Session 2007/2008 First Report COMMITTEE FOR HEALTH, SOCIAL SERVICES AND PUBLIC SAFETY Report on Health (Miscellaneous Provisions) Bill (NIA 2/07) TOGETHER WITH THE MINUTES OF PROCEEDINGS, MINUTES OF EVIDENCE AND WRITTEN SUBMISSIONS RELATING TO THE REPORT Ordered by Committee for Health, Social Services and Public Safety to be printed 11 October 2007 Report: 01/07R (Committee for Health, Social Services and Public Safety) MEMBERSHIP AND POWERS The Committee for Health, Social Services and Public Safety is a Statutory Departmental Committee established in accordance with paragraphs 8 and 9 of the Belfast Agreement, section 29 of the Northern Ireland Act 1998 and under Standing Order 46. The Committee has power to: . Consider and advise on Departmental budgets and annual plans in the context of the overall budget allocation; . Consider relevant secondary legislation and take the Committee stage of primary legislation; . Call for persons and papers; . Initiate inquires and make reports; and . Consider and advise on any matters brought to the Committee by the Minister for Health, Social Services and Public Safety The Committee has 11 members including a Chairperson and Deputy Chairperson and a quorum of 5. The membership of the Committee since 9 May 2007 has been as follows: Mrs Iris Robinson MP (Chairperson) Ms Michelle O’Neill (Deputy Chairperson) Mr Thomas Buchanan Mrs Carmel Hanna Rev Dr Robert Coulter Mr John McCallister Dr Kieran Deeny Ms Carál Ní Chuilín Mr Alex Easton Ms Sue Ramsey Mr Tommy Gallagher Table of Contents Report Executive Summary Introduction Consideration of the Bill Clause by clause consideration of the Bill Appendix 1 Minutes of Proceedings relating to the Report Appendix 2 Minutes of Evidence Appendix 3 Written Submissions Appendix 4 Written Evidence and other Correspondence considered by the Committee Appendix 5 List of Witnesses Executive Summary 1. The Bill has three main purposes. These are to - . amend the provisions of the Health and Personal Social Services (Northern Ireland) Order 1972 in relation to the regulation of the four family practitioner services: general practitioners; opticians; pharmacists; and dentists; . set out a legislative base for a new contract for dental practitioner services; and . amend the Smoking (Northern Ireland) Order 2006 to make provision to permit smoking by performers taking part in performances if artistic integrity so requires. 2. The Committee agreed that it was content with clauses 1 to 14, 16 to 20, and Schedules 1 and 2. It was opposed to clause 15 which proposed an amendment to the Smoking (Northern Ireland) Order 2006 to permit smoking by those taking part in performances. The Committee noted that the Minister had indicated during the Second Stage of the Bill that he was also opposed to the inclusion of this clause in the Bill and that he was minded to table an amendment setting out his opposition to clause 15 during Consideration Stage of the Bill. The Committee agreed that it would oppose clause 15. Enabling powers 3. The Committee noted that the Bill would introduce enabling powers to make regulations in a number of areas such as the conditions under which a suspension of an individual practitioner could take place; the details of the rights and obligations under the new General Dental Services contracts and the criteria under which persons not ordinarily resident in Northern Ireland would not be charged for services. The Committee looks forward to receiving the policy proposals for these regulations in due course, which it will scrutinise very carefully. Introduction 1. The Health (Miscellaneous Provisions) Bill (NIA 2/07) (the Bill) was referred to the Committee for consideration in accordance with Standing Order 31(1) on completion of the Second Stage of the Bill on 19 June 2007. 2. The Minister for Health, Social Services and Public Safety (the Minister) made the following statement under section 9 of the Northern Ireland Act 1998: “In my view the Health (Miscellaneous Provisions) Bill would be within the legislative competence of the Northern Ireland Assembly.” 3. The stated purpose of the Bill is as follows: 1) To amend the Health and Personal Social Services (Northern Ireland) Order 1972 in relation to the provision of health care; 2) To amend the Smoking (Northern Ireland) Oder 2006 to provide in certain circumstances premises may not be smoke-free in relation to performers; and 3) For connected purposes. 4. During the period covered by this Report, the Committee considered the Bill and related issues at 8 meetings - on 24 May 2007; 21 and 28 June 2007; 5 July 2007; 6, 13 and 20 September and 11 October 2007. The relevant extracts from the Minutes of Proceedings for these meetings are included at Appendix 1. 5. The Committee had before it the Health (Miscellaneous Provisions) Bill (NIA 2/07) and the Explanatory and Financial Memorandum that accompanied the Bill. 6. On referral of the Bill to the Committee after Second Stage, the Committee wrote on 20 June 2007 to key stakeholders and on 20 June 2007 inserted advertisements in the Belfast Telegraph, Irish News and News Letter seeking written evidence on the Bill. 7. A total of 24 organisations responded to the request for written evidence and a copy of the submissions received by the Committee is included at Appendix 3. 8. On 24 May 2007 prior to the introduction of the Bill the Committee took evidence from Departmental officials about the policy behind the Bill and its general provisions. Following the referral of the Bill for Committee Stage the Committee took evidence from the British Medical Association and the British Dental Association on 21 June; the Pharmaceutical Society, the Health and Social Services Councils on 28 June, and the Theatrical Management Association, Arts Council and Smokefree Northern Ireland Coalition on 5 July. Officials from the Department were present at each of these evidence sessions. The Minutes of Evidence are included at Appendix 2. 9. The Committee began its clause by clause consideration of the Bill on 6 September and concluded this on 20 September 2007 – see Appendix 2. Extension of Committee stage of the Bill 10. On 1 October 2007, the Assembly agreed to extend the Committee Stage of the Bill to 7 November 2007. Report on the Health (Miscellaneous Provisions) Bill 11. At its meeting on 11 October 2007, the Committee agreed its report on the Bill and agreed that it should be printed. Consideration of the Bill 12. On 24 May 2007, prior to the introduction of the Bill, the Committee took evidence from Departmental officials on the general proposals for the Bill – see Appendix 2. The Committee noted that the Bill had three main aims. 13. At the evidence session, the Committee discussed with officials a number of issues including the proposed changes to the organisation of dental services which would allow the Health and Social Services Boards to provide services either through contracts with individual practices or to directly employ dentists to provide dental services; the provision for regulations to allow suspension of a listed practitioner directly by a Board and the proposed amendment to the Smoking (Northern Ireland) Order 2006 to permit smoking by those taking part in performances if required for artistic integrity. Committee members expressed strong opposition to the proposed exemption to the smoking ban. 14. At the Second Stage of the Bill on 19 June 2007 the Committee referred to the comments by the Chief Medical Officer the previous week when he told the Committee “From a public health perspective … I could not support the introduction of such a provision”. The Committee welcomed the announcement by the Minister of his intention to drop the proposed exemption on smoking. Evidence from the British Medical Association and the British Dental Association 15. On 21 June 2007 the Committee took evidence from the British Medical Association (BMA) and the British Dental Association (BDA) – see Appendix 2. The BMA advised the Committee that it supported the provisions of the Bill which allowed for the inclusion of practitioners on a single performers’ list; the removal of the sanction of local disqualification from the powers of the Health Service Tribunal and the repeal of the powers held by the Department to specify the age at which GPs must retire. However, the BMA outlined a number of concerns about the proposals to extend the powers of a Health and Social Services Board to suspend a practitioner before referral to the Tribunal, the lack of an appeal mechanism and advised the Committee that it was opposed to the proposed amendment to the Smoking (Northern Ireland) Order 2006. The BMA also drew attention to the lack of any recognition in the Bill to the role of professional regulatory bodies such as the GMC and the medical defence organisations (MDOs). 16. The BDA also raised similar concerns about the proposals for the suspension of practitioners and about the introduction of an additional ground, that of unsuitability by virtue of professional or personal conduct, under which a Tribunal may deal with a practitioner. The BDA was also concerned that the Bill contained a number of enabling powers and that the regulations made under these powers would be subject, in the Assembly, to negative and not affirmative resolution. Evidence from the Pharmaceutical Society of Northern Ireland and the Health and Social Services Councils 17. The Committee took evidence from these groups on 28 June 2007 – see Appendix 2. The Pharmaceutical Society was concerned about the proposals in the Bill to increase the remit for sanctions of the Health and Social Services Boards. The Society was of the view that this proposal would add an additional layer of regulation and duplicate already established procedures. 18. The Health and Social Services Councils (the Councils) advised the Committee that they supported the proposals to confer on each Health and Social Services Board a new specific duty to provide or secure the provision of primary dental services within its area.