes place and agreed to amend the clause accordingly. The Committee agreed to clause 6 as drafted subject to the proposed amendment to section (3).

Proposed amendment, clause 6(3), “leave out subsection (3) and insert:

(3) Where the Department is of the opinion that because of the urgency of the matter it is necessary to act under subsection (1) without consulting the body concerned—

(a) subsection (2) does not apply; but

(b) the Department must as soon as reasonably practical give notice to that body of the grounds on which the Department formed that opinion.

(3A) Where the Department is of the opinion that (for any reason other than the urgency of the matter) it is not reasonably practical to comply with subsection (2)—

(a) that subsection does not apply; but

(b) the Department must as soon as reasonably practicable give notice to the body concerned of the grounds on which the Department formed that opinion.”

Clause 7 – The Regional Health and Social Care Board

37. The Committee noted that clause 7 establishes a Regional Health and Social Care Board to replace the existing four Health and Social Services Boards. The Committee agreed to clause 7 as drafted.

Clause 8 – Functions of the Regional Board

38. The Committee noted that this clause sets out the functions of the regional board which are chiefly those transferred to it from the existing four Health and Social Services Boards and any other function that the Department directs. The Committee also noted that section (3) requires the Board to draw up an annual commissioning plan and in doing so it must consult the Regional Agency and have due regard to the views of the Agency. Uncertainty about the relationship between the various bodies and particularly the Regional Board and the Regional Agency has been a recurring theme of the written submissions received by the Committee. The Committee acknowledges that to some extent those concerns may be addressed in the framework document to be drawn up under clause 5. However, the Committee recognises the importance of the role of the two main bodies in drawing up the commissioning plan. The Committee, therefore, welcomes the proposal by the Department to amend this clause to provide for joint sign-off of the commissioning plan by requiring the prior approval of the Regional Agency to the contents of the plan. The Committee agreed to clause 8 as drafted and supports the proposal to amend section (3) requiring the Regional Board and the Regional Agency to jointly sign-off the commissioning plan.

Clause 9 – Local Commissioning Groups

39. The Committee noted that clause 9 provides for the establishment of the Local Commissioning Groups and that the Department is proposing five such groups to align with the existing trust boundaries. The Committee raised concerns, highlighted by the Royal College of Nursing, calling for the provision in subsection (4)(b)(i) relating to consultation with the regional agency, to be strengthened. Following consideration the Department accepted the need to amend the subsection and has proposed a revised text. The Committee agreed to clause 9 as drafted subject to the proposed amendment to subsection (4)(b)(i).]

Proposed amendment, clause 9(4)(b)(i), “leave out ‘consult RAPHSW’ and insert ‘work in collaboration with the Regional Agency’.

Clause 10 – Power of Regional Board to give directions and guidance to HSC trusts

40. The Committee noted that clause 10 gives the Regional Board power to give directions to trusts about the carrying out of their functions. It also places a duty on trusts to comply with those directions. The Committee agreed to clause 10 as drafted.

Clause 11 – Provision of information, etc. to Regional Board by HSC trusts

41. The Committee agreed to clause 11 as drafted.

Clause 12 – The Regional Agency for Public Health and Social Well-being

42. The Committee noted that clause 12 provides for the establishment of a separate regional agency for public health and social well-being. A number of members questioned the merits of setting up a separate agency arguing that it creates another layer of bureaucracy, that it is contrary to the aim of creating more efficient structures, and that its functions could be dealt with by the regional board. Other members strongly supported a separate agency arguing that a much stronger public-health message is needed.

43. The Department explained that one of the driving factors underpinning the current reform proposals was the need to address existing inequalities in morbidity and mortality and that to do this the profile of public health and social well-being needed to be much higher up the agenda and issues dealt with in a more focused manner. The Department argued that

“another important issue was the need to develop improved partnerships, not only with local government but with the full range of public-sector stakeholders and others who have a strong influence and a role to play in improving public health and social well-being”.

On the question of whether these functions could be dealt with by the proposed regional board the Department argued

“if responsibility for public health and social well-being is to lie with a regional board that will inevitably be driven by the significant concerns and priorities that must be addressed, the prioritisation of funds specifically targeted at public health and social well-being can necessarily take second place”.

The Chief Medical Officer stated bluntly “In a single organisation the public-health agenda would disappear”. The Department pointed out that during the consultation 59% of those who discussed the issue of an agency were supportive, 20% were undecided and 21% were not supportive.

44. In response to concerns that the separate agency must not be a talking shop but must be able to make a difference the Department stated

“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 … 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.”

45. Following detailed discussion on the issue a proposal ‘that the regional public health agency be incorporated into the proposed regional board under clause 7’ was not carried. The Committee agreed to clause 12 as drafted. (For details of the divisions see the Minutes of Proceedings of 6 November 2008 in Appendix 1)

Clause 13 – Functions of RAPHSW

46. The Committee noted that clause 13 details the functions of the Regional Agency and that the agency will have both health improvement functions and health protection functions. The health improvement functions include the reduction in health inequalities and health promotion. The health protection functions relate to protection against communicable diseases and other wide ranging dangers to the health and social well-being of the public. The Committee raised three drafting concerns about the clause which were highlighted in written submissions. Disability Action called for subsection (2)(b) to be expanded to better outline the health promotion function while the British Red Cross asked for the same subsection to be strengthened by including a reference to ‘risk reduction’. Following consideration the Department accepted the proposal relating to health promotion but did not accept the inclusion of ‘risk reduction’.

47. The Association of the British Pharmaceutical Industry called for the Regional Agency to be required to consult the Committee for Health, Social Services and Public Safety about making ‘persons, materials and facilities’ available to other bodies. Following consideration, the Department did not accept this proposal pointing out that “to insert a provision to the effect that support services could only be provided to other bodies after consultation with the Health Committee would be a significant inhibitor to the day to day performance of functions and prove to be extremely bureaucratic”. The Committee accepted this argument. The Committee agreed to clause 13 as drafted subject to the proposed amendment to subsections (2)(b).

Proposed amendment, clause 13(2)(b), “after ‘health promotion’ insert “, including in particular enabling people in Northern Ireland to increase control over and improve their health and social well-being’.

Clause 14 – The Regional Support Services Organisation

48. The Committee noted that clause 14 establishes a regional support services organisation to replace the Central Services Agency and to undertake additional functions. The Committee noted that the Central Services Agency in its evidence made a case that the name of the new body should be changed to the ‘Regional Business Services Organisation’ to better reflect the business and business-support functions it will provide. The Central Services Agency also pointed out that the acronym RSSO could have unfortunate and unintended pronunciation. The Committee called for the name of the organisation to be changed and following consideration the Department agreed to amend the title of the body to the “Regional Business Services Organisation”. The Committee agreed to clause 14 subject to the proposed amendment to the title of the body.

Clause 15 – Functions of RSSO

49. The Committee noted that clause 15 sets out in broad terms the list of functions that the Regional Support Services Organisation is required to provide on behalf of health and social care bodies. The Committee raised an issue, highlighted by the Northern Health and Social Services Board, proposing that in subsection (3)(a) in relation to the securing the provision of services the word “equitable” should be included as well as “in the most economic, efficient and effective way”. Following consideration the Department did not accept the proposed amendment and argued that

“The RSSO, like all of the newly created bodies will be bound by existing legislative requirements of Section 75 of the Northern Ireland Act in relation to fairness to all. In addition, RSSO’s business is to provide a range of transactional and support services to a number of health and social care bodies. In most cases, the services it provides are in response to demand from those bodies and, as such, it would be difficult for RSSO to demonstrate that it will provide its services in an “equitable” way.”

The Committee agreed to clause 15 as drafted.

Clause 16 – The Patient and Client Council

50. The Committee noted that clause 16 establishes a new body to be known as the Patient and Client Council which will replace the existing four health and social services councils. The Committee was strongly supportive of the new council. The Committee agreed to clause 16 as drafted.

Clause 17 – Functions of the Patient and Client Council

51. The Committee noted that clause 17 sets out the four main functions of the Patient and Client Council, which include representing the interests of the public and promoting involvement by the public, as well as other provisions relating to how those functions are exercised. The Committee raised an issue relating to subsection (2)(a), highlighted by Disability Action, which proposes that the council should be required to consult the public “in an accessible way”. Following consideration the Department did not accept the proposed amendment and argued that the Disability Discrimination (NI) Order 2006 provides sufficient provision to ensure that public bodies consult in an accessible way.

52. Disability Action also questioned whether section (4) refers to reasonable adjustment under the Disability Discrimination Act or not. The Department advised that section (4) is about the Patient and Client Council making arrangements to the extent it considers necessary to meet all reasonable requirements to provide assistance to individuals making or intending to make complaints. As a public body bound by the provisions of the Disability Discrimination Act, the Patient and Client Council would be required to make any reasonable adjustment to meet any special needs in relation to disabled persons. Following further consideration the Committee accepted this explanation. The Committee agreed to clause 17 as drafted.

Clause 18 – Duty to co-operate with the Patient and Client Council

53. The Committee noted that clause 18 places a duty on health and social care bodies to co-operate with the Patient and Client Council. The Committee had concerns that the wording of section (6) – “a body to which this section applies shall have regard to any views expressed by the Patient and Client Council” – could allow the body to listen to the views but not necessarily act upon them. The Committee proposed that it be amended to “have due regard to”. Following consideration the Department accepted this proposal. The Committee agreed to clause 18 subject to the proposed amendment to section (6).

Proposed amendment, clause 18(6), “after ‘have’ insert ‘due’”.

Clause 19 – Public involvement and consultation

54. The Committee noted that clause 19 relates to public involvement in the planning and delivery of services and it places a duty on health and social care bodies to provide information, to obtain information on the needs of the population, and to encourage and assist people. The Committee raised an issue relating to subsection (1)(a), highlighted by Disability Action, which proposes that each body should be required to promulgate information “in accessible formats”. Following consideration the Department did not accept the proposed amendment for the reasons set out in relation to a similar issue at clause 17. After further consideration the Committee accepted the explanation. The Committee agreed to clause 19 as drafted.

Clause 20 – Public involvement: consultation schemes

55. The Committee noted that clause 20 requires health and social care bodies to show, in their consultation schemes, what arrangements are in place to consult with the Patient and Client Council and the recipients of health and social care. The Committee had concerns about the use of the phrase in subsection (3)(a) “to have regard to any comments” and proposed that, as in clause 17, this be amended to “have due regard to”. Following consideration the Department accepted this proposal. The Committee agreed to clause 20 as drafted subject to the proposed amendment to subsection (3)(a).

Proposed amendment, clause 20(3)(a), “after ‘have’ insert ‘due’”.

Clause 21 – Duty on HSC trusts in relation to improvement of health and social well-being

56. The Committee noted that clause 21 places a duty on each health and social care trust to exercise its functions with the aim of improving the health and social well-being of those for whom it provides care. The Committee raised an issue, highlighted by the Community Development and Health Network, which proposes that each trust should also have a duty to exercise its functions with the aim of reducing health inequalities. Following consideration the Department accepted the proposed amendment. The Committee agreed to clause 21 subject to the proposed amendment that after the words “the health and social well-being of” in line 2 is inserted the words “and reducing health inequalities between”.

Proposed amendment, clause 21, “after ‘of’ insert ‘, and reducing health inequalities between,’”.

Clause 22 – Public-private partnerships

57. The Committee noted that clause 22 relates to the forming of public-private partnerships to provide facilities or services for the promotion or provision of health and social care. The Committee expressed concerns around the principle of public-private partnerships. The Committee also proposed that the clause should include a reference to ensuring the long term financial viability and value of any schemes. The Department pointed out that this clause enables the new bodies to form or participate in forming Public-Private Partnerships but the existing DFP and Treasury guidance, which is binding on all organisations, makes it clear that the central concern of any procurement route is the achievement of value for money. The Committee agreed to clause 22 as drafted

Clause 23 – Schemes for transfer of assets and liabilities

58. The Committee agreed to clause 23 as drafted.

Clause 24 – Transfer of functions of Health and Social Services Boards

59. The Committee agreed to clause 24 as drafted.

Clause 25 – Transfer of functions of the Mental Health Commission

60. The Committee noted that clause 25 provides for the transfer of functions exercisable by the Mental Health Commission to the Regulation and Quality Improvement Authority. In oral evidence to the Committee the Mental Health Commission had expressed concerns about the proposed transfer but the Committee noted that in later evidence from the Regulation and Quality Improvement Authority the two organisations were working closely to implement the transfer. The Committee agreed to clause 25 as drafted.

Clause 26 – Transfer of functions of Central Services Agency

61. The Committee agreed to clause 26 as drafted.

Clause 27 – Amendment of statutory and other references to dissolved bodies, etc

62. The Committee agreed to clause 27 as drafted.

Clause 28 – Dissolution of special agencies

63. The Committee agreed to clause 28 as drafted.

Clause 29 – Orders, regulations, guidance and directions

64. The Committee noted that clause 29 deals with the procedures for making subordinate legislation under the Bill. The Committee also noted that subordinate legislation made under different procedures are subject to different levels of scrutiny and approval within the Assembly. The Committee asked what consideration had been given to whether the subordinate legislation should be subject to affirmative resolution or negative resolution. The Examiner of Statutory Rules provided advice to the Committee on this issue. The Department advised that

“Subsection (1) of the Clause provides that orders altering the functions of the proposed new Regional Agency (13(5)) and Regional Business Support Organisation (15(6)) and orders which include supplementary, incidental or consequential provisions to be used for expediency to give full effect to the Bill (30(1)) must use the affirmative resolution procedures. This is because it was considered that since such orders are akin to primary legislation and, therefore, more important and more likely to merit discussion they should be formally approved by the Assembly. The regulations and other orders which may be made principally relate to the day to day organisation of the various organisations and, therefore, considered more appropriate to the negative resolution procedure.”

The Committee agreed to clause 29 as drafted.

Clause 30 – Further provision

65. The Committee agreed to clause 30 as drafted.

Clause 31 – Interpretation

66. The Committee agreed to clause 31 as drafted.

Clause 32 – Minor and consequential amendments

67. The Committee agreed to clause 32 as drafted.

Clause 33 – Repeals

68. The Committee agreed to clause 33 as drafted.

Clause 34 – Commencement

69. The Committee agreed to clause 34 as drafted.

Clause 35 – Short title

70. The Committee agreed to clause 35 as drafted.

Schedule 1 – The Regional Health and Social Care Board

71. The Committee noted that schedule 1 deals with the membership of the Regional Board and also covers other provisions including committees, sub-committees, finance and accounts. The Committee agreed to schedule 1 as drafted.

Schedule 2 – The Regional Agency for Public Health and Social Well-being

72. The Committee noted that schedule 2 deals with the membership of the Regional Agency and also covers other provisions including committees, sub-committees, finance and accounts. The Department accepted that there was an error in paragraph 7(3) in that the reference to ‘the Regional Board’ should read ‘RAPHSW’. The Department also advised that there was an error in paragraph 6 relating to the resignation or removal of members of district councils who are appointed to the regional agency. The Department advised that it intends to bring forward a revised schedule 2 because of the large number of changes required as a result of the title changes. The Committee agreed to schedule 2 subject to the proposed amendments to paragraphs 6 and 7(3).

Schedule 3 – The Regional Support Services Organisation

73. The Committee noted that schedule 3 deals with the membership of the Regional Support Services Organisation and also covers other provisions including committees, sub-committees, finance and accounts. The Committee agreed to schedule 3 as drafted.

Schedule 4 – The Patient and Client Council

74. The Committee noted that schedule 4 sets out the arrangements for the operation of the Patient and Client Council and deals with its status, constitution, remuneration, staffing, procedures, finance and annual reports. The Committee agreed to schedule 4 as drafted.

Schedule 5 – Transfer of assets, etc

75. The Committee noted that schedule 5 deals with the transfer of assets and liabilities and outlines arrangements for the completion of annual reports and accounts of health and social care bodies that have been dissolved. The Department advised that it proposed to make an amendment to paragraph 2(6) to insert a reference to the ‘transferor’ organisations. The Department explained that the provisions, as currently drafted, do not exclude the ‘transferor’ organisations from the process of consideration of grievances. The Committee agreed to schedule 5 as drafted subject to the proposed amendment to paragraph 2(6).

Proposed amendment, schedule 5, paragraph 2(6)(a), “after the second ‘of’ insert ‘a transferor or’”

Schedule 6 – Minor and consequential amendments

76. The Committee noted that schedule 6 deals with amendments to other legislation as a result of the Bill. The Department indicated that it needed to make a technical amendment to the paragraph 18(1)(a) of the schedule, namely that the words ”the Regional Board or RAPSHW” will be replaced by “Regional Business Services Organisation”. The Committee agreed to schedule 6 as drafted subject to the proposed technical amendment.

Proposed amendment, schedule 6, paragraph 18(1)(a), “leave out ‘the Regional Board or RAPHSW’ and insert ‘RBSO’”

Schedule 7 – Repeals

77. The Committee agreed to schedule 7 as drafted.

Appendix 1

Minutes of Proceedings
Relating to the Report

Thursday, 6 March 2008
Room 135, Parliament Buildings

Present: Mrs Iris Robinson MP MLA (Chairperson)
Mr Thomas Buchanan MLA
Dr Kieran Deeny MLA
Mr Tommy Gallagher MLA
Mrs Carmel Hanna MLA
Mr John McCallister MLA
Ms Michelle O’Neill MLA (Deputy Chairperson)
Ms Sue Ramsey MLA

In Attendance: Mr Hugh Farren (Clerk)
Mr Mark McQuade (Assistant Clerk)
Mrs Noelle Bourke (Clerical Supervisor)
Mr Alister Strain (Clerical Supervisor)
Mr Joe Westland (Clerical Officer)

Apologies: Rev Dr Robert Coulter MLA
Mr Alex Easton MLA
Ms Carál Ní Chuilín MLA

The meeting commenced at 2.40 p.m. in closed session.

The meeting moved to Public Session at 3.07p.m.

3. Evidence session with the Minister for Health, Social Services and Public Safety

The Minister was accompanied by:

Dr Andrew McCormick Permanent Secretary
Dr Michael McBride Chief Medical Officer
Dr Miriam McCarthy Deputy Secretary Health Care Policy
Bernard Mitchell Modernisation Directorate
David Bingham Director Human Resources

The Minister briefed the Committee on proposals for Health and Social care reform then took questions from Members. The Minister then addressed other issues raised by Members. The Chairperson thanked the Minister and officials’ for attending.

[EXTRACT]

Thursday, 22 May 2008
Boardroom, Northern Ireland
Fire & Rescue Service, Lisburn

Present: Ms Michelle O’Neill MLA, Deputy Chairperson (In the Chair)
Dr Kieran Deeny MLA
Mr Alex Easton MLA
Mr Tommy Gallagher MLA
Mr John McCallister MLA

In Attendance: Mr Hugh Farren (Clerk)
Ms Hilary Bogle (Assistant Clerk)
Mrs Noelle Bourke (Clerical Supervisor)
Mr Joe Westland (Clerical Officer)

Apologies: Mrs Iris Robinson MLA (Chairperson)
Mr Thomas Buchanan MLA
Rev Robert Coulter MLA
Mrs Carmel Hanna MLA
Ms Claire McGill
Ms Sue Ramsey MLA

The meeting commenced at 2.58 p.m. in public session.

5. Evidence session with the Health Promotion Agency

Members took evidence from Dr Brian Gaffney, Chief Executive, Health Promotion Agency about the proposals to reform the health and social care system.

A question and answer session ensued. The chairperson thanked Dr Gaffney for attending.

[EXTRACT]

Thursday, 19 June 2008
Room 135, Parliament Buildings

Present: Ms Michelle O’Neill MLA, Deputy Chairperson (in the Chair)
Mr Thomas Buchanan MLA
Rev Robert Coulter MLA
Mr Alex Easton MLA
Dr Kieran Deeny MLA
Mrs Carmel Hanna MLA
Mr John McCallister MLA
Ms Claire McGill MLA
Ms Sue Ramsey MLA

In Attendance: Mr Hugh Farren (Clerk)
Ms Hilary Bogle (Assistant Clerk)
Mr Mark McQuade (Assistant Clerk)
Mr Alister Strain (Clerical Supervisor)
Mr Joe Westland (Clerical Officer)

Apologies: Mrs Iris Robinson MLA (Chairperson)
Mr Tommy Gallagher MLA

The meeting commenced at 2.37 p.m. in public session.

5. Evidence session with the Institute for Public Health on the Department’s proposals for health care reform

Members took evidence from the following witnesses:

Dr Jane Wilde Chief Executive, Institute for Public Health

Ms Claire Higgins Public Health development Officer, Institute for Public Health

2.55pm Mr Alex Easton joined the meeting.

3.06pm Ms Sue Ramsey left the meeting.

A question and answer session ensued. The chairperson thanked the witnesses for attending.

3.40pm the Committee adjourned

3.50pm the Committee reconvened

6. Evidence session with the Northern Ireland Local Government Association (NILGA) on the Department’s proposals for health care reform

Members took evidence from the following witnesses:

Ms Heather Moorhead Chief Executive, NILGA

Arnold Hatch President, NILGA

A question and answer session ensued. The chairperson thanked the witnesses for attending.

4.27pm Dr Deeny left the meeting

[EXTRACT]

Thursday, 3 July 2008
Senate Chamber, Parliament Buildings

Present: Mrs Iris Robinson MP MLA (Chairperson)
Mr Thomas Buchanan MLA
Mr Alex Easton MLA
Mrs Carmel Hanna MLA
Mr John McCallister MLA
Ms Sue Ramsey MLA

In Attendance: Mr Hugh Farren (Clerk)
Ms Hilary Bogle (Assistant Clerk)
Mr Mark McQuade (Assistant Clerk)
Mrs Noelle Bourke (Clerical Supervisor)
Mr Joe Westland (Clerical Officer)

Apologies: Rev Robert Coulter MLA
Dr Kieran Deeny MLA
Mr Tommy Gallagher MLA
Ms Claire McGill MLA
Mrs Michelle O’Neill MLA (Deputy Chairperson)

The meeting commenced at 2.39 pm in public session.

5. Evidence session with the Mental Health Commission

Members took evidence from the following witnesses:

Mr Paul McBrearty Chief Executive, Mental Health Commission

Mr Noel McKenna Chairperson, Mental Health Commission

Ms Clare Quigley Social Work Member of the Commission

Dr Brian Fleming Consultant Psychiatrist and Medical Member of the Commission

3.18pm Ms Ramsey left the meeting

3.22pm Ms Ramsey returned to the meeting

A question and answer session ensued. The chairperson thanked the witnesses for attending.

7. Health and Social Care (Reform) Bill

Members noted that the Health and Social Care (Reform) Bill received its Second Reading in the Assembly on Tuesday 1 July 2008 and that the Bill has been passed to the Committee to undertake the ‘Committee Stage’. The Committee agreed to release a press release and public notice and that relevant organisations should be invited to submit comments on the provisions of the Bill.

[EXTRACT]

Thursday, 11 September 2008
Room 135, Parliament Buildings

Present: Mrs Iris Robinson MP MLA (Chairperson)
Mr Thomas Buchanan MLA
Mr Alex Easton MLA
Mrs Carmel Hanna MLA
Mr John McCallister MLA
Ms Claire McGill MLA
Mrs Michelle O’Neill MLA (Deputy Chairperson)
Ms Sue Ramsey MLA

In Attendance: Mr Hugh Farren (Clerk)
Mr Mark McQuade (Assistant Clerk)
Mrs Noelle Bourke (Clerical Supervisor)
Mr Alister Strain (Clerical Supervisor)
Mr Joe Westland (Clerical Supervisor)

Apologies: Dr Kieran Deeny MLA
Mr Tommy Gallagher MLA

The meeting commenced at 2.34 pm in public session.

5. Health & Social Care (Reform) Bill.

Briefing on the provisions of the Bill

Members took evidence from the following witnesses:

Bernard Mitchell Modernisation Unit, DHSSPS

Ivan McMaster Modernisation Unit, DHSSPS

Craig Allen Modernisation Unit, DHSSPS

A question and answer session ensued. The chairperson thanked the witnesses for attending.

[EXTRACT]

Thursday, 18 September 2008
Room 135, Parliament Buildings

Present: Mrs Iris Robinson MP MLA (Chairperson)
Mr Thomas Buchanan MLA
Dr Kieran Deeny MLA
Mr Alex Easton MLA
Mr Tommy Gallagher MLA
Mr Sam Gardiner, MLA
Mrs Carmel Hanna MLA
Mr John McCallister MLA
Ms Claire McGill MLA
Ms Sue Ramsey MLA

In Attendance: Mr Hugh Farren (Clerk)
Mr Mark McQuade (Assistant Clerk)
Mrs Noelle Bourke (Clerical Supervisor)
Mr Joe Westland (Clerical Supervisor)

Apologies: Mrs Michelle O’Neill MLA (Deputy Chairperson)

The meeting commenced at 2.05 pm in public session.

5. Health & Social Care (Reform) Bill.

Evidence session with the Central Services Agency

Members took evidence from the following witnesses:

Stephen Hodkinson Chief Executive, Central Services Agency

Jacqueline Kennedy Director of Human Resources and Corporate Services

Paula Sheils Director of Family Practitioner Services

A question and answer session ensued. The chairperson thanked the witnesses for attending.

[EXTRACT]

Thursday, 25 September 2008
Seminar Rooms,
Muckamore Abbey Hospital

Present: Mrs Iris Robinson MP MLA (Chairperson)
Dr Kieran Deeny MLA
Mr Alex Easton MLA
Mr Tommy Gallagher MLA
Mr Sam Gardiner, MLA
Mrs Carmel Hanna MLA
Ms Claire McGill MLA
Mrs Michelle O’Neill MLA (Deputy Chairperson)

In Attendance: Mr Hugh Farren (Clerk)
Mr Mark McQuade (Assistant Clerk)
Mrs Noelle Bourke (Clerical Supervisor)
Mr Joe Westland (Clerical Supervisor)
Mr Rodney Aiken (Clerical Officer)

Apologies: Mr Thomas Buchanan MLA
Mr John McCallister MLA
Ms Sue Ramsey MLA

The meeting commenced at 2.01 pm in public session.

5. Health & Social Care (Reform) Bill

Evidence session with the Health & Social Services Boards

Members took evidence from the following witnesses:

Dominic Burke Acting Chief Executive, Western Health & Social Services Board

Paula Kilbane Chief Executive, Eastern Health & Social Services Board

Stuart MacDonnell Chief Executive, Northern Health & Social Services Board

Fionnuala McAndrew Director of Social Services, Southern Health & Social Services Board

Dr Kieran Deeny made a declaration of interest that he was a member of a Local Commissioning Group

A question and answer session ensued. The chairperson thanked the witnesses for attending.

A Member made a request that witnesses avoid using abbreviations when presenting evidence to the Committee.

6. Health & Social Care (Reform) Bill.

Evidence session with the Health & Social Services Councils

Members took evidence from the following witnesses:

Richard Dixon Chief Officer, Eastern Health & Social Services Council

A question and answer session ensued. The chairperson thanked the witnesses for attending.

3.08 p.m. Committee meeting adjourned.

3.16 p.m. Committee meeting resumed.

7. Health & Social Care (Reform) Bill.

Evidence session with the Regulation & Quality Improvement Authority

Members took evidence from the following witnesses:

Alice Casey Interim Chief Executive, Regulation & Quality Improvement Authority

Phelim Quinn, Director of Operations, Regulation & Quality Improvement Authority

Jude O’Neill Head of Mental Health and Learning Disability, Regulation & Quality Improvement Authority

A question and answer session ensued. The chairperson thanked the witnesses for attending.

3.22 p.m. Mr Tommy Gallagher rejoined the meeting.

[EXTRACT]

Thursday, 2 October 2008
Senate Chamber, Parliament Buildings

Present: Mrs Michelle O’Neill MLA (Deputy Chairperson)
Mr Thomas Buchanan MLA
Dr Kieran Deeny MLA
Mr Alex Easton MLA
Mr Tommy Gallagher MLA
Mr Sam Gardiner, MLA
Mrs Carmel Hanna MLA
Mr John McCallister MLA
Mrs Claire McGill MLA
Ms Sue Ramsey MLA

In Attendance: Mr Hugh Farren (Clerk)
Mr Mark McQuade (Assistant Clerk)
Mrs Noelle Bourke (Clerical Supervisor)
Mr Joe Westland (Clerical Supervisor)
Mr Rodney Aiken (Clerical Officer)

Apologies: Mrs Iris Robinson MP MLA (Chairperson)

The meeting commenced at 2.06 pm in public session with the Deputy Chairperson in the Chair.

5. Health & Social Care (Reform) Bill.

Evidence session with the Royal College of Nursing

Members took evidence from the following witnesses:

Mary Hinds Director, Royal College of Nursing Northern Ireland

Ann Marie O’Neill Chair, Royal College of Nursing Northern Ireland Board.

A question and answer session ensued. The Deputy Chairperson thanked the witnesses for attending.

6. Health & Social Care (Reform) Bill.

Evidence session with the British Medical Association

Members took evidence from the following witnesses:

Dr Brian Patterson British Medical Association (NI), Chairman of Northern Ireland Council

Dr Brian Dunn British Medical Association (NI), Chairman of the General Practitioners Committee

Mr Danny Lambe British Medical Association (NI), Deputy Secretary

Mr Ivor Whitten British Medical Association (NI), Assembly & Research Officer

A question and answer session ensued. The Deputy Chairperson thanked the witnesses for attending.

Mr Sam Gardiner made a declaration of interest that he is a Local Councillor.

Mrs Claire McGill made a declaration of interest that she is a Local Councillor.

2.50 p.m. Mr Tommy Gallagher left the meeting.

3.02 p.m. Mr Tommy Gallagher rejoined the meeting.

3.02 p.m. Mr Thomas Buchanan joined the meeting.

3.12 p.m. Mr John McCallister joined the meeting.

3.14 p.m. Ms Sue Ramsey left the meeting.

7. Health & Social Care (Reform) Bill.

Evidence session with the Allied Health Profession Federation

Members took evidence from the following witnesses:

Mrs Liz Cavan Committee Member, Allied Health Professions Federation UK

Ms Liz McKnight Chair, Allied Health Professions Federation NI.

Mr Tom Sullivan Policy Officer, Chartered Society of Physiotherapy NI.

A question and answer session ensued. The Deputy Chairperson thanked the witnesses for attending.

Dr Kieran Deeny made a declaration of interest that he is a member of a Local Commissioning Group.

3.44 p.m. Ms Sue Ramsey rejoined the meeting.

3.44 p.m. Committee meeting adjourned.

3.56 p.m. Committee meeting resumed.

8. Clause by Clause consideration of the Health & Social Care (Reform) Bill

The following witnesses attended:

Ivan McMaster Department of Health, Social Services & Public Safety

Bernard Mitchell Department of Health, Social Services & Public Safety

Craig Allen Department of Health, Social Services & Public Safety

The Deputy Chairperson referred Members to the legislation & copy of responses received from relevant bodies.

Clause 1 (Restructuring of administration of health and social care)

Clause 1 deferred. The Department is to provide further information.

Clause 2 (Department’s general duty)

Clause 2 deferred.

Clause 3 (Department’s general power)

Clause 3 deferred.

Clause 4 (Department’s priorities and objectives)

Clause 4 deferred. The Department is to consider proposed amendment.

Clause 5 (The framework document)

Clause 5 deferred. The Department is to consider proposed amendment.

Clause 6 (Power of Department to give directions to certain bodies)

Clause 6 deferred. The Department is to consider proposed amendment.

[EXTRACT]

Thursday, 9 October 2008
Senate Chamber, Parliament Buildings

In Attendance: Mr Hugh Farren (Clerk)
Mr Mark McQuade (Assistant Clerk)
Mrs Noelle Bourke (Clerical Supervisor)
Mr Joe Westland (Clerical Supervisor)
Mr Rodney Aiken (Clerical Officer)

The meeting commenced at 2.04 pm in public session.

3. Clause by Clause consideration of the Health & Social Care (Reform) Bill

The following witnesses attended:

Bernard Mitchell Department of Health, Social Services & Public Safety

Ivan McMaster Department of Health, Social Services & Public Safety

Craig Allen Department of Health, Social Services & Public Safety

Michael McBride Chief Medical Officer

The committee discussed the rationale for the proposed Regional Board and the separate Regional Agency for Public Health and Social Wellbeing.

4.19 p.m. Mrs Carmel Hanna left the meeting.

4.19 p.m. Mrs Michelle O’Neill rejoined the meeting

4.20 p.m. Mrs Carmel Hanna rejoined the meeting.

4.20 p.m. Mr Tommy Gallagher rejoined the meeting.

4.27 p.m. Mrs Claire McGill rejoined the meeting.

4.42 p.m. Mr Thomas Buchanan rejoined the meeting.

4.42 p.m. Mr Sam Gardiner left the meeting.

4.45 p.m. Mr John McCallister rejoined the meeting.

4.52 Dr Michael McBride left the meeting.

4.54 p.m. Mr Tommy Gallagher left the meeting.

The Chairperson referred Members to the legislation & copy of responses received from relevant bodies. The committee commenced clause by clause consideration of the Health & Social Care (Reform) Bill at Clause 7.

Clause 7 (The Regional Health and Social Care Board)

Clause 7 deferred.

Schedule 1 (The Regional Health and Social Care Board)

Schedule 1 deferred.

Clause 8 (Functions of the Regional Board)

Clause 8 deferred, officials advised that the Minister was considering an amendment to Clause 8(3) (b).

Clause 9 (Local Commissioning Groups)

Clause 9 deferred, The Department is to consider a proposed amendment.

Dr Kieran Deeny made a declaration of interest that he is a member of a Local Commissioning Group.

Clause 10 (Power of Regional Board to give directions and guidance to HSC trusts)

Clause 10 deferred.

Clause 11 (Provision of information, etc. to Regional Board by HSC trusts)

Clause 11 deferred.

The Committee agreed to continue consideration of Bill at its next meeting. The Chairperson thanked the witnesses for attending.

5.06 p.m. Mrs Carmel Hanna left the meeting.

[EXTRACT]

Thursday, 16 October 2008
Senate Chamber, Parliament Buildings

In Attendance: Mr Hugh Farren (Clerk)
Mr Mark McQuade (Assistant Clerk)
Mrs Noelle Bourke (Clerical Supervisor)
Mr Joe Westland (Clerical Supervisor)
Mr Rodney Aiken (Clerical Officer)

Apologies: Mrs Michelle O’Neill MLA (Deputy Chairperson)

The meeting commenced at 2.03 pm in public session.

7. Clause by Clause consideration of the Health & Social Care (Reform) Bill

The following witnesses attended:

Bernard Mitchel Department of Health, Social Services & Public Safety

Ivan McMaster Department of Health, Social Services & Public Safety

Craig Allen Department of Health, Social Services & Public Safety

Michael McBride Chief Medical Officer

The Chief Medical Officer provided the Committee with an update on screening for breast cancer.

2.28 p.m. Mr Tommy Gallagher left the meeting.

2.35 p.m. Mr Tommy Gallagher rejoined the meeting.

Clause 12 (The Regional Agency for Public Health and Social Well-being)

Clause 12 deferred. The Department is to provide further information.

Schedule 2 (The Regional Agency for Public Health and Social Well-being)

Schedule 2 deferred.

Clause 13 (Functions of RAPHSW)

Clause 13 deferred. The Department is to consider proposed amendment.

3.09 p.m. Mr Tommy Gallagher left the meeting.

3.14 p.m. Dr Michael McBride left the meeting.

3.14 p.m. Mr Tommy Gallagher rejoined the meeting.

Clause 14 (The Regional Support Services Organisation)

Clause 14 deferred. The Department is to consider proposed amendment.

3.15 p.m. Mrs Iris Robinson left the meeting.

3.15 p.m. Ms Sue Ramsey took the Chair.

Schedule 3 (The Regional Support Services Organisation)

Schedule 3 deferred.

Clause 15 (Functions of RSSO)

Clause 15 deferred. The Department is to consider proposed amendment.

3.20 p.m. Mrs Iris Robinson rejoined the meeting & resumed the chair.

Clause 16 (The Patient and Client Council)

Clause 16 deferred

3.26 p.m. Ms Sue Ramsey left the meeting.

Schedule 4 (The Patient and Client Council)

Schedule 4 deferred

Clause 17 (Functions of the Patient and Client Council)

Clause 17 deferred. The Department is to consider proposed amendment.

Clause 18 (Duty to co-operate with the Patient and Client Council)

Clause 18 deferred. The Department is to consider proposed amendment.

3.32 p.m. Mrs Carmel Hanna left the meeting.

Clause 19 (Public involvement and consultation)

Clause 19 deferred

3.39 p.m. Ms Sue Ramsey rejoined the meeting.

Clause 20 (Public involvement: consultation schemes)

Clause 20 deferred

Clause 21 (Duty on HSC trusts in relation to improvement of health and social well-being)

Clause 21 deferred

Clause 22 (Public-private partnerships)

Clause 22 deferred

Clause 23 (Schemes for transfer of assets and liabilities)

Clause 23 deferred

Clause 24 (Transfer of functions of Health and Social Services Boards)

Clause 24 deferred

Clause 25 (Transfer of functions of the Mental Health Commission)

Clause 25 deferred

Clause 26 (Transfer of functions of Central Services Agency)

Clause 26 deferred

Clause 27 (Amendment of statutory and other references to dissolved bodies, etc)

Clause 27 deferred

Clause 28 (Dissolution of special agencies)

Clause 28 deferred

Clause 29 (Orders, regulations, guidance and directions)

Clause 29 deferred. The Department is to consider proposed amendment.

Clause 30 (Further provision)

Clause 30 deferred

Clause 31 (Interpretation)

Clause 31 deferred

Clause 32 (Minor and consequential amendments)

Clause 32 deferred

Clause 33 (Repeals)

Clause 33 deferred

Clause 34 (Commencement)

Clause 34 deferred

Clause 35 (Short title)

Clause 35 deferred

Schedule 5 (Transfer of assets, etc)

Schedule 5 deferred

Schedule 6 (Minor and consequential amendments)

Schedule 6 deferred

Schedule 7 (Repeals)

Schedule 7 deferred

The Committee agreed to continue formal consideration of Bill at its next meeting. The Chairperson thanked the witnesses for attending.

Members agreed a motion to extend the Committee Stage of the Bill to 5 December 2007.

[EXTRACT]

Thursday, 23 October 2008
Senate Chamber, Parliament Buildings

Present: Ms Sue Ramsey MLA (In the chair)
Mr Thomas Buchanan MLA
Mr Alex Easton MLA
Mr Tommy Gallagher MLA
Mr Sam Gardiner, MLA
Mrs Carmel Hanna MLA
Mr John McCallister MLA
Mrs Claire McGill MLA

In Attendance: Mr Hugh Farren (Clerk)
Mr Mark McQuade (Assistant Clerk)
Mrs Noelle Bourke (Clerical Supervisor)
Mr Joe Westland (Clerical Supervisor)
Mr Rodney Aiken (Clerical Officer)

Apologies: Mrs Iris Robinson MP MLA (Chairperson)
Mrs Michelle O’Neill MLA (Deputy Chairperson)
Dr Kieran Deeny MLA

The meeting commenced at 2.06 pm in public session.

8. Clause By Clause consideration of the Health & Social Care (Reform) Bill

The following witnesses attended:

Bernard Mitchel Department of Health, Social Services & Public Safety

Ivan McMaster Department of Health, Social Services & Public Safety

Craig Allen Department of Health, Social Services & Public Safety

Carolyn Harper Department of Health, Social Services & Public Safety

The Committee agreed to consider clauses where there was no dispute and defer consideration of other clauses to the next Committee meeting

Clause 1 (Restructuring of administration of health and social care)

Clause 1 deferred for further consideration.

Clause 2 (Department’s general duty)

Question: That the Committee is content with the clause as drafted, put and agreed to.

Clause 3 (Department’s general power)

Question: That the Committee is content with the clause as drafted, put and agreed to.

Clause 4 (Department’s priorities and objectives)

Clause 4 deferred for further consideration.

Clause 5 (The framework document)

Question: That the Committee is content with the clause as drafted subject to the proposed amendment by the Department, put and agreed to.

Clause 6 (Power of Department to give directions to certain bodies)

Clause 6 deferred for further consideration.

Clause 7 (The Regional Health and Social Care Board)

Question: That the Committee is content with the clause as drafted, put and agreed to.

Clause 8 (Functions of the Regional Board)

Clause 8 deferred for further consideration

Clause 9 (Local Commissioning Groups)

Clause 9 deferred for further consideration.

Clause 10 (Power of Regional Board to give directions and guidance to HSC trusts)

Question: That the Committee is content with the clause as drafted, put and agreed to.

Clause 11 (Provision of information, etc. to Regional Board by HSC trusts)

Question: That the Committee is content with the clause as drafted, put and agreed to.

Clause 12 (The Regional Agency for Public Health and Social Well-being)

Clause 12 deferred for further consideration.

Schedule 2 (The Regional Agency for Public Health and Social Well-being)

Schedule 2 deferred for further consideration.

Clause 13 (Functions of RAPHSW)

Clause 13 deferred for further consideration

Clause 14 (The Regional Support Services Organisation)

Question: That the Committee is content with the clause as drafted subject to the change in the title of the body, put and agreed to.

Schedule 3 (The Regional Support Services Organisation)

Question: That the Committee is content with schedule 3 as drafted, put and agreed to.

Clause 15 (Functions of RSSO)

Clause 15 deferred for further consideration.

Clause 16 (The Patient and Client Council)

Question: That the Committee is content with the clause as drafted, put and agreed to.

Schedule 4 (The Patient and Client Council)

Question: That the Committee is content with schedule 4 as drafted, put and agreed to.

Clause 17 (Functions of the Patient and Client Council)

Clause 17 deferred for further consideration.

Clause 18 (Duty to co-operate with the Patient and Client Council)

Question: That the Committee is content with the clause as drafted subject to the proposed amendment by the Department, put and agreed to.

Clause 19 (Public involvement and consultation)

Clause 19 deferred for further consideration.

Clause 20 (Public involvement: consultation schemes)

Question: That the Committee is content with the clause as drafted subject to the proposed amendment by the Department, put and agreed to.

Clause 21 (Duty on HSC trusts in relation to improvement of health and social well-being)

Question: That the Committee is content with the clause as drafted subject to the proposed amendment by the Department, put and agreed to.

Clause 22 (Public-private partnerships)

Clause 22 deferred for further consideration.

Clause 23 (Schemes for transfer of assets and liabilities)

Question: That the Committee is content with the clause as drafted, put and agreed to.

Schedule 5 (Transfer of assets, etc)

Schedule 5 deferred for further consideration.