Official Report: Minutes of Evidence

Committee for Health, meeting on Thursday, 21 October 2021

Members present for all or part of the proceedings:

Mr Colm Gildernew (Chairperson)
Mrs Pam Cameron (Deputy Chairperson)
Ms Paula Bradshaw
Mr Gerry Carroll
Mr Alan Chambers
Miss Órlaithí Flynn
Mr Colin McGrath
Ms Carál Ní Chuilín


Mr Allan Chapman, Department of Health
Mr John Millar, Department of Health

Health and Social Care Bill: Department of Health

The Chairperson (Mr Gildernew): Departmental officials are here to brief members on the Department's proposed amendments. The Committee has agreed its own amendments to the Bill but agreed to consider the Department's proposed amendments once they became available. I welcome Mr John Millar, head of the Health and Social Care Board closure project branch.

Mr John Millar (Department of Health): Can I just clarify, Chair? Actually, I am responsible for the Bill team.

The Chairperson (Mr Gildernew): OK. Thank you, John. So, John Millar, from the Bill team. We are also joined by Allan Chapman, who is future planning model planning team lead. Is that correct, Allan, and can you hear us?

Mr Allan Chapman (Department of Health): Yes, Chair. I can hear you. Good morning.

The Chairperson (Mr Gildernew): OK. Thank you. Please brief the Committee on the amendments. We look forward to your briefing. Which of you will lead off?

Mr Millar: Chair, I will, and Allan will join in. Thank you for the opportunity to provide this briefing in respect of the proposed amendments to the Health and Social Care Bill. I hope that the information provided by the Minister prior to today's session proved useful. The Minister's letter included attachments detailing the proposed amendments. They were developed following the evidence session that Allan and Martina Moore attended, and following receipt of the Health Committee's scrutiny report.

The Committee's report included the need for inclusion of legislative powers to place a duty on the Department to bring forward regulations on the new integrated care system (ICS) model framework to include reporting mechanisms and the retention of local commissioning groups (LCGs) until regulations are approved by the Assembly.

We have been working with the Office of the Legislative Counsel (OLC) to develop suitable and necessary amendments. As previously stated, those were shared by the Minister. For clarity, I will refer to them as they are labelled in the Minister's letter.

JA3 provides for the continuation of local commissioning groups beyond the closure of the Health and Social Care Board. JA4 provides for relevant sections of the Health and Social Care (Reform) Act (Northern Ireland) 2009 to be retained in relation to the continued local commissioning groups. In addition, it maintains the Safeguarding Board's duty to advise local commissioning groups on safeguarding and promoting the welfare of children. JA1 provides a duty to establish local area bodies. SA3 sets out the detail for the continued local commissioning groups.

Therefore, our amendments have focused on the continuation of local commissioning groups and a statutory duty to bring forward regulations for local area bodies, the latter being a key component of the integrated care system that is being developed. Allan will provide further detail on that.

JA3 preserves the local commissioning groups. It provides for the continuation of LCGs beyond the closure of the Health and Social Care Board. I should explain that, on the closure of the board, to continue, LCGs must become statutory bodies in their own right and will remain in place until such time as the Department makes regulations for area integrated partnership boards (AIPBs). For clarity, the Department can only make regulations to close LCGs following the progression of regulations on those area boards through the Assembly via the draft affirmative process.

SA3 sets out the detail about the continued LCGs. It includes a provision to retain LCG functions and membership as they currently stand. It also includes a provision to extend membership beyond an initial six months following the closure of the Health and Social Care Board, should that be necessary, and 12-month intervals thereafter. It also includes a provision to disqualify and replace LCG members in line with existing regulations. It also includes necessary consequential and transitional provisions to ensure that existing references to LCGs in legislation are maintained and, where necessary, extended to reflect the change of status from a committee of the Health and Social Care Board to a statutory body. Finally, it includes powers for the Department to dissolve the continued LCGs. It is worth highlighting again that that can be done only when the Department has made regulations for area integrated partnership boards.

I will now pass to Allan, who will explain the provisions that are contained in the amendments that deal with area integrated partnership boards.

Mr Chapman: Thanks, John. Members and Chair, given the context of the proposed departmental amendments, I would like to recap briefly on the local area integrated partnership boards and their role in the integrated care system model.

Area integrated partnership boards are at the core of the model that is being developed. As members will be aware, the model will bring together partners from within and beyond health and social care, including partners in the voluntary and community sectors, local government and others, to plan, manage and deliver services that are based on the identified needs of the population.

As set out in the draft framework for the model, it is envisaged that five local area integrated partnership boards will be established, one per health and social care trust area, in order to deliver against their aims at a local level. They will have responsibility for strategic local area planning and local delivery and will be guided by an overarching strategic outcomes framework set by the Minister and the Department of Health. The area integrated partnership boards will take account of the identified needs of their local populations and will have wide representation from

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A targeted consultation on the integrated care system draft framework was launched on 19 July and closed on 17 September. Analysis of the responses to that consultation is ongoing, but early indications are that the approach is broadly supported, with the majority of respondents agreeing that it is the right approach to adopt in Northern Ireland. In addition to the briefings that we provided to the Committee, engagements in the health and social care sector and with other stakeholders and interested parties have continued. Feedback from the consultation and that ongoing engagement is being considered and will inform the development and finalisation of the draft framework for the ICS model and, ultimately, the regulations that will be developed under the statutory duty provided for in the proposed amendments. As John noted, those regulations must be laid in the Assembly and will be subject to the draft affirmative procedure.

The amendment detailed in JA1 sets out the duty of the Department to establish bodies for local areas. In essence, those are the area integrated partnership boards that are detailed in the draft framework. It also includes the high-level functions, duties and responsibilities of the boards that may be prescribed in regulations and a power for the Department to give direction and provide guidance to the boards.

The proposed amendments were drafted with the intention of ensuring that the power to make regulations adequately reflects the aims and objectives set out in the draft framework for the model and the continuing duties of the Department as set out in the Health and Social Care (Reform) Act (Northern Ireland) 2009. The proposed amendments were drafted following careful consideration of the existing provisions relating to local commissioning groups, with the overarching aim of ensuring that they provide the required powers to support the successful implementation of the new model and ensuring that a continued mechanism for securing local input and intelligence in the planning of services remains in statute.

In summary, Chair, clauses 1 and 2 will contain the headline provisions of the dissolution of the board and the transfer of its functions; new clauses JA3 and JA1 will form an addendum about local involvement and health; and existing clauses 3 to 7 will contain supplementary provision. We hope that members found this useful. We are happy to take questions.

The Chairperson (Mr Gildernew): Thank you Allan and John. There are a number of amendments, and that is welcome. It seems to me that the main difference is new clause 1A in respect of the regulations for the new model of health and social care. There does not appear to be a departmental amendment that specifically addresses that as a whole, but there is an amendment that relates to the area integrated partnership boards, which provides for one element of the model. What is your rationale for addressing just one element of that model? Why have you taken that approach?

Mr Chapman: Thanks, Chair. We used the Committee's proposed amendment to help to develop what would be the most effective way to provide legislative provisions for the new model. The advice from OLC was clear: legislating for a model in the broader sense could prove difficult in providing clarity, purpose and scope for the powers being proposed. Rather than providing for the power to legislate for a model or system per se, it recommended that the power be focused on providing for the specific elements of the model that would need to be and which would benefit from being placed in statute. As we considered the amendments for a new model, it became clear that the focus should be on the local level, given that that is where the model proposes to establish significant new structures and processes that are not currently explicitly set out in

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Our approach also links the power directly to the policy framework for the integrated care system in Northern Ireland. On that basis, it was felt that the most appropriate approach was to focus the provisions of the Bill on a duty to develop the regulations for local area bodies, ensuring that there will be no ambiguity in what the regulations may or may not include, and that the regulations for local bodies would detail the roles of and expectations of those involved and detail the relevant functions of the local bodies and how they operate. As a consequence, the regulations will detail how the broader model will be expected to operate, given the legislative requirements that will underpin local bodies through those regulations.

The Chairperson (Mr Gildernew): Are you saying that OLC recommended that it was possible or desirable to focus on one element only? My concern is about how that will interact with the wider framework. A particular issue is trusts' involvement in commissioning. We could have a very robust AIPB in place, but that could be diluted if it does not have the necessary authority or status within the overall framework. What are your views on that?

Mr Chapman: In our discussions, OLC made it clear that it would be very difficult to create a power that does not have a more solid grounding than we actually want to legislate for. If it was just a power based on the concept of a model, there is a risk that, if anything happened to change that model, the power that we had provided would then apply. Uncertainty could arise about whether a change in six months or eight months could effect a change in the model such that the regulations would no longer be fit for purpose.

The key is to ensure that we provide clear regulations for specific elements of the model, including membership of the local area integrated partnership boards, which includes the local health and social care trusts, and that the functions that apply directly to those AIPBs are clear in the regulations and that they read across to how the trusts and other partners interact with one another within the system in relation to the planning, management and delivery of services at a local level.

The Chairperson (Mr Gildernew): Allan, you referred to potential primary legislation. Is there an intention to bring forward primary legislation on some of those issues at a later date?

Mr Chapman: There is no outright intention to bring forward primary legislation, and no date has been set. What we intend to do is bring forward proposed amendments through regulations. We believe that that would give good grounds in statute for the model. We have to take cognisance of how the model develops. Of course, should there be a need for primary legislation in the future, and it is required to give full effect to the model, we will bring that forward in due course. At present, however, we do not know whether that need will arise, or, if it were to arise, when it might do so. It will just take time to work through as we develop the model. A significant amount of detail still needs to be worked out. As we get the model to the implementation phase, we will be able to determine whether there is additional need for primary legislation.

The Chairperson (Mr Gildernew): OK. I have a final question before I go to Colin and then to Carál. Having seen the Committee amendments now, how do you believe that your amendments differ? Do you feel that they address all the points? Can you outline where the two sets differ, and why your amendments have been taken?

Mr Chapman: I think that we have covered specifically the Committee's amendment on the model as a whole and our amendment focusing to the local level. They do differ, but, hopefully, I have set out the rationale and reasoning for that.

With regard to local commissioning groups, our amendments just work through the detail of retaining the existing provisions and move those across into a setting that will continue to allow local commissioning groups to operate as they currently do. The only difference, possibly, is that we have worked through some of the broader detail from the local commissioning groups in regulations and included it in the proposed amendments at this stage. Essentially, it gives the same effect as the Committee's amendments in that it retains the LCGs and provides that they cannot be closed down until such time as that is brought forward in regulations with regard to the integrated care system model — specifically the area integrated partnership boards. That it is to be done through the draft affirmative process, and that LCGs cannot be closed or dissolved until such times as that has been agreed by the Assembly.

The Chairperson (Mr Gildernew): OK. Thank you, Allan. I welcome the work that has gone into that. I think that the Committee generally welcomes the fact that the LCGs are now being protected and put on a statutory footing and that there will be an opportunity to look, at least, at that element that we have discussed. We can see how we feel about that more fully when we get a better chance to consider your amendments. For now, I will go to members. First to Colin and then to Carál by video link. Colin, go ahead, please.

Mr McGrath: Thank you very much, Chair. Apologies if some of my questions are a bit basic. I have just rejoined the Committee today, and some of this may have been explored previously.

The move was made to wind down the Health and Social Care Board because there were too many organisations in health, and they were pulling in different directions and in different ways. Notwithstanding that it is critical to have a local voice in that, does giving the LCGs a statutory footing turn them into separate organisations, whereby we would actually increase the number of organisations rather than decrease it? Alongside that, how long will it be before the area integrated partnership boards are up and running? It would have been ideal for them to be up and running on day one when the board wound down. What has been the delay in getting them into place? Is it the case that the LCGs could not just become AIPBs overnight and just move on like that?

Mr Millar: I will take the first bit on LCGs. They already exist. We are not creating new bodies, if you see what I mean; those committees are already there. The statutory basis of LCGs has to change, because they were committees of the board. The board will close, and that statutory basis will no longer exist. Without going through the history of the various Committee briefings, our initial position was that LCGs were part of a commissioning system that did not work, so our initial position was that LCGs should go. The view remains that the AIPBs will be an improvement on the current commissioning system.

Mr Chapman: Thanks, John. I will come in on that, if you do not mind. I do not want to go over the previous briefings either, but, in relation to the time frame, our initial position was that we would continue to develop an integrated care system model and the parts of that, including the area integrated partnership boards, on a policy rather than a legislative basis. We would have worked towards the intention of having those in place on 1 April to align with the closure of the Health and Social Care Board.

We understand the Committee's position and the need to have the assurance that local input and intelligence into the planning processes is maintained on a legislative basis. Doing that and producing the regulations for the area integrated partnership boards will take time to develop. With the end of the mandate approaching, it is not possible to progress the Bill in order to provide the legislative powers to develop the regulations and, subsequently, to get the regulations through in such a short time. Therefore, there will be a bit of a difference in the time frame in relation to when we can bring through area integrated partnership boards.

We will start to work on the proposed amendments that are agreed and to put in place and develop the regulations in advance. We will make preparations to ensure that we can bring those forward to the Assembly as early as possible. I want to reassure the Committee that there is no intention to continue with LCGs indefinitely. We have been clear about our position that, whilst LCGs have done a lot of good work and provided us with a strong foundation to build on, the integrated care system model looks to move us in a different direction.

I will touch on your last point. We have considered the sound base that LCGs have given us, and we have looked at their provisions and everything involved with what they have done, but we feel that it is important to make that step change and to bring forward new recommendations for the area integrated partnership boards to signal that it is a different way of planning, managing and delivering the services. It will help to reinforce and support the necessary changes not just in practice but in culture and behaviours. It will signal that it is different. Hopefully, that is a helpful explanation of your points.

Mr McGrath: To clarify, I sat on an LCG at one point, so I know what they are. I was wondering about the requirement for them to have some sort of statutory footing. I get the point that if the board goes, they need a statutory home to belong to, so that needs to transfer across as well.

I am worried. It is not your side of the Department but another side that will need to move quickly with those, because we will have LCGs that are not coterminous with the area integrated partnership boards, some of which are in existence and delivering. The landscape for commissioning services will get more complicated in the short term, rather than less complicated, which was probably the purpose behind removing the Health and Social Care Board. I appreciate that you have a tough task in trying to legislate on all of that. Thank you.

Ms Ní Chuilín: Thank you, John and Allan, for your presentation. I welcome the work of the Bill team in trying to formalise, or even formulate, potential amendments and the work that the Department has taken on board in listening to the Committee.

Nobody wants any ambiguity about the role of commissioning, but the issue was that the integrated partnerships and other acronyms were not in position, even after the potential dissolution of the Health and Social Care Board. Commissioning was a big issue for the Committee, particularly given that the Department has consistently failed to bring forward plans for how it will tackle inequalities in health and social care.

The other issue from my point of view — I have been persistent in this, as have other members — is that giving all that power to the Department at this stage was not very democratic. That is my rationale. I have worked with LCGs, the community and voluntary sector and health and social care, and none of us wants a cumbersome, over-bureaucratic system that makes it feel as if you were walking through treacle to get to the bottom of what you hope

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will be.

I will come back to the point that the Chair raised, particularly in relation to the

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or the future need to bring forward legislation. We do not want LCGs to continue for evermore; that is not the intention. The intention is to make sure that we are match fit. In relation to the passage of the Bill through the Assembly, I would be surprised if these questions about the potential need for further legislation or even amending regulations are not asked by Members who are not on the Health Committee. There needs to be a timeline or a draft of what will happen and when. That is a reasonable ask. If amending legislation is not needed, there should be a clear and more definitive response on why it may not be needed. It is still jargon-based in that

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I put on record my appreciation that the Department has listened to the concerns of the Committee and, indeed, the wider community. Thank you.

The Chairperson (Mr Gildernew): There are no other questions from members. John and Allan, thank you for coming along and for your work. We will take a closer look and see where we go. It is welcome that we have the amendments that address much of what the Committee had raised concerns about. Thank you for that, John and Allan. I can let you go. Take care.

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