Health and Social Care Bill: Consideration Stage

Executive Committee Business – in the Northern Ireland Assembly at 10:30 am on 16th November 2021.

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Photo of Alex Maskey Alex Maskey Sinn Féin 10:30 am, 16th November 2021

The next item in the Order Paper is the Consideration Stage of the Health and Social Care Bill. I call the Minister of Health, Mr Robin Swann, to move the Consideration Stage.

Moved. — [Mr Swann (The Minister of Health).]

Photo of Alex Maskey Alex Maskey Sinn Féin

Members will have a copy of the Marshalled List of amendments detailing the order of consideration. The amendments have been grouped for debate in the provisional grouping of amendments selected list. There is a single group of seven amendments that deal with the continuation of local commissioning groups (LCGs) and provisions for local area integrated partnership boards (AIPBs). In the group, amendment Nos 3 to 7 are consequential to amendment No 1 being made.

I remind Members who intend to speak that, during the debate on the single group of amendments, they should address all the amendments on which they wish to comment. Once the debate is completed, any further amendments will be moved formally as we go through the Bill, and the Question on each will be put without further debate. Questions on stand part will then be taken at the appropriate points in the Bill. If that is clear, we shall proceed.

Clauses 1 and 2 ordered to stand part of the Bill.

New Clause

Photo of Alex Maskey Alex Maskey Sinn Féin

We now come to the group of amendments for debate. With amendment No 1, it will be convenient to debate amendment Nos 2 to 7. I call the Minister of Health to move amendment No 1 and to address the other amendments in the group as he so chooses.

Photo of Robin Swann Robin Swann UUP

I beg to move amendment No 1:

After clause 2 insert -

<BR/>

&quot;Continuation of Local Commissioning Groups


 


2A.—(1) Despite the dissolution of the Regional Board, the Local Commissioning Groups appointed under section 9 of the Health and Social Care (Reform) Act (Northern Ireland) 2009 are to continue in existence as unincorporated bodies.


 


(2) Schedule 1A contains provision about the Local Commissioning Groups as so continued, including provision for their dissolution.&quot;

The following amendments stood on the Marshalled List:

No 2: After clause 2 insert -



&quot;Duty to establish bodies for local areas



2B.—(1) After section 15A of the Health and Social Care (Reform) Act (Northern Ireland) 2009 insert—



&#x0027;Local area bodies



Duty to establish bodies for local areas


15B.—(1) The Department must by regulations establish one or more bodies under this section.



(2) A body established under this section is to be called an &#x0027;Area Integrated Partnership Board&#x0027; or such other name as may be prescribed.


(3) Each Board is to exercise its functions for such area of Northern Ireland as may be prescribed; and the Department must ensure that there is a Board for each area of Northern Ireland.


(4) Each Board is to exercise such functions relating to the following matters as may be prescribed—


(a) the identification of the health and social care needs of the people in its area,


(b) the planning, delivery and management of health and social care for those people, and


(c) the facilitation and encouragement of co-operation between those responsible for planning, delivering or managing health and social care for those people.


(5) Each Board must exercise its functions with the aim of—


(a) improving the health and social well-being of the people in its area;


(b) reducing health inequalities between those people, and between those people and other people in Northern Ireland.


(6) The Department may by regulations—


(a) provide that Article 18 of the Order of 1972 is to apply to each Board with such modifications (if any) as may be prescribed, and


(b) require each Board to exercise its functions in accordance with any scheme having effect under that Article.


(7) The Department may by regulations—


(a) provide that each Board is established as a body corporate (and that section 19 of the Interpretation Act (Northern Ireland) 1954 applies to each Board with such modifications (if any) as may be prescribed);


(b) make provision for the constitution of Boards (including, in particular, their membership, general powers and proceedings);


(c) make provision for the payment of remuneration and allowances to members of Boards, and for the defraying of the expenses of Boards;


(d) make provision in relation to accounting, reporting and record-keeping by Boards;


(e) make such further provision in relation to Boards as the Department considers appropriate.


(8) Regulations under this section may apply (with or without modifications), amend or repeal any statutory provision whenever passed or made, including any provision of this Act.


(9) In this section—


&#x0027;Board&#x0027; means a body established under this section;


a reference to the area of a Board is to the area prescribed for that Board under subsection (3).



Power of Department to give directions and guidance


15C.—(1) The Department may give directions of a general or specific nature to a Board as to the carrying out by the Board of any of its functions.


(2) The Department may give guidance to a Board as to the carrying out by the Board of any of its functions.


(3) Before giving any directions to a Board under subsection (1) the Department must consult the Board.


(4) Where the Department is of the opinion that because of the urgency of the matter it is necessary to give directions under subsection (1) without consulting the Board concerned—


(a) subsection (3) does not apply; but


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


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


(a) that subsection does not apply; but


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


(6) It is the duty of a Board—


(a) to comply with any directions given to it under subsection (1);


(b) to have regard to any guidance given to it under subsection (2).


(7) In this section &#x0027;Board&#x0027; means a body established under section 15B.


(8) This section does not affect the Department’s powers to give directions or guidance apart from this section.&#x0027;.


(2) In section 29 of that Act—


(a) after subsection (1) insert—


&#x0027;(1A) No regulations are to be made under section 15B unless a draft of the regulations has been laid before, and approved by a resolution of, the Assembly.&#x0027;;


(b) in subsection (2), for &#x0027;this Act&#x0027; substitute &#x0027;any provision of this Act other than section 15B&#x0027;.&quot; — [Mr Swann (The Minister of Health).]

No 3: In clause 6, page 2, line 31, at end insert -



&quot;(ba) section 2A and Schedule 1A;&quot;. — [Mr Swann (The Minister of Health).]

No 4: In schedule 1, page 42, leave out line 35 and insert -



&quot;232. Omit sections 7 and 8 and the italic heading before section 7.


232A. In section 9, omit subsections (1), (3)(b), (6)(b) and (7).


232B. Omit sections 10 and 11.&quot; — [Mr Swann (The Minister of Health).]

No 5: In schedule 1, page 43, leave out line 13 and insert -



&quot;239. In Schedule 1 omit—


 


(a) paragraphs 1 to 7;


(b) paragraphs 8 to 11(1), except so far as those paragraphs apply to, or relate to, the Local Commissioning Groups and their members;


(c) paragraph 11(2);


(d) paragraphs 12 to 21.&quot; — [Mr Swann (The Minister of Health).]

No 6: In schedule 1, page 43, leave out lines 38 and 39 and insert -



&quot;(3) In section 3(6)—


(a) for &#x0027;the Regional Health and Social Care Board&#x0027; substitute &#x0027;the Department&#x0027;;


(b) omit &#x0027;and Local Commissioning Groups&#x0027;.&quot; — [Mr Swann (The Minister of Health).]

No 7: After schedule 1 insert -



&quot;SCHEDULE 1A


Section 2A.


 


LOCAL COMMISSIONING GROUPS


 


Statutory provisions to continue to operate in relation to Groups as continued


 


1.—(1) The following provisions continue to apply to or in relation to Local Commissioning Groups and their members—


(a) section 9(2), (3)(a), (4), (5) and (6)(a) and (c) of the Health and Social Care (Reform) Act (Northern Ireland) 2009 (&#x0027;the 2009 Act&#x0027;);


(b) paragraphs 8 to 11(1) of Schedule 1 to the 2009 Act, so far as those paragraphs apply to, or relate to, committees of the Regional Board and their members;


(c) regulations 1, 2(2) and 3 of, and the Schedule to, the Local Commissioning Groups (Number, Area and Functions) Regulations (Northern Ireland) 2009 (S.R. 2009/99);


(d) the Local Commissioning Groups (Membership) Regulations (Northern Ireland) 2009 (S.R. 2009/395) (the &#x0027;Membership Regulations&#x0027;), except regulation 3(1) to (3) (appointments);


but this is subject to the modifications made by sub-paragraph (2).


(2) The provisions applied by sub-paragraph (1) are modified as follows—


(a) the power conferred by paragraph 9 of Schedule 1 to the 2009 Act is conferred on the Department, and in that paragraph the words &#x0027;Without prejudice to section 19(1)(a)(v) of the Interpretation Act (Northern Ireland) 1954 (c. 33)&#x0027; are omitted;


(b) in the Membership Regulations—


(i) references (however expressed) to employment by the Regional Board are to be read as references to employment by the Department or the Regional Business Services Organisation;


(ii) other references to the Regional Board are to be read as references to the Department.


2. Paragraph 1 does not affect the continued operation of any other statutory provision that applies to, or relates to, Local Commissioning Groups.


Appointments and terms of office


 


3.—(1) Any person who is a member of a Local Commissioning Group immediately before the dissolution of the Regional Board is to continue to be a member of that Group; but this is subject to the following provisions of this paragraph.


(2) The term of office of a person who is a member of a Group by virtue of sub-paragraph (1) is to end six months after the date on which the Regional Board is dissolved.


(3) The Department may direct in writing that the term of office under sub-paragraph (2) is to be extended by such period, not exceeding 12 months, as may be specified in the direction.


(4) The Department may exercise the power conferred by sub-paragraph (3) more than once.


4.—(1) In the event of any vacancy in the membership of a Local Commissioning Group (as determined in accordance with regulation 2 of the Membership Regulations), the Department may appoint a person to fill the vacancy.


(2) The terms of appointment under sub-paragraph (1) must comply with the Membership Regulations, but otherwise are to be determined by the Department.


(3) A person who has ceased to be a member of a Group is eligible for re-appointment.


5. Paragraphs 3 and 4 are subject to regulations 3(4) to (9) and 4 to 6 of the Membership Regulations (cessation of membership in certain circumstances, disqualification, resignation and removal).


 


Other provision about the Groups as continued


 


6. The Department may pay to members of a Local Commissioning Group who are not employees or officers of the Department or the Regional Business Services Organisation such remuneration and allowances as the Department may determine.


7. In the 2009 Act—


(a) section 2(3)(h) (duty of Department to monitor and hold to account) applies in relation to Local Commissioning Groups;


(b) the duty in section 5 (preparation of framework document) applies as if a Local Commissioning Group were a health and social care body;


(c) section 6 (power of Department to give directions) applies in relation to Local Commissioning Groups;


(d) a Local Commissioning Group is a relevant body for the purposes of section 15 (RBSO support services);


(e) sections 17 to 19 (Patient and Client Council and public involvement) apply to Local Commissioning Groups.


8.—(1) The Department may give guidance to a Local Commissioning Group as to the carrying out by the Group of any of its functions.


(2) It is the duty of a Local Commissioning Group to have regard to any guidance given to it under sub-paragraph (1).


(3) Section 29(3) of the 2009 Act applies to guidance given under sub-paragraph (1).


9. References in the following provisions to a health and social care body are to be treated as including a Local Commissioning Group—


(a) Article 67 of the 1972 Order (duty of various bodies to co-operate with one another);


(b) section 3(8) of the Health and Social Care (Control of Data Processing) Act (Northern Ireland) 2016 (code of practice on processing of information);


(c) sections 14(2)(a) and 15(1) of the Public Services Ombudsman Act (Northern Ireland) 2016 (matters which the Ombudsman may investigate).


 


Continuity


 


10.—(1) Any document made or other thing done by the Regional Board in relation to the Local Commissioning Groups, if in effect immediately before the dissolution of the Board, continues to have effect to the same extent and subject to the same provisions.


(2) Sub-paragraph (1)—


(a) does not apply if the context requires otherwise, and


(b) is subject to any power conferred on the Department by paragraphs 1 to 9 to make other provision.


 


Power of Department to dissolve the continued Groups


 


11.—(1) The following provisions cease to have effect on such day as the Department may by regulations appoint—


(a) section 9(2), (3)(a), (4), (5) and (6)(a) and (c) of the 2009 Act;


(b) paragraphs 8 to 11(1) of Schedule 1 to the 2009 Act, so far as those paragraphs apply to, or relate to, the Local Commissioning Groups and their members;


(c) section 2A and this Schedule;


(d) the Local Commissioning Groups (Number, Area and Functions) Regulations (Northern Ireland) 2009;


(e) the Membership Regulations.


(2) Accordingly, on the day appointed under sub-paragraph (1), the Local Commissioning Groups are dissolved.


(3) The Department may not make regulations under sub-paragraph (1) unless the Department makes, or has made, regulations under section 15B(1) of the 2009 Act, as inserted by section 2B(1) of this Act (establishment of local area bodies).


(4) Regulations under sub-paragraph (1) are subject to negative resolution.


(5) But sub-paragraph (4) does not apply if a draft of the regulations (whether alone or with other provision) has been laid before, and approved by a resolution of, the Assembly.&quot; — [Mr Swann (The Minister of Health).]

Photo of Alex Maskey Alex Maskey Sinn Féin

I call the Chairperson of the Committee for Health, Colm Gildernew. Sorry: I will not deny the Minister the opportunity to make —

Photo of Robin Swann Robin Swann UUP

To make my argument.

Photo of Alex Maskey Alex Maskey Sinn Féin

— his argument. My apologies.

Photo of Robin Swann Robin Swann UUP

Maybe it was apt, Mr Speaker, because the amendments were drafted in conjunction with the Committee on issues that it raised with the Department of Health. The Chair or I could equally have moved them at this stage.

I thank the Health Committee for its detailed scrutiny of the Health and Social Care Bill. I am pleased to be able to open the debate on the Bill, not least because the closure of the Health and Social Care Board (HSCB) was first announced some five years ago. The objective of the Bill is simple: it is to facilitate the closure of the Health and Social Care Board and transfer responsibility for its functions, in the main, to my Department. However, the Committee raised concerns. Having listened to those concerns, I have tabled seven amendments to be debated that reflect the detailed scrutiny that has been carried out by the Committee and my Department's consideration of the Committee's report.

Amendment No 1 introduces new clause 2A, which relates to the continuation of local commissioning groups beyond the closure of the Health and Social Care Board and also introduces new schedule 1A, which contains specific provisions for the functions and membership of continued local commissioning groups and provision for their dissolution. It ensures that the local commissioning groups that were appointed under section 9 of the Health and Social Care (Reform) Act (Northern Ireland) 2009 can continue to exist beyond the closure of the Health and Social Care Board.

These groups will remain in place and continue to operate until the Department can bring forward legislation for new area integrated partnership boards.

Amendment No 2 inserts new clause 2B, which sets out the duty on my Department to bring forward regulations to establish bodies for local areas that will be known as area integrated partnership boards. It also includes the high-level functions, duties and responsibilities of the area integrated partnership boards that may be prescribed in regulations and a power for the Department to give directions and provide guidance to the boards.

The proposed amendments have been drafted with the intention of ensuring that the power to make regulations adequately reflects the aims and objectives set out in the draft framework of the integrated care system (ICS), on which there has recently been consultation, and the continuing duties of the Department, as set out in the Health and Social Care (Reform) Act (Northern Ireland) 2009.

Amendment No 3, which amends clause 6, is a technical amendment that provides for local commissioning groups to continue beyond the closure of the Regional Health and Social Care Board and the commencement of schedule 1A, which includes the provision for the closure of local commissioning groups.

Amendments Nos 4, 5 and 6 amend schedule 1. Amendment No 4, the first of the three, retains the necessary provisions of section 9 of the 2009 Act to require that the local commissioning groups have regard in the exercise of their functions to improving the health and well-being of people in their area. With the exception of the omission of now redundant references to the Health and Social Care Board, there is no other amendment to section 9.

Amendment No 5 retains paragraphs 8 to 11 of schedule 1 to the 2009 Act, on the Health and Social Care Board, insofar as they relate to local commissioning groups and their members. The paragraphs include necessary provision for Standing Orders, validity of proceedings and disclosure of interests by members.

Amendment No 6 maintains the Safeguarding Board's duty, which is included in the Safeguarding Board Act (Northern Ireland) 2011, to advise local commissioning groups on safeguarding and promoting the welfare of children.

The final amendment, amendment No 7, adds new schedule 1A, which provides for retention of the local commissioning groups' functions and memberships. It also includes provision for extending membership beyond an initial six months following the closure of the Health and Social Care Board and at intervals of twelve months thereafter, should that be necessary, and provision for disqualification and replacement of local commissioning group members in line with the provisions of existing regulations.

Photo of Colm Gildernew Colm Gildernew Sinn Féin

I welcome the opportunity to outline the Committee's scrutiny of the Health and Social Care Bill before commenting on the Department's amendments. The purpose of the Bill is, as referred to by the Minister, to give effect to the decision to close the Health and Social Care Board. Following agreement of Second Stage on 16 March 2021, the Committee issued a call for evidence. Nine written responses were received, and the Committee took evidence from the Department and nine other organisations. I thank those who responded to the call for evidence and subsequently gave oral evidence that highlighted their concerns about the Bill.

All the organisations that provided evidence to the Committee acknowledged the need for reform of our health and social care (HSC) structures, and a number of them welcomed the Bill as part of the ongoing transformation process. Members of the Committee shared stakeholders' views on the need for reform and acknowledged the Department's assertion that the closure of the board was an important first step on a wider transformation journey. The Committee also acknowledged that the closure of the board has been the policy position of the Department since 2015 and endorsed by three Health Ministers in turn, including Minister Swann.

During consideration of the Bill, the Committee highlighted a number of its concerns to the Department. They included a lack of clarity and detail about the new arrangements and, in particular, what would replace local commissioning groups; the Department's lack of engagement with stakeholders on future arrangements; a desire on the part of stakeholders to have input to the development of the future planning arrangements; diminished local input to commissioning; reporting arrangements; and whether the transfer of functions would deliver increased transparency and accountability and reduce bureaucracy.

I will now outline the Committee's views on those issues. Its primary concern was the lack of clarity on the future commissioning framework. The Committee had significant concerns about how local engagement and input into decision-making would continue when the Health and Social Care Board and the local commissioning groups were dissolved. During oral evidence, the Committee heard that there was a lack of engagement on the future planning model. We were concerned about that lack of engagement.

The Committee sees local engagement and input into the commissioning of services as being one of the key pathways to addressing health inequalities and ensuring that services meet local communities' needs. The Committee was concerned that removing the local commissioning groups would remove a significant amount of accountability and transparency from the decision-making process. The Department advised during Committee Stage that significant work was under way to develop a new integrated care system model, whereby local providers and communities would be empowered to come together to plan, manage and deliver care for their local population, based on a population health approach managed and delivered at a local level.

The Department advised that the new model reflected the importance of ensuring that local input and intelligence remained key to the shaping of HSC services that would meet the needs of the population. It further advised the Committee that the expertise and experience of the LCGs, particularly their role in gathering local intelligence and informing the planning and delivery of services based on identified need, would be built on in the design of those groups.

The Committee remained concerned, however, that it did not have enough information on the future planning model and on what would replace the work of the LCGs. Following the briefing session with the chairperson and the chief executive of the HSCB on 29 April, we asked the Department to provide further detail and briefing on the new commissioning structures. The Department provided the Committee with an advance copy of the draft framework and advised of its intentions to engage with key stakeholders. The draft framework document provided information on what the ICS model would look like. It will include provision for a regional group, five area integrated partnership boards, as the Minister outlined, and locality- and community-level structures. The framework document also sets out the Department's views on the development of governance, accountability, finance and budgetary arrangements.

The Department undertook a targeted consultation on the future planning model draft framework document between 19 July and 17 September 2021. The Committee welcomed the consultation on the draft framework and, additionally, the consultation on the development of a new independent appeals process for family practitioner services contractors as being important first steps in garnering key stakeholders' views. The Committee looks forward to seeing the Department undertake further and ongoing engagement work.

The Committee values the important contribution that HSC stakeholders can make to the future planning arrangements and encourages the Department to continue to adopt a collaborative approach to that work going forward. At that point, however, the Committee remained unsatisfied about the lack of certainty and detail on future arrangements, and, at the start of July, it asked the Department to consider tabling amendments that would allow LCGs to continue until the new framework was in place. The Committee also agreed that it wanted to see an amendment that would provide the Assembly with a role in the scrutiny of the transitional arrangements.

At a briefing on 9 September, the Department advised that the new AIPBs would not be in place when the board and LCGs were dissolved, as the new system needed to develop and mature, and that any legislative process could be restrictive to the development of the new framework. The Department advised that it would not be tabling any amendments to address the Committee's concerns. At its meeting on 16 September, the Committee considered the Department's response and remained of the opinion that it would be difficult for it to support the clause if unamended. The Committee maintained its concerns that the Bill, as currently drafted, did not include any statutory underpinning for the new health and social care system that would be in place upon the closure of the board.

At that point, the Committee agreed that it wished to see an amendment made to the Bill to include provision for legislative powers that placed a statutory duty on the Department to bring forward regulations on the new ICS model and framework to be laid in the Assembly, and for such regulations to be approved by the affirmative resolution procedure. It was the Committee's view that such an amendment would ensure that the Committee and the Assembly would have oversight of the new model and that a higher level of scrutiny would be afforded to the Assembly in that instance. In addition, the Committee outlined its concerns about the possible loss of local input during the transitional arrangements. The Committee agreed that any amendment should reflect an additional requirement that LCGs be retained.

It was the Committee's view that an amendment of that type would allow the retention of the LCGs until regulations were drafted and ensure that there was no vacuum in local engagement and input. The Committee further agreed that the LCGs should cease to exist once the regulations on the new model were approved. That should prevent the Department from having to double-run the two systems.

The Committee considered options for amendments provided by the Bill Clerks and agreed amendments to clauses that would provide the Committee with the necessary assurances that it sought. The Committee was also advised that the Department was considering proposing amendments, and the Committee agreed that it would not table its amendments until it had considered any amendments proposed by the Department.

Before speaking on the amendments, I will address one of the other key concerns for the Committee: openness and transparency in decision-making. Significant resource is allocated when decisions are made on the commissioning of services, and the Committee believes that there should be a robust accountability framework that provides not only the Assembly but the general public with the necessary reassurances that decisions on the commissioning of services are evidence-based and meet the needs of the local community. The Committee sees the reporting framework as key to ensuring accountability, transparency and public confidence in decision-making. The Committee is content that any accountability framework and reporting regime will now come back to the Assembly through the amendments proposed today. The Committee also requested that any reports should outline how the new ICS addresses health inequalities in our communities.

The Committee welcomes the amendments proposed by the Minister. The Committee was briefed on the amendments on 21 October and agreed at its meeting on 4 November that it was content to support the amendments and therefore would not table its own amendments. Amendment No 1 provides for the continuation of the local commissioning groups beyond the closure of the board and will make LCGs statutory bodies. The LCGs will remain in place until the Department makes regulations in respect of the area integrated partnership boards.

Amendment No 2 places a statutory duty on the Department of Health to bring forward regulations on the AIPBs. The regulations will be subject to the draft affirmative procedure, giving the Committee and the Assembly the highest level of approval. The Committee looks forward to considering the regulations when they are brought forward. The rest of the amendments make the necessary changes to allow the provisions of the first two amendments.

As I mentioned, members agreed to support the Department's amendments and wish to thank the Minister and his officials for taking the Committee's concerns into account and addressing them. The Committee looks forward to continuing engagement on the new structures. I also place on record my thanks to the Committee team and the Bill Clerks for supporting members through scrutiny of the Bill in such a challenging time when workloads are extremely heavy. I place on record the thanks of myself and the Committee to the Minister and his officials for their ongoing engagement with us throughout the Committee Stage.

I will make some remarks now as a Sinn Féin MLA and the party's spokesperson for health. The Bill is a first step in the important and vital project of transforming the health and social care system. The move to close the Health and Social Care Board has been widely agreed upon by past Ministers, including my party colleague joint First Minister Michelle O'Neill when she was Minister of Health. As we know, our entire health and social care sector is under unprecedented pressures, and while those pressures have been worsened by the ongoing COVID pandemic, they are hardly new. The need for a major overall and complete transformation has never been more evident. One of the principles of the Bengoa expert panel was that the system should be collaborative, not competitive, and should work in partnership across government and with industry, academia, the community and voluntary sector, staff and patients to deliver new models of care, and, further, that the remodelling of the system should be a transparent and collaborative process.

It is with that in mind that I am a staunch proponent of the amendment relating to the continuation of local commissioning groups, allowing them to remain in place until the Department finalises its proposals for the replacement area integrated partnership boards. The transformation of any system can succeed only when the local voice of knowledge, expertise, connection and commitment is part of the decision-making process. Transformation of the health and social care sector has to be designed and delivered collaboratively between the people who commission the service, those who use it, those who deliver it and those who can provide their unique perspectives as experts with experience.

It must recognise the unique demographics and geography of this place and serve everyone in our community in a way that effectively and fairly meets our growing health and social care needs, whether urban or rural, east or west and, indeed, North and South. It must fundamentally and effectively bear down on the unsustainable inequalities that exist throughout our physical, mental and social care systems at present. We cannot continue to tolerate postcode lotteries, mental health underspending or the lack of social care to support our loved ones to live out their lives in a place of their choosing with the support and dignity that they so richly deserve. It must provide secure, properly staffed, fairly paid work and career opportunities for our invaluable front-line health and social care workers, who we must now surely recognise as the real backbone of our community.

Transparency and accountability must be an integral part of the transformation going forward, and so I am also a strong proponent of amendment No 2. That amendment places a duty on the Department of Health to bring forward its regulations on the AIPBs, subject to the draft affirmative procedure, meaning that the proposal must come before the Assembly and the Committee for scrutiny. That will ensure that there is Assembly and Committee representative input and sign-off on the new model when those plans are complete. That, a chairde, is another important step on one of the most fundamental challenges facing the Assembly, our community and the island. The Bill, with the proposed amendments, can act as a real catalyst towards that shared ambition and goal. I support the amendments and the Bill.

Photo of Pam Cameron Pam Cameron DUP 10:45 am, 16th November 2021

I thank the Minister and the Committee Chair for outlining the finer details of the Bill and the amendments this morning. As we are all well aware, the purpose of the Health and Social Care Bill is to give effect to the decision to close the Health and Social Care Board. I welcome the fact that we have reached the Consideration Stage of this particular Bill, which has been long awaited.

Clarity on accountability in decision-making is vital in any organisational structure, and there is no doubt that the Bill is a framework that delivers improvements in our healthcare structures. The need to strengthen the whole area of organisational structure was identified by the Donaldson report in 2014. As is often the case, it has taken us too long to get to this point of much-needed reform, not helped by the boycott of this place by the party opposite. Vital time was lost in so many ways.

Mr Speaker, I am sure that you, like me, want to see a less bureaucratic approach in our public sector across the board. The consultation on the Bill identified that as a key issue among consultees. It is important that the responses received have been taken on board by the Department in the drafting of the Bill. I know that the Minister wants to see reduced bureaucracy across our health service, and he has my full support in driving forward that agenda. While the Bill and its effect will save only around £0·4 million, greater savings and efficiency can be found through further, more-ambitious reform. I urge the Minister to accelerate the reform that is so desperately needed across our health service.

As the Health Committee scrutinised the Bill, we came to a collective belief that, in providing for the dissolution of the regional board and the transfer of its functions, we ought to support the requirement for the Department to make transfer schemes for assets and staff. However, we felt that, in some areas, the Bill required amendments to make it more robust and to ensure better outcomes. That involved amending the Bill to include provision for legislative powers, to place a statutory duty on the Department of Health to bring forward regulations on the new integrated care system model or framework that must be laid before the Assembly and to require such regulations to be approved by affirmative procedure. Any regulation should include the reporting mechanism of the new model.

Furthermore, I joined others in outlining our concerns about a possible loss of local input during the transition. The Committee agreed that the Bill should be amended to reflect an additional requirement to retain local commissioning groups in the interim. It was the Committee's view that an amendment of that type would allow the retention of those local commissioning groups until regulations on area integrated partnership boards are laid before and approved by the Assembly in order to ensure that there is no gap in the invaluable local engagement and input.

I welcome the Department's positive engagement with and acceptance of those sensible and measured amendments to the Bill. They will make the Bill better law and ensure that the transition is well managed and that the journey is aided and shaped by local views.

I commend the Bill to the House. It will help us to deliver the greater level of accountability and decision-making that was identified by the Donaldson report and the 2015 review of health and social care commissioning arrangements. Importantly, it will also strengthen the challenge to providers' mechanisms, which is vital. Complexity is being stripped out. In my view and that of those who were consulted, the objective is achieved.

To conclude, it is always right and proper that thanks go not just to Committee members for their work but to the Committee Clerk and his team, the Bill Clerk and, of course, the departmental officials in what has been an especially challenging time for all. I support the Bill and the amendments.

Photo of Colin McGrath Colin McGrath Social Democratic and Labour Party 11:00 am, 16th November 2021

I welcome the opportunity to speak at the Consideration Stage of this important Bill and, more importantly, on the amendments. There can be no doubt amongst any of us that we need to see radical change in our health service if it is going to survive. That is what the public and those who work in the service are telling us, and it is what all of us are saying as well. The Health portfolio that Minister Swann inherited last year had issues going back some 13 years. I greatly appreciate that the portfolio has been largely dominated by the COVID response, but I welcome that we seem to be reaching a turning point in the road, where we can start to scrutinise legislation that looks at some of the transformation that is required.

The Health and Social Care Bill is, as I said, an important piece of draft legislation. The need for it dates back to the days of direct rule, when we saw 18 health trusts cut down to five plus the Ambulance Service. However, when the Minister's predecessor, Michael McGimpsey, assumed the position in late 2007, the question turned very much to the role and future of local commissioning groups. We seem to have come full circle with the issue of local commissioning groups coming up once again with this Bill. It is quite amazing how the more things change, the more they stay the same.

The amendments that we are debating are, in greater part, a result of the Committee's deliberations on the Bill. I appreciate that the purpose of the Health and Social Care Bill is to cut out levels of bureaucracy and allow decision-making processes to be much more efficient. However, I have some concerns that this had not been considered in the Bill as initially drafted and that it took the Committee's deliberations to spot what was, quite frankly, a glaring oversight. Our local commissioning groups play an invaluable role in the commissioning of local services. By their very nature, they are responsible for the commissioning of health and social care by addressing the care needs of the local population.

The Health Minister knows me and he knows my commitment to local services in the Down area, especially those that are delivered at the Downe Hospital. I know how committed he is to the Dalriada Hospital in his constituency, and I absolutely applaud that. Nobody could ever accuse us of being parochial. We both know the importance of the local commissioning groups, which assess health and social care needs. They plan and secure the delivery of health and social care to meet emerging and assessed needs. That local knowledge and input, which is derived from local GPs, nurses, dentists, allied health professionals, social workers, pharmacists, Public Health Agency (PHA) representatives, local government representatives and those from the voluntary sector, is totally and utterly invaluable. It is on-the-ground information that feeds right into the overall shaping of and decision-making on services. As we move to a position of having area integrated partnership boards, it is essential that the local commissioning groups remain in situ to provide that voice to highlight the needs of the local community.

As I mentioned at the outset, we need to do something radical to turn our health service around. Even today's announcement that the Health Minister will introduce a paper to the Executive proposing COVID certificates is a step in that direction in these exceptional times. However, the problems of our health system, as I have said, predate COVID. COVID may have exacerbated those problems, but it did not create them. We still had long waiting lists when Michelle O'Neill left the post of Health Minister. We had people in corridors when Edwin Poots was Health Minister. It is amazing to see that the more things seem to change, the more they stay the same.

The Bill is a step in the right direction. However, it is not a radical change. Its purpose is to allow for greater transparency and to cut levels of bureaucracy. However, what I hear from those in the sector is concern that, by giving up several smaller fences of bureaucracy, we are substituting them with a greater wall of bureaucracy, that being the Department of Health. Therefore, while I am content, at this stage, to support the amendments, I do so with caution. I would really like to get reassurance from the Minister that the new system will be as open and transparent as possible.

We need radical transformation of the health service, not a piecemeal approach. The Bill will save us around £400,000 per year, which is hardly a massive financial incentive. As part of COVID recovery, the Department has issues that have not been funded, have yet to be funded or simply have not been confirmed. They include rebuilding and supporting primary care, GP, dental, optometry and pharmacy services; rebuilding children's paediatric services; recovering cancer services; supporting and reforming adult social care services; and supporting the transformation of urgent and emergency care services. A lot of work needs to be done, and, while I and the SDLP will not be found wanting, I hope that the Department is up to the job and will drive forward the radical transformation that our health services so urgently need.

I support the amendments and the Bill.

Photo of Alan Chambers Alan Chambers UUP

I welcome the latest stage of the Bill; a Bill that, at last, will deliver the policy first announced over six years ago regarding the proposed closure of the board.

Closely connected with the board, however, are the existing local commissioning groups. The groups were established by a former Ulster Unionist Minister, Michael McGimpsey. He was clear that they were to be strongly rooted in their communities and to have patients at the heart of their thinking and advocacy. In the intervening years, the groups have worked with varying levels of success. However, they undoubtedly have provided an important vehicle for engagement. That was especially important throughout the three years of a non-functioning Executive and the lack of clear accountability or direction on decision-making.

That is why there was broad agreement from around the Committee that, even after the abolition of the board, but before the new, more permanent alternatives were in place, there needed to be some degree of local input. I very much welcomed the early commitment from the Minister that he would retain the LCGs until the new area integrated partnership boards had been legislated for. The amendments are delivering on his commitment, and I hope that, after today, we will be one more important step towards securing the change that has already taken too long.

I, and my party, fully support the Bill and the amendments.

Photo of Paula Bradshaw Paula Bradshaw Alliance

Since clauses 3 to 5 and the two amendments to add content after clause 2 are at the core of the Bill, I intend to make my remarks on the Bill as amended during this group. Although I do not intend to oppose any of the groups, and, indeed, I am supportive of the amendments, I was reluctant to support the Bill when it was last debated in the Chamber, and I remain somewhat unconvinced by it.

It still seems to me that a lot of effort is ongoing to achieve very little in practice; rather, in fact, it reinforces existing administrative mechanisms that, over the years, have been shown not to work. Just look at the length of our waiting lists. Ultimately, the Bill merely puts more responsibility in the hands of the same leadership system that delivered those. What we should be doing is proper reform, introducing new thinking and placing more power genuinely in the hands of service users. I have been, and I remain, open to hearing a clear case that that is what the Bill achieves, but, as yet, I have not heard it.

By abolishing the regional board with responsibility for commissioning and then transferring its assets, we leave more questions than answers. For example, how will pathways for people with rare diseases now be developed, and how will those be better linked to treatment and expertise away from Northern Ireland if that is necessary? For people with ME who have been waiting 11 years for commissioned services, what is the likelihood of more urgency being put into developing and commissioning those specialist services so that they can be delivered by those with specialist expertise? If a specific regional board with specific responsibility could not do that, why are we to believe that a Department will be able to? That view is reinforced by the decision to maintain local commissioning groups as per the amendments, including amendment Nos 5 to 7.

To be clear, this is a measure that I support, and, in fact, it was the focus of my speech when I last spoke on the Bill. However, such a fundamental reversal of policy only raises further questions about why we are making any of these reforms at all. A Bill that initially set out fundamentally to abolish elements of administration in health and social care is now not abolishing one of those elements yet, for some reason, is still abolishing the other, seemingly before adequate commissioning frameworks have been put in place to replace it. Is that really the wisest thing that we could be doing and discussing in health at this juncture? Is there not a case for putting all those provisions on the back-burner while we focus on immediate, short-term priorities and then proceed only once we have a Bill that has been properly thought-through and that seeks to add new expertise to the administration of our health system without merely pushing more power and responsibility towards those who already have much of it?

It is perhaps useful to go through some of the apparent benefits of the Bill, which should be most evident in clauses 3 to 5. It will apparently streamline bureaucracy, but I would like to hear much more about how that will be achieved. As Mr McGrath just pointed out, there have been indications that there will be reduction in costs of £400,000 per year. However, it must be said that that is a miniscule amount given the scale of the effort in a Department whose annual budget is already over £6 billion. I would like to hear more about how that will be a benefit.

The question that this all raises is this: what we have learnt from previous experience? Have we really seen any learning from, say, the reform of local government, which has essentially seen the same services delivered by the same council departments, with no identifiable efficiencies or savings readily apparent to the public?

That is not to say that the need for reform in health administration is not urgent. In the past year or so, we have seen the resignation of an entire board from the Regulation and Quality Improvement Authority (RQIA), the ongoing departure of senior officials who were replaced almost invariably by others acting on an interim basis and serious questions emerging about where accountability ultimately rests, particularly in social care. That is why, while I see nothing wrong with the content of the clauses or the Bill as a whole, I am frustrated at how much effort is being made to achieve very little.

The real question from the public — those who use health and social care services — is about scrutiny. Who is independently scrutinising performance? How did we arrive at such a shocking situation with waiting lists and waiting times? What new expertise will be brought on board in order to ensure that such gross failures in performance are neither repeated nor perpetuated? Those clauses and the Bill as a whole seem silent on those things, and the fact that we are taking up time now, during a pandemic and when hospitals are about to come under the greatest ever pressure, talking about a reform that does not deliver new expertise, better scrutiny and clearly improved performance for patients seems astonishing to me.

Given that the legislation is largely about how Northern Ireland is not large enough to do full commissioning on its own, we still need to ask exactly how commissioning and contracting health and social care services through the integrated care system model will improve performance for the public. I ask this again: how precisely will new services for those areas where the patient base may be low, like rare diseases or ME, which are currently lacking a full resource pathway or service, be of benefit? Where will responsibility lie for identifying, planning and engaging with primary and secondary care, and how will that be scrutinised? The fundamental question on behalf of the public is this: what are the benefits of all these reforms to those who need and rely on our health and social care services?

Photo of Carál Ní Chuilín Carál Ní Chuilín Sinn Féin 11:15 am, 16th November 2021

I support the Bill and the amendments. Before I begin my substantial remarks, I thank the Committee staff and, in particular, Aoibheann and Claire from the Bill Office. Without their help, our scrutiny would have been much more difficult.

Our party was the first to raise concerns about the Health and Social Care Bill. We scrutinised it thoroughly and, for some people who attended the Committee, ad nauseam. I see that the Minister is trying to hide his joy at that remark, but that is our job. The Health Committee is flat to the mat. Everybody who attends it does so diligently — well, most of us who stay for most of the meetings do. When hard subjects come up, some people duck out or let on that they cannot lend their services, but that is another day's crack.

We did not advocate these amendments in order to be mischievous but because we, and those who responded to the Bill, felt that there was something slightly lacking. Many people had concerns. Everybody agreed that there was a need for reform. All the parties supported the transformation of healthcare, going right back and focusing on the Bengoa report. We focused on "systems, not structures". Anybody who watched the state of health and social care at that time appreciated that that was an opportunity for us all to try to get it right.

There was a suspension of the institutions for three years. A lot of work by health and social care professionals continued, but people need to understand that we could not have a situation in which men who wanted to give blood were prevented from doing so by the party opposite because they were gay. We could not have the situation with organ donation, where people were speaking out of two sides of their mouths, and that was the case with vaccination, sexual health and awareness, mental health and the rest. A lot of platitudes were offered, but we needed to ensure that equality was delivered.

I am content that the Bill and the amendments address a lot of those concerns. I do not recall hearing previously many of the concerns that Paula has raised here today, although she raised some. I am delighted that she will not oppose the Bill, because we all appreciate the strain that our providers of health and social care are under.

There has been a lot of scrutiny of the Bill. As I said, there was recognition that transformation is key. However, my concern was that, while people had difficulties in the scrutiny of the Health and Social Care Board with the LCGs, the LCGs were critical for going back to the grassroots. They are not just looking at how acute care is delivered by health and social care, as primary and secondary care and the community and voluntary sector are really critical.

The amendments lend themselves to the aspirations that were laid out by all political parties in the run-up to New Decade, New Approach. Certainly, they are within the principles and guidance of that agreement, when we look at co-production and co-design. Integrated care partnerships and area integrated boards will lend themselves to better scrutiny. For example, when this was being discussed, no one predicted that there would be a health pandemic. We are now dealing with what people call "long COVID", and we have to make additional provision for additional services as the learning progresses and is internalised and institutionalised. It could be put into the realm of respiratory care in the primary care sector. I am sure that my colleague Órlaithí Flynn will touch on the mental health aspect. However, the impact of COVID on us physically, economically, socially and in mental health is critical. Any new commissioning that is done by the commissioning groups — commissioning is key to this — will certainly have that reflected in any plans.

The Committee heard from a lot of people on the Bill. They spoke about our health and social care trusts, right through to the need for multidisciplinary teams of family practitioners. Our GPs, district nurses and carers all said that there is a need for better service provision and a more joined-up approach.

We have an opportunity to try to set out what will happen when we come out of the pandemic — post COVID — and during the health recovery. Everyone has said that there is a need for greater investment in health. I take the opportunity to agree with that. I also welcome the Executive's support for that. However, that always comes with conditions.

Even in the last equality screening exercise that the Minister brought forward for the Budget — we welcome the fact that there will be multi-year budgets soon — certain issues with major implications were screened out. There is a job for local commissioning to ensure that that is corrected. The issues relate to the provision for disability, older people, younger people and lots of the issues that each of us raised. More provision for oral health is needed, particularly for children and young people from deprived communities, and better dentistry is required for people with autism and disabilities. The list goes on and on, and we all have a list of those things. Local commissioning, and getting the local commissioning structures and frameworks right in the new setting, will be critical.

In many respects, the Bill is about hitting the reset button and giving us the opportunity to do better what we already do well, and then some. The "then some" comes from the global pandemic. Health and social care was always at a critical point. COVID and everything that came with it certainly exacerbated that.

I also want to raise the ongoing scandals in health, which predate the Minister's term in office. I have no doubt that the services that are needed will be challenged and tackled by the different public inquiries and the recommendations that come from those. However, we already have the recommendations from the O'Hara hyponatraemia inquiry. Those need to be implemented. We heard about some of that, and, although progress has been made, there is still a lot to be done. Those recommendations will be critical in any new commissioning. That is why the amendments are so important. We cannot assume, and we do not assume. Those will be writ large and will be part of our scrutiny. A lot of that stuff has come back to the Assembly for affirmative resolution, and that is the other safeguard that we put in. It is not about a lack of trust; it is to make sure that we have belt and braces when we make legislation. This is a perfect opportunity for us to do that.

I am sure that the Minister already knows this: when he calls a health summit with all the health and social care professionals, he will hear a lot of conversations about what needs to happen and when it needs to happen. There will be a lot of competition. There is a maturity and an acceptance of what is needed now and about trying to prioritise those needs. That needs to happen as soon as possible. I appreciate that the Minister said that he is waiting to see the Budget outcomes, but I urge him to do that now. It would help with his discussions and negotiations on the Budget. However, that is a political call. That is up to him.

The amendments and, indeed, the whole process of bringing the legislation, show what the legislative process looks like. All of us, particularly those of us on the Health Committee, are dealing with a raft of Bills, and there is the potential for private Members' Bills to come forward. Despite the fact that we will have a lot of late nights, long Committee meetings, no lunches on Tuesdays and all the rest of it, I welcome that. If you ask any MLA what are the top five issues that they deal with, health and social care will certainly be in the top three, if not at the top. You then have housing, mental health and stuff like the economy, education and everything else behind that.

Not to be political, but I want to raise the point that we should look at the potential for having all-island healthcare. For example, the Minister will know from his own experience that all-island healthcare can look at paediatric coronary care, as well as at cancer care for people in Altnagelvin and in Donegal hospitals. We need to look at big set pieces. We have no autopsy provision for children, for example. We need to look at what we can do on this island, because it is a small place. We already do some things across the island, and we do them very well. What additional provision can we commission? That is really important. No one would wish to have the experience of having to bring back from England the remains of a child who has passed. We need to look at what we can do to support our population across the board.

Minister, I enjoyed scrutinising the Bill. I am delighted at the collaborative approach that we have taken, and I thank you and your departmental officials for accepting and tabling the amendments.

Photo of Deborah Erskine Deborah Erskine DUP

I am pleased to speak to the Bill, following the proposal and consultation on its introduction that began almost six years ago under former Health Minister Simon Hamilton.

I will not labour my points. I thank the Minister for listening to the Health Committee's concerns. I hope that, with the Bill's proper implementation, the closure of the Health and Social Care Board will allow the Department to deal as efficiently as possible with the ever-changing demands on our health service.

Amendment No 1 allows any potential gaps in the service to be filled. It helps address the concerns that were previously set out, such as the feeling that local input would be lost with the loss of local commissioning groups. As others have pointed out, local intelligence and engagement are key to building services.

Last night, my local accident and emergency department in the South West Acute Hospital sent out a message to say that it was under pressure and that people should come to the ED only in an emergency. At around 8.00 pm, I understand that 59 people were in the ED and that 22 were waiting to be admitted to hospital. A constituent contacted me to say that it is time for politicians to take the difficult decisions to reform our health service, and I absolutely agree. We owe it to our health and social care staff and our patients. The Member opposite talked about the fact that we will have extra Health Committee meetings and late nights. To be honest, those pale into insignificance when we look at what our healthcare staff have to go through daily in our accident and emergency departments. They have to go without toilet breaks and without being able to eat their lunch or see their family. As a member of the Health Committee, I rise to that challenge. I want to act now to do something for the staff and patients whom we represent. I thank our healthcare staff, who are stressed out and trying their best in difficult situations.

Naturally, with health, behind such Bills are people. Ensuring that everyone has access to better health and well-being is paramount, as is, for example, effective management of budgets. Throwing money at a system that is creaking, however, will not be enough. We need to act. Many of the problems predate COVID, but a spotlight has been shone on them during the pandemic, and they have been exacerbated. As we look at the circumstances in which we find our health service, it is important that the Bill's reforms not be made in isolation but form part of the greater transformation of our health and social care services. For example, the reform of social care will have an impact on accountability arrangements and performance management functions.

I commend the Bill and the amendments to the House. I thank the Minister, the Department and the Bill Clerks for their engagement on the Bill.

Photo of Órlaithí Flynn Órlaithí Flynn Sinn Féin 11:30 am, 16th November 2021

I also support the Health and Social Care Bill as amended by my party and other Committee colleagues.

The closure of the Health and Social Care Board is a policy that has cross-party support, and it has the support of those who gave evidence to our Committee and many of those who responded to the consultation. As we know, there is almost universal recognition among all participants that reform is necessary and that what will replace the old board must be better. The closure of the board is a step in the right direction in the transformation that, we know, is vital to improving Health and Social Care services. It has already been said by other Members that each of us in the Assembly agrees that transformation of the health and social care system overall is completely necessary and that it must be completed in a considered and measured fashion so that, going forward and into the future, we get right all of the issues that Members have raised today. The amendments proposed by my colleagues improve the Health and Social Care Bill in particular, as they acknowledge the necessary co-production requirements going forward as we transform the sector.

The amendment to retain the local commissioning groups has my strong support. Until the Department brings satisfactory proposals before the Assembly and the Committee for their replacement, the LCGs will remain a participant and an integral part of any transformation of the health and social care sector. During consideration of the Bill, members of our Health Committee highlighted concerns with the Department, including the lack of clarity that we had around the new arrangements and what would replace the local commissioning groups and concerns around the diminished local input into the commissioning process. As my party's spokesperson on mental health and substance use, I cannot overstate the importance of that local input, particularly from the community and voluntary sector and other local organisations that, as we all know, provide an invaluable understanding around mental health and substance use challenges on the ground in our communities. We cannot understand substance use or design the needed treatments without understanding the circumstances of mental health patients or of people who suffer with addictions. For me, that is one of the reasons why the amendment is so important. The community and voluntary sector and local groups provide much of the important intelligence that is needed around the commissioning process for mental health and addiction services and, of course, other health services. In the context of mental health and addiction, that is one of the ones that I wanted to focus on today. Thankfully, through amendment No 1, if it is passed, that local engagement and input into the commissioning of services can be and will be maintained throughout the transitional phase of the process and the legislation passing.

Amendment No 2 places a statutory duty on the Department of Health to make regulations on area integrated partnership boards, and that amendment also has my full support, as it will give the Committee and the Assembly the highest level of approval when we come to consider those regulations when they are introduced.

To conclude, like the Chair, the Deputy Chair and other Members, I thank the Minister and all of his officials for taking Committee members' concerns on board and for tabling the amendments. I look forward to engaging and continuing to engage on the new structures into the future.

Photo of Robin Swann Robin Swann UUP

I thank all of those who contributed to the debate today on the amendments. As I said, the amendments have been developed as a consequence of my Department's consideration and co-working and co-production with the Health Committee and the Health Committee's scrutiny report to address the issues that have been raised in full.

(Mr Deputy Speaker [Mr McGlone] in the Chair)

I turn to a number of comments of Members in the debate today. I note that there is no objection to the amendments that we have tabled. The Chair had a query regarding where we are with local input and engagement, and many Members raised LCGs and the transition to area integrated partnership boards.

From some Members' input, it sounded as though local input was being done away with completely, but Ms Flynn acknowledged that, if we get area integrated partnership boards right, they will add real value, structure and local input to what we do — possibly more than LCGs added in the past. That matter was responded to during the consultations, as well. The LCGs committed a very important piece of work, because local input and intelligence have always been key components of our planning process and are the underpinning principle of the new ICS planning model that my Department has consulted on.

I have, however, taken account of the Committee's concerns about the loss of the legislative provision for local input while the work on the new planning model develops. The amendments tabled today will therefore allow the continuation of local commissioning groups until such time as regulations are laid on the new local area bodies, which will be known as area integrated partnership boards and will be at the heart of the integrated care system. That amendment also provides the legislative basis for bringing forth those regulations. Members referred to that as well.

The Chair noted that nine groups engaged with the Committee about the Bill and the next session. When we went out to targeted consultation on the draft framework that was going to underpin this model, we received over 120 responses, which shows the importance of the integrated care system for Northern Ireland. That has shown the value and importance of that engagement process, but it has also shown where the integrated care system and AIPBs could be in bringing forward what could be transformational local input.

As regards comments from the Deputy Chair and others around the House about work, I note that this legislation started in 2015. Ms Erskine referred to that. It was continued under Minister O'Neill and, finally, has been brought to fruition by me. I could use the phrase "Success has many fathers" or "Success has many mothers", but, when other Members talk about the waiting lists and challenges that we have, I do not often hear them say that they were Minister at that point in time. It is about where we take the work that is progressing now. It is about how we take that work forward. It is good to see that we are making progress on this. It would have been very wrong to park this legislation, considering so much work had been done and so much engagement had been carried out in the background while we were going through a pandemic. Many organisations would have found it a slight and an insult had we stopped and parked this work, especially the work on the transformation in local engagement.

When Mr McGrath opened his contribution by talking about the loss of local input, I thought that he had missed the importance of the area integrated partnership boards, but he went on to acknowledge that they were there. I think that we needed to have that engagement with the Committee about the transitional period while we got those into place.

Mr McGrath mentioned the cost savings that will be brought about by this and said that, while those savings may be minimal, this is not solely about the financial cost but about the streamlining and the transformation of our health service. He went on to list a number of areas in my Department that are still not funded. I say to that Member that, if his Minister had got her way with her £76 million bid at the last monitoring round, a lot of what we are currently doing would not be funded. A call has to be made somewhere about asks and realisations of where money is being spent, considering the last monitoring round was mostly Health Barnett consequentials from Westminster.

With regard to Mr Chambers' contribution, today's commitments recognise that it is through the partnership approach between the Department and the Committee, working in conjunction with Bill Clerks, Committee staff and my departmental officials, that we have got to where we are today. Paula's contribution was about the wider precepts of the Bill, as well as acknowledging the benefits that these practical amendments brought. This is the Consideration Stage. This was the opportunity for further amendments to have been proposed by not just me or the Committee but individual Members. However, as Ms Ní Chuilín recognised, the concerns that were raised did not transform into amendments that could have been discussed or debated here today and changed the Bill.

There was a question about decentralisation and bureaucracy. As I have outlined, it is important that we take a staged approach to how we transform, plan and manage our services. The first step of closing the board streamlines our structures and reduces bureaucracy. Staff will continue to undertake the same functions as before. Building on that first step, the Bill also includes a duty for my Department to establish local bodies in the form of area integrated partnership boards. Those local bodies will be key to the development and success of an integrated care system, which will be underpinned by a population health approach. That integrated care system model will look to promote collaboration and partnership working across sectors and traditional organisational boundaries to identify and remove any barriers and unnecessary bureaucracy in our system.

That leads to Ms Ní Chuilín's point about the benefits that come from the Bill. I know what she said, but I also welcome the Member's detailed scrutiny of the Bill and the issues that she raised at Second Stage. She will know me well enough to know that, when she raised those questions, I would get the answers and ask why. After the Committee deliberated on its amendments and worked in conjunction with my departmental officials, the amendments have come from me, as Minister, because they are the right thing to do. It is about the building bases approach, as the Member identified. It is what this place should be about when it comes to legislation: co-working and co-challenge. It is not always about Members coming in here to grab a headline. The "L" in MLA stands for "legislative"; that is what we are meant to be about. This is what legislation looks like. It is heavy work and heavy going. Mrs Erskine, Ms Ní Chuilín, a number of other Members and I recognise the heavy workload that is in front of the Health Committee as we move to the end of the mandate, but it is all very important work. It is all legislation that will be heavy going and will not grab headlines. It will not keep a lot of people up at night, apart from us and the people whose lives will be changed by that legislation. That is what it is about. It is about delivering legislation and change that does not always come with a headline or a media announcement. I thank the Member for the acknowledgement and recognition of the Committee staff and the work that has been done. It is about having a collaborative approach and working with my departmental officials.

Mrs Erskine acknowledged the importance of the work at even a local level, where we currently are and the challenges that are in front of us. This piece of work started under Minister Hamilton in 2016. We have got here now, but the rest of the transformation that we need to do cannot, and should not, take that long. We need to move at a pace that is in keeping with the changes that we need to make in our health and social care system.

I thank Órlaithí Flynn for her continued engagement on our substance use strategy and the mental health strategy, and for bringing community organisations to engage with my departmental officials and trust officials. That shows the benefits that AIPBs can bring to the structure of Health and what it should be doing so that we really make the changes that can be brought about.

I acknowledge the comments that Members have made. Given that there are no objections to the amendments that have been brought forward, I propose that they be accepted.

Amendment No 1 agreed to. New clause ordered to stand part of the Bill.

New Clause

Amendment No 2 made:

After clause 2 insert -

<BR/>

&quot;Duty to establish bodies for local areas



2B.—(1) After section 15A of the Health and Social Care (Reform) Act (Northern Ireland) 2009 insert—



&#x0027;Local area bodies



Duty to establish bodies for local areas


15B.—(1) The Department must by regulations establish one or more bodies under this section.



(2) A body established under this section is to be called an &#x0027;Area Integrated Partnership Board&#x0027; or such other name as may be prescribed.


(3) Each Board is to exercise its functions for such area of Northern Ireland as may be prescribed; and the Department must ensure that there is a Board for each area of Northern Ireland.


(4) Each Board is to exercise such functions relating to the following matters as may be prescribed—


(a) the identification of the health and social care needs of the people in its area,


(b) the planning, delivery and management of health and social care for those people, and


(c) the facilitation and encouragement of co-operation between those responsible for planning, delivering or managing health and social care for those people.


(5) Each Board must exercise its functions with the aim of—


(a) improving the health and social well-being of the people in its area;


(b) reducing health inequalities between those people, and between those people and other people in Northern Ireland.


(6) The Department may by regulations—


(a) provide that Article 18 of the Order of 1972 is to apply to each Board with such modifications (if any) as may be prescribed, and


(b) require each Board to exercise its functions in accordance with any scheme having effect under that Article.


(7) The Department may by regulations—


(a) provide that each Board is established as a body corporate (and that section 19 of the Interpretation Act (Northern Ireland) 1954 applies to each Board with such modifications (if any) as may be prescribed);


(b) make provision for the constitution of Boards (including, in particular, their membership, general powers and proceedings);


(c) make provision for the payment of remuneration and allowances to members of Boards, and for the defraying of the expenses of Boards;


(d) make provision in relation to accounting, reporting and record-keeping by Boards;


(e) make such further provision in relation to Boards as the Department considers appropriate.


(8) Regulations under this section may apply (with or without modifications), amend or repeal any statutory provision whenever passed or made, including any provision of this Act.


(9) In this section—


&#x0027;Board&#x0027; means a body established under this section;


a reference to the area of a Board is to the area prescribed for that Board under subsection (3).



Power of Department to give directions and guidance


15C.—(1) The Department may give directions of a general or specific nature to a Board as to the carrying out by the Board of any of its functions.


(2) The Department may give guidance to a Board as to the carrying out by the Board of any of its functions.


(3) Before giving any directions to a Board under subsection (1) the Department must consult the Board.


(4) Where the Department is of the opinion that because of the urgency of the matter it is necessary to give directions under subsection (1) without consulting the Board concerned—


(a) subsection (3) does not apply; but


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


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


(a) that subsection does not apply; but


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


(6) It is the duty of a Board—


(a) to comply with any directions given to it under subsection (1);


(b) to have regard to any guidance given to it under subsection (2).


(7) In this section &#x0027;Board&#x0027; means a body established under section 15B.


(8) This section does not affect the Department’s powers to give directions or guidance apart from this section.&#x0027;.


(2) In section 29 of that Act—


(a) after subsection (1) insert—


&#x0027;(1A) No regulations are to be made under section 15B unless a draft of the regulations has been laid before, and approved by a resolution of, the Assembly.&#x0027;;


(b) in subsection (2), for &#x0027;this Act&#x0027; substitute &#x0027;any provision of this Act other than section 15B&#x0027;.&quot; — [Mr Swann (The Minister of Health).]

New clause ordered to stand part of the Bill.

Clauses 3 to 5 ordered to stand part of the Bill.

Clause 6 (Commencement)

Amendment No 3 made:

In clause 6, page 2, line 31, at end insert -



&quot;(ba) section 2A and Schedule 1A;&quot;. — [Mr Swann (The Minister of Health).]

Clause 6, as amended, ordered to stand part of the Bill.

Clause 7 ordered to stand part of the Bill.

Schedule 1 (Transfer of the Regional Board’s functions)

Amendment No 4 made:

In schedule 1, page 42, leave out line 35 and insert -



&quot;232. Omit sections 7 and 8 and the italic heading before section 7.


232A. In section 9, omit subsections (1), (3)(b), (6)(b) and (7).


232B. Omit sections 10 and 11.&quot; — [Mr Swann (The Minister of Health).]

Amendment No 5 made:

In schedule 1, page 43, leave out line 13 and insert -



&quot;239. In Schedule 1 omit—


 


(a) paragraphs 1 to 7;


(b) paragraphs 8 to 11(1), except so far as those paragraphs apply to, or relate to, the Local Commissioning Groups and their members;


(c) paragraph 11(2);


(d) paragraphs 12 to 21.&quot; — [Mr Swann (The Minister of Health).]

Amendment No 6 made:

In schedule 1, page 43, leave out lines 38 and 39 and insert -



&quot;(3) In section 3(6)—


(a) for &#x0027;the Regional Health and Social Care Board&#x0027; substitute &#x0027;the Department&#x0027;;


(b) omit &#x0027;and Local Commissioning Groups&#x0027;.&quot; — [Mr Swann (The Minister of Health).]

Schedule 1, as amended, agreed to.

New Schedule

Amendment No 7 made:

After schedule 1 insert -



&quot;SCHEDULE 1A


Section 2A.


 


LOCAL COMMISSIONING GROUPS


 


Statutory provisions to continue to operate in relation to Groups as continued


 


1.—(1) The following provisions continue to apply to or in relation to Local Commissioning Groups and their members—


(a) section 9(2), (3)(a), (4), (5) and (6)(a) and (c) of the Health and Social Care (Reform) Act (Northern Ireland) 2009 (&#x0027;the 2009 Act&#x0027;);


(b) paragraphs 8 to 11(1) of Schedule 1 to the 2009 Act, so far as those paragraphs apply to, or relate to, committees of the Regional Board and their members;


(c) regulations 1, 2(2) and 3 of, and the Schedule to, the Local Commissioning Groups (Number, Area and Functions) Regulations (Northern Ireland) 2009 (S.R. 2009/99);


(d) the Local Commissioning Groups (Membership) Regulations (Northern Ireland) 2009 (S.R. 2009/395) (the &#x0027;Membership Regulations&#x0027;), except regulation 3(1) to (3) (appointments);


but this is subject to the modifications made by sub-paragraph (2).


(2) The provisions applied by sub-paragraph (1) are modified as follows—


(a) the power conferred by paragraph 9 of Schedule 1 to the 2009 Act is conferred on the Department, and in that paragraph the words &#x0027;Without prejudice to section 19(1)(a)(v) of the Interpretation Act (Northern Ireland) 1954 (c. 33)&#x0027; are omitted;


(b) in the Membership Regulations—


(i) references (however expressed) to employment by the Regional Board are to be read as references to employment by the Department or the Regional Business Services Organisation;


(ii) other references to the Regional Board are to be read as references to the Department.


2. Paragraph 1 does not affect the continued operation of any other statutory provision that applies to, or relates to, Local Commissioning Groups.


Appointments and terms of office


 


3.—(1) Any person who is a member of a Local Commissioning Group immediately before the dissolution of the Regional Board is to continue to be a member of that Group; but this is subject to the following provisions of this paragraph.


(2) The term of office of a person who is a member of a Group by virtue of sub-paragraph (1) is to end six months after the date on which the Regional Board is dissolved.


(3) The Department may direct in writing that the term of office under sub-paragraph (2) is to be extended by such period, not exceeding 12 months, as may be specified in the direction.


(4) The Department may exercise the power conferred by sub-paragraph (3) more than once.


4.—(1) In the event of any vacancy in the membership of a Local Commissioning Group (as determined in accordance with regulation 2 of the Membership Regulations), the Department may appoint a person to fill the vacancy.


(2) The terms of appointment under sub-paragraph (1) must comply with the Membership Regulations, but otherwise are to be determined by the Department.


(3) A person who has ceased to be a member of a Group is eligible for re-appointment.


5. Paragraphs 3 and 4 are subject to regulations 3(4) to (9) and 4 to 6 of the Membership Regulations (cessation of membership in certain circumstances, disqualification, resignation and removal).


 


Other provision about the Groups as continued


 


6. The Department may pay to members of a Local Commissioning Group who are not employees or officers of the Department or the Regional Business Services Organisation such remuneration and allowances as the Department may determine.


7. In the 2009 Act—


(a) section 2(3)(h) (duty of Department to monitor and hold to account) applies in relation to Local Commissioning Groups;


(b) the duty in section 5 (preparation of framework document) applies as if a Local Commissioning Group were a health and social care body;


(c) section 6 (power of Department to give directions) applies in relation to Local Commissioning Groups;


(d) a Local Commissioning Group is a relevant body for the purposes of section 15 (RBSO support services);


(e) sections 17 to 19 (Patient and Client Council and public involvement) apply to Local Commissioning Groups.


8.—(1) The Department may give guidance to a Local Commissioning Group as to the carrying out by the Group of any of its functions.


(2) It is the duty of a Local Commissioning Group to have regard to any guidance given to it under sub-paragraph (1).


(3) Section 29(3) of the 2009 Act applies to guidance given under sub-paragraph (1).


9. References in the following provisions to a health and social care body are to be treated as including a Local Commissioning Group—


(a) Article 67 of the 1972 Order (duty of various bodies to co-operate with one another);


(b) section 3(8) of the Health and Social Care (Control of Data Processing) Act (Northern Ireland) 2016 (code of practice on processing of information);


(c) sections 14(2)(a) and 15(1) of the Public Services Ombudsman Act (Northern Ireland) 2016 (matters which the Ombudsman may investigate).


 


Continuity


 


10.—(1) Any document made or other thing done by the Regional Board in relation to the Local Commissioning Groups, if in effect immediately before the dissolution of the Board, continues to have effect to the same extent and subject to the same provisions.


(2) Sub-paragraph (1)—


(a) does not apply if the context requires otherwise, and


(b) is subject to any power conferred on the Department by paragraphs 1 to 9 to make other provision.


 


Power of Department to dissolve the continued Groups


 


11.—(1) The following provisions cease to have effect on such day as the Department may by regulations appoint—


(a) section 9(2), (3)(a), (4), (5) and (6)(a) and (c) of the 2009 Act;


(b) paragraphs 8 to 11(1) of Schedule 1 to the 2009 Act, so far as those paragraphs apply to, or relate to, the Local Commissioning Groups and their members;


(c) section 2A and this Schedule;


(d) the Local Commissioning Groups (Number, Area and Functions) Regulations (Northern Ireland) 2009;


(e) the Membership Regulations.


(2) Accordingly, on the day appointed under sub-paragraph (1), the Local Commissioning Groups are dissolved.


(3) The Department may not make regulations under sub-paragraph (1) unless the Department makes, or has made, regulations under section 15B(1) of the 2009 Act, as inserted by section 2B(1) of this Act (establishment of local area bodies).


(4) Regulations under sub-paragraph (1) are subject to negative resolution.


(5) But sub-paragraph (4) does not apply if a draft of the regulations (whether alone or with other provision) has been laid before, and approved by a resolution of, the Assembly.&quot; — [Mr Swann (The Minister of Health).]

New schedule agreed to.

Schedules 2 and 3 agreed to.

Long title agreed to.

Photo of Patsy McGlone Patsy McGlone Social Democratic and Labour Party 11:45 am, 16th November 2021

That concludes the Consideration Stage of the Health and Social Care Bill. The Bill stands referred to the Speaker.

Members should take their ease before we move to the next item of business.