Legacy Report 2017 - 2022

Review of 2017 – 2022 Mandate

Scrutiny

The key points of the Committee’s scrutiny during the 2017 - 2022 mandate are summarised below.

Care Home Inquiry

The Committee undertook an inquiry into the impact of COVID-19 on care homes, in order to produce recommendations to help mitigate and manage the impact of a second surge of COVID cases.  The inquiry aimed to discover the key issues impacting care homes as a result of the COVID-19 pandemic, and to identify domestic and international examples of best practice in arrangements to protect and care for residents of care homes during the pandemic.  The Committee received written submissions and held oral sessions with a number of stakeholders; these included international experts with experience in working with the SARS outbreak in Hong Kong.  

The Committee made a total of 54 recommendations in its report, the majority of which were accepted by the Department.

Read more on the Committee’s Inquiry Report on the Impact of COVID-19 in Care Homes.

Policy Scrutiny

The impact of COVID-19 and the Committee’s heavy legislative workload limited the time available for scrutiny of Departmental policy.  However, the Committee focussed on a number of key areas.  The Committee also held regular budget briefing sessions with Departmental officials, and paid particular attention to the budget allocations for COVID, transformation of services, workforce, waiting lists and mental health services.

COVID-19

The emergence of Covid-19 and its impact on the health service dominated the Committee’s workload from the early days of the mandate.  The Committee agreed to add COVID-19 as a standing agenda item in the early stages of the pandemic, and to give priority to COVID related issues, including COVID-related subordinate legislation.  The Department’s handling of the pandemic was scrutinised by the Committee through regular briefings from the Minister, the Chief Medical Officer and Chief Scientific Adviser.  The Committee heard evidence from Departmental officials, the Health and Social Care Trusts, the Public Health Agency, Business Services Organisation and the Regulation and Quality Improvement Authority (RQIA) on aspects of the pandemic.  In addition, the Committee heard from a wide range of stakeholder organisations.

Initially, the Committee focussed on issues such as the supply of personal protective equipment (PPE), testing, track and trace arrangements, the supply of ventilators and oxygen and workforce.  As the situation developed, the Committee received regular briefings on the roll out of the vaccination programme, as well as the Department’s plans to deal with surges of the virus and the rebuilding of services, post pandemic.

The Committee tabled a motion in the Assembly, acknowledging the impact of COVID-19, and called on the Minister to bring forward a robust find, test, trace, isolate and support (FTTIS) strategy based on international best practice, as part of a wider Executive strategy to help avoid a cycle of lockdowns and the particular negative impacts on mental health and well-being.  The motion was agreed by the Assembly on 23 November 2020.

To inform its scrutiny of the pandemic, the Committee held a number of evidence sessions with international academic and experts in epidemiology and global public health, some of whom had experience with the SARS outbreak in Hong Kong.

The Committee was particularly concerned about the impact of the pandemic on the most vulnerable, including the elderly and the disabled.  The Committee heard evidence from stakeholders on the impact of COVID-19 on care homes, and agreed to hold an inquiry on the matter.  In addition, the Committee sought clarity from the Department on the provision of guidance to those deemed to be clinically extremely vulnerable, and continued to press the Department on the restoration of day care and respite services, which closed in the early days of the pandemic.  A Committee motion calling for the rebuilding of respite services and financial support for carers was agreed by the Assembly on 15 June 2021.

The Committee recommends that the incoming Committee continues to scrutinise the Department’s handling of the pandemic, and any subsequent virus surges, as well as the rebuilding of services post pandemic and the application of lessons learned for future planning.

Transformation and post–pandemic rebuilding of services

The Committee continued to scrutinise the transformation of health and social care services as set out in the document Health and Wellbeing 2026: Delivering Together.  The Committee held a number of evidence sessions with Departmental officials and stakeholders on the rebuilding of services post pandemic, and on progress on the transformation programme.  In addition, the Committee sought information on the budget and staff resources required for rebuilding and transformation projects.  The Committee also recognised the importance of the use of data in achieving transformation of services, and heard evidence from officials on progress on the Encompass Programme. 

The Committee acknowledged the impact of the pandemic on the Department’s ability to progress with the transformation programme as originally envisioned; however, the Committee expressed its disappointment that the rollout of multi-disciplinary teams (MDTs) in particular had not progressed, in view of the enormous pressures on GP services and the feedback from GPs and patients of the benefits of MDTs.

The Committee would outline the importance of the Encompass roll-out in achieving transformation and providing the tools to collect data in order to allocate resources to those most in need. The gathering of data will allow more effective allocation of resources to target the health inequalities that are apparent in the system.

The Committee acknowledged the importance of the role of Allied Health Professionals (AHPs) in rebuilding and transformation, and wrote to the Department to successfully request that the Chief Allied Health Professions Officer be given a place on the newly established management board for the rebuilding of services.

The Committee would outline the importance of having, where possible, an all-island approach to healthcare.  There have been some good examples of an all-island approach to some health treatments and would encourage the Department to work with its counterpart in the Republic of Ireland to identify further opportunities that may build into the transformation agenda.

The Committee believes that the transformation of health and social care is essential, and that the rebuilding of services post-pandemic presents opportunities as well as challenges.

The Committee therefore recommends that the incoming Committee applies close scrutiny to the Department’s progress in implementation of both the ‘Delivering Together’ recommendations on transformation and the Strategic Framework for Rebuilding Health and Social Care Services.

Waiting Lists/Elective care

Waiting times for elective care were a priority for the Committee from the outset and the Committee was acutely aware that the COVID-19 pandemic would result in even greater deterioration of the waiting lists.  The Committee heard evidence from the Department and clinicians on the management of elective care during the COVID crisis.  In particular, the Committee heard from the Royal College of Surgeons, England, on its 10- point action plan for the recovery of surgical services, and sought the view of the Department on the plan.  The Committee questioned how much of the Department’s budget was allocated to addressing waiting lists.  In addition to elective waiting lists, the Committee was also concerned with the waiting lists for CAMHS, GP counselling services, transgender surgeries, physiotherapy rehabilitation services, and other services.

The Committee recommends that the incoming Committee scrutinises the implementation of the Department’s Elective Care Framework, and the associated budget allocations.

Workforce

From the very beginning of this mandate, the Committee was aware of serious workforce issues in the health and social care sector, particularly pay and vacancy rates.  The arrival of COVID-19, and the rapid increase in staff absence rates due to illness, self-isolation and caring responsibilities of staff intensified the already critical workforce situation.  The Committee heard evidence from staff organisations, such as the trade unions and professional bodies, and continued to question the Department on its handling of the workforce crisis.  The Committee expressed its disappointment that the Department’s Workforce Appeal did not yield a greater result, and questioned the effectiveness of the application process.  The Committee was also concerned about the continued reliance on agency staff, and the cost to the health service.

The Committee considers that addressing workforce shortages will be crucial to the transformation of services and reduction in waiting times.  The Committee acknowledges the Department’s efforts to increase the workforce through additional training places for nurses and the opening of the graduate training school in Magee, and through other initiatives, such as extending the pool of professionals permitted to prescribe.

The Committee recommends that the incoming Committee scrutinises progress in improving the vacancy rates, and continues to press the Department to find ways to address the workforce issue in the short term, such as the use of AHPs and the roll out of MDTs. The Committee would outline there needs to be a step change in how the Department addresses the workforce issue and would highlight the importance of retention and recruitment in delivering the Transformation agenda and that a considerable proportion of the spend on Agency staff could be better directed to retention and recruitment of staff.

Neurology Services

The investigations into the work of the former neurologist, Michael Watt, led to the biggest ever recall of patients so far in Northern Ireland. From the outset, the Committee was supportive of those affected by the patient recall, and held a number of briefings with the Minister, Departmental officials, the RQIA and the panel of the Independent Neurology Inquiry (INI).  In addition, the Committee heard evidence from the General Medical Council (GMC) on the voluntary removal of Michael Watt from the GMC register; the Committee wrote to the Committee for Health and Social Care in Westminster to ask for its assistance in closing the loophole that allows doctors under investigation to voluntarily remove themselves from the GMC register, avoiding further sanctions.  The Committee welcomed the change of status of the INI to a full public inquiry, announced by the Minister on 11 December 2020.

The Committee expects the report to be published shortly, and recommends that the outworking of this Inquiry be subject to scrutiny in the new Assembly mandate.

Mental Health/Substance abuse

The Committee heard from a number of stakeholders in relation to mental health during the mandate, including the (then) interim Mental Health Champion and the NI Commissioner for Children and Young People (NICCY).  The Committee raised a number of issues with the Department in relation to mental health, including funding for mental health crisis services, the inclusion of infant mental health in the mental health strategy and waiting lists for CAMHS.  The Committee undertook an engagement programme during Mental Health Awareness Week, which culminated in a Committee motion debated in Plenary.  In addition, the Committee heard from stakeholders working with those with addictions, and raised a number of issues with the Department in relation to the street testing of drugs, a ban on advertising of gambling and the provision of PPE to community and voluntary staff working with those with addictions during the COVID crisis.  During Children’s Mental Health Week, the Committee held a joint meeting with the Committee for Education to take evidence from NICCY on children’s mental health and wellbeing. The budget allocation for mental health services was also closely scrutinised by the Committee.

The Committee recommends that the incoming Committee scrutinise the implementation of the mental health and substance abuse strategies, and continues to closely scrutinise the budget for mental health services and the waiting list for CAMHS.

Inquiry into Hyponatraemia Related Deaths - O’Hara report

The Committee was briefed from the Department on the 96 recommendations of the Inquiry into Hyponatraemia Related Deaths, and asked the Department for details of the implementation plan for the IHRD recommendations, including the Duty of Candour work stream.  The Committee also sought assurances from the Department that it would fully engage with the families affected by the issue.  The Department has indicated that it will bring legislation on the Duty of Candour in the next mandate. This will be a key piece of legislation that the incoming Committee will need to scrutinise in detail.

Dental Services

Early in the mandate, the Committee heard evidence from the British Dental Association NI on issues facing dentistry, including the need for an oral health strategy and investment in community dental services.  The Committee later heard evidence on how COVID- 19 exacerbated the problems in dental services, due to the imposition of restrictions on dental treatments, the need for PPE and inequalities arising from the application of criteria for the financial support scheme (FSS). The Committee sought further information on these issues from the Department; the Department agreed to a proposal from the Committee to amend its approach to the calculation of FSS for those dentists on maternity leave.  The Committee responded to stakeholders’ concerns about the future provision of NHS dental services, by engaging with the Chief Dental Officer and senior HSCB officials; the Committee sought further information from the Department on funding for dental services and plans to address the key workforce issues.

Legislative Consent Memorandums

The Committee considered a number of legislative consent motion during the reporting period. The LCMs that the Committee considered are listed below:

• Medicines and Medical Devices Bill;
• Medicines and Medical Devices Bill: Further LCM;
• Health and Care Bill: International Healthcare Arrangements;
• Health and Care Bill: Medicines and Healthcare Products Regulatory Agency;
• Health and Care Bill: Professional Regulation;
• Health and Care Bill: Arm’s Length Bodies – Transfer of Functions;
• Health and Care Bill: Information about payments etc.; and
• Health and Care Bill: Virginity Testing and Hymenoplasty.

Statutory Rules

The Committee considered a significant volume of statutory rules during the reporting period, the majority of which brought into operation public health measures to protect against the incidence and spread of Coronavirus infection in Northern Ireland.  Despite the volume and pace at which these rules were made by the Department, the Committee endeavoured to undertake its scrutiny role and requested briefing from the Department on each one of these rules.  At all times the Committee challenged the Department to provide the rationale and evidence base to support both the introduction and later, the removal of what were significant restrictions on people’s lives. 

The Committee was particularly concerned that coronavirus response regulations to make temporary modifications to the provision of children’s social care services should only remain in place for the shortest amount of time possible.  After consultation with the key children’s advocacy stakeholders on this matter, the Committee sought assurances from the Department to put in place monthly monitoring arrangements on the extent to which the modifications provided by the Regulations were being applied and to share these monthly monitoring reports with the Committee.  The Committee also sought reassurances that the regulations would be revoked at the earliest opportunity.

One of the final SRs that the Committee considered in this mandate was to agree the extension of the emergency powers within the Coronavirus Act 2020 until 24 September 2022 to ensure that measures can continue to be introduced, amended or withdrawn in response to the latest risk assessment associated with the incidence and spread of the coronavirus disease albeit for a time limited period.

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This Report can be made available in a range of formats including large print, Braille etc. For more information please contact:

Keith McBride, Clerk

Committee for Health

Northern Ireland Assembly

Room 419, Parliament Buildings

Ballymiscaw

Stormont

Belfast BT4 3XX

Telephone: 028 90 520348

Email: committee.health@niassembly.gov.uk

Twitter: @niahealth