Order of Bath
Companion (CB)

Carol Patricia Moore, lately director, justice policy, Department of Justice

Order of the British Empire
Dame Commander (DBE)

Professor Judith Eileen Hill CBE, chief executive, Northern Ireland Hospice

Commanders (CBE)
Catherine Elizabeth Bell, deputy secretary, Department for Employment and Learning

Professor Jack Crane, state pathologist

Officers (OBE)
David William Best, director of finance and support services, PSNI

Darren Christopher Clarke, for services to golf

James Dobson, managing director, Dunbia

James Stephen Foster, head of corporate real estate and sourcing (Europe, Middle East and Africa), JP Morgan Chase

David Alexander Gibson, senior lecturer, enterprise education, Queen’s University Belfast

David Dunbar Mawhinney, managing director, Equiniti-ICS

Fionnuala McAndrew, director of children and executive director for social work, Health and Social Care Board

Professor James Andrew McLaughlin, advanced functional materials, University of Ulster

Reverend Wilfred John Orr, Newtownbreda Presbyterian Church

Shelagh Rosemary Rainey, chair, Belfast Education and Library Board

Reverend William Alexander Shaw, director, 174 Trust

Joanne Stuart, former chairman, Institute of Directors, Northern Ireland Division

Members (MBE)
Esther Robina Yvette Anderson, musical director, PSNI Ladies Choir

Philip Moore Bolton, director of music, Royal Belfast Academical Institution

Beverley Eleanor Ann Burns, Trading Standards Service, Department of Enterprise, Trade and Investment

Dr Samuel John Burnside

Dr Linda Margaret Caughley, consultant histopathologist, Northern Ireland Cancer Registry

Brian Dorman

Jeffrey Edward Anthony Dudgeon

Charles Herbert Gerard Gould, chairman, board of governors, Carrickfergus Grammar School

Robert James Haughey

Dr Raman Kapur, chief executive, Threshold

Eileen May Kenny, head of quality, South West College

Lily Kerr, head of bargaining and representation, UNISON Northern Ireland

George Gordon Archibald Knowles, welfare officer, Disabled Police Officers’ Association

Renée Alice Logan, volunteer, Institute of Advanced Motorists

Flora Magee

Rosemary Magill, Women’s Aid

Anne Marie Marley, respiratory nurse consultant, Belfast Health and Social Care Trust

Henry Irwin Mayne, social worker, Belfast Health and Social Care Trust

Ann McCrea, breastfeeding co-ordinator

Patricia McDermott

Patrick McGonagle, managing director, Pakflatt Ltd

Rory McIlroy, golfer

William James McKittrick

Maura Muldoon

Robina Parkes

James Peel JP, lately assistant senior education officer, South Eastern Education and Library Board

Alderman John Mervyn Rea, Antrim Borough Council

Agnes Mary Reilly, chairman, Belfast Titanic Society

David Robinson, founder, Northern Ireland Transplant Association

Robert Moore Robinson, principal, Rainey Endowed School, Magherafelt

Richard Michael Sherry

David Smith, director, customer support, South Eastern Regional College

Councillor Marion Smith, North Down Borough Council

Eileen Watson, lately teacher, Ashfield Girls High School, Belfast

Thomas Joseph Welsh

John Victor Williamson, owner, Valley Hotel, Fivemiletown

Queen’s Police Medal
Detective Chief Inspector

Kim McCauley

Acting Inspector

Alexander Penney

Sergeant Russell Vogan

The BEM returns
In the Queen’s birthday honours this summer, the British Empire Medal will be reintroduced to recognise local acts of voluntary service. It was established in 1917 but discontinued by John Major in 1993, as it overlapped with the MBE and was seen as reinforcing class divisions. Recipients tended to come from working class backgrounds. David Cameron, though, sees it a way to reward a wider range of volunteers. Presentations were made by a Lord Lieutenant rather than the Queen, and this will continue through the new system.

The welfare reforms currently working their way through Westminster have been widely described as the most radical shake-up of the social security system in over 40 years. With the aim of simplifying the benefits system, improving work incentives to encourage the move from benefits to work and reducing administration costs, the implementation of the changes will impact upon a significant percentage of the working age population in Northern Ireland.

No one can argue that the present overly complicated and bureaucratic social security system doesn’t need to be overhauled. However, there is much more to this than simplification and achieving a better outcome for customers.

A recent report by the Institute of Fiscal Studies found that after London, Northern Ireland will be the hardest hit by the tax and benefit cuts announced and soon to be implemented under the Bill between January 2012 and April 2015. This is for two reasons: the high numbers of those in receipt of Disability Living Allowance, especially for mental health disorders, and the high number of families with children who will be adversely affected by cuts to social security. The loss to Northern Ireland’s benefit recipients will be more than £600 million per year by 2014-2015.

The changes will include existing work related benefits being replaced with a single universal credit, a cap on the total amounts of benefit families and individuals can receive, changes to how housing benefit is calculated, a new benefit to replace DLA which will require all existing and new claimants to undergo a new assessment, the abolition of the independent review of Social Fund decisions and the end of community care grants and crisis loans.

The issues are huge and the potential ramifications for Northern Ireland have yet to be fully understood. Though we do know two things for sure: that these changes will mean less spending power available for the economy and, secondly, that once again the most vulnerable and disadvantaged will bear the brunt of attempts to correct economic problems that are not of their making.

A group of organisations in the voluntary and community sector concerned about the very real potential of these changes to increase poverty, hardship and inequality in Northern Ireland has been meeting to monitor developments and unpick what this will mean for people, families and communities here. Led by the Northern Ireland Law Centre, group members include NICVA, Gingerbread, Save the Children, Barnardos, Advice NI, Disability Action, A2B, the Housing Rights Service, Employers for Childcare and the Women’s Support Network. The group has addressed MLAs and Stormont committees on this issue and has produced a useful overview of the changes proposed in the Bill which is available at www.nicva.org/news

The Bill is expected to receive royal assent early in the new year. Following this the Bill is due to be presented to the Northern Ireland Assembly, which will give our own elected representatives the opportunity to debate the impact of the reforms in Northern Ireland and shape how they are implemented here. NICVA supports the argument from the Welfare Reform Group that the DSD should set out its own arrangements and proposals which are tailored to Northern Ireland’s needs so that a full debate can occur on the practical consequences of any proposal within the Welfare Reform Bill.

In March 2012, NICVA and the Law Centre are joining forces to host a high level conference which will aim to explain and debate the impact of welfare reform in Northern Ireland. Details will be made available as we confirm the agenda and you can get more information by contacting Lorraine Boyd at lorraine.boyd@nicva.org

Lisa McElherron is NICVA’s Head of Public Affairs. For more information:

Tel: 028 9087 7777

Email: lisa.mcelherron@nicva.org

Ministers suggest action on ‘peace walls’ and shared education but language and the past are two major obstacles.

The Executive claims that “much progress has been made” in creating a shared and better future and it “remains as committed as ever” to achieving that. However, the first step of its “Building a Strong and Shared Community” chapter relies on three separate sports stadia projects, rather than the single one proposed under direct rule in 2006. The whole community can unite around the World Police and Fire Games in Belfast (1-10 August 2013) and plans for a major golf tournament in 2013-2014.

On dismantling interface barriers, the Executive will take action (starting in 2013-2014) if local communities agree to bring them down.

There are currently 59 interface barriers. David Ford’s preference is to invest funds into good relations work instead of extending walls. When asked how it would reduce paramilitary influence, the Department of Justice said that an ‘inter-agency’ group would deal with interface problems (with PSNI involvement).

Prison reform, a legacy of the peace process, should be “ready to launch” in 2012-2013 and swift action is demanded. Thirty-six of the 40 prison review recommendations are to be achieved by 2015. At present, 79.4 per cent of prison officers are from a Protestant background and 10 per cent from a Catholic background; the remaining 10.6 per cent are “undetermined”.

As expected, the Troubles are not mentioned. The Assembly has separately passed an Alliance proposal for cross-party talks on dealing with the past and the Secretary of State has written to party leaders to ask for their views on the way forward.

Irish language and Ulster Scots strategies, promised five years ago in the St Andrews Agreement, have been held up by DUP-Sinn Féin disagreements.

Culture Minister Carál Ní Chuilín said her officials were “working to determine the scope” of a draft Irish Language Bill, which unionists view as unnecessary. Ní Chuilín wants Irish to be protected in law (similarly to Scots Gaelic and Welsh) but concedes that promoting the language is “not simply about a piece of legislation”.

DCAL officials started a ‘scoping exercise’ last month, which is due to finish by 31 January 2012. A “suggested timetable for consultation and publication” will then be provided to the Minister.

The ministerial advisory group on shared education (due to report in 2012-2013) could encourage a more detailed and rational debate. Shared education programmes and facilities can bring pupils together for certain classes, but fall short of permanently shared schools.

In 2010-2011, 6.5 per cent of pupils (21,051) attended integrated sector schools. This figure increases to 10.5 per cent and 33,629 pupils when other forms of mixing (e.g. Catholic pupils in controlled schools) are included. Northern Ireland Life and Times Survey results over the last Assembly term indicated that 62-70 per cent of parents would prefer to send their children to a “mixed-religion” school.

Those plans should be underpinned by a cohesion, sharing and integration (CSI) strategy. OFMDFM admits that the June 2010 draft was seen as a “politically negotiated document” which did not reflect what most of society wanted.

agendaNi understands that the cross-party working group on CSI has been meeting weekly since September. However, the draft Programme for Government says that this would only be finalised in 2012-2013. The Community Relations Council is continuing with its work in the meantime.

The level of fuel poverty in Northern Ireland has been revised downwards following a Department for Social Development-commissioned study. The University of Ulster study revised the 2009 figure of 44 per cent figure to 13 per cent (75,000 households), using a new method of calculation.

Previously, the threshold was set at twice the median amount of household income that families in England spent on heating their homes in 1991 (10 per cent of household income), to maintain an acceptable temperature in their home. The study says 23°C for living rooms and 20°C for all other occupied rooms is recommended, with higher temperatures advised for the elderly and vulnerable.

It concluded that with the median amount of money spent in Northern Ireland on heating at 9 per cent of household income, applying a local twice-median (18 per cent), meant that 13 per cent were in fuel poverty in 2009. It also found that 33,499 households need to spend at least 25 per cent of their income on light and heat.

A UK-wide threshold shows that Northern Ireland has an acute problem. In 2009, the House Condition Survey found that Northern Ireland’s 44 per cent proportion contrasted sharply with 16 per cent of English households. Fifty-three per cent of those between 60-74 years of age and 76 per cent of those 75 years or older were in fuel poverty. The Registrar General’s annual report for 2010 found that there has been an average of 910 excess winter deaths (difference in the number of deaths in winter and the four month periods before and after) over the past 33 years.

According to the DSD, households in Northern Ireland spend approximately

60 per cent more disposable income on energy than the UK average, due to lower household incomes, greater heat needs and dependence on oil. Northern Ireland’s annual average fuel bill is £2,114. The Executive has allocated approximately £23 million for a one-off fuel allowance payment in February, for cancer patients and benefit claimants.

In March the then Social Development Minister Alex Attwood launched a fuel poverty strategy, Warmer Healthier Homes, which identified four key areas for action:

• targeting of resources;

• improving energy efficiency;

• achieving affordable energy; and

• building “strong partnerships”.

It included a target of achieving at least a 15 per cent average energy efficiency gain in homes assisted by the Warm Homes scheme; more energy efficient standards in the Code for Sustainable Homes; and a smart meters pilot to conclude and be evaluated by 30 September 2012. A DSD spokesman told agendaNi that the 12 month pilot commenced in November. The University of Ulster is expected to complete a project evaluation within six months of it finishing.

The draft Programme for Government commits to introducing “a range of initiatives aimed at reducing fuel poverty”. It promises full double glazing in Housing Executive properties by 2014-2015.

Northern Ireland’s Fuel Poverty Coalition, which includes Age NI and Save the Children, said that “tackling fuel poverty presents clear benefits across a number of key priority areas included in the draft Programme for Government” and that there should be a “detailed and costed action plan to eradicate fuel poverty” in the final document. A spokesman admitted that eradication is not possible in the short term but that it can be eventually achieved with a co-ordinated response.

The Fuel Poverty Coalition proposes energy brokering schemes in which the purchasing power of the Executive’s estate would be used to negotiate lower fuel and electricity prices for fuel poor households. The DSD has said it will introduce a test scheme for social housing providers by the end of March 2012.

The Energy Saving Trust administers Northern Ireland’s Sustainable Energy Programme, which is funded by an energy efficiency levy. It has a range of schemes to improve energy efficiency, and targets 80 per cent of its funding at alleviating fuel poverty.

Northern Ireland’s population is set to age, with an 18.6 per cent increase in over 65s between 2011 and 2020 and a 42 per cent increase by 2025. The population of children (under 16) will increase by 4.3 per cent and every working age person will have the equivalent of three children or four pension age dependants from now until 2020.

These trends, from NISRA’s statistics, will have implications for all health policies, especially residential care planning and care for the elderly in hospitals. Provision of childcare in the face of an increasing elderly population will be an ongoing challenge.

Budget cuts have already resulted in nursing home closures and only those assessed with having the highest levels of need receiving a care package. With the working-age population, which generates the money for the health and pension systems, not growing as quickly as the elderly population, policy-makers are faced with decisions as to where to place money to anticipate future demand.

Meanwhile, the region’s health is getting worse, with more older people suffering from long-term illnesses and a rise in chronic conditions such as obesity and cancer, often resulting from smoking, alcohol and drug use and a sedentary lifestyle.

Thirty six per cent of 4,085 respondents to the 2010-2011 DHSSPS’ health survey were overweight, while 23 per cent were obese (8 per cent were children aged between two and 15.) A weight-loss specialist has warned that Northern Ireland is facing an obesity “tsunami” in the next five to ten years.

Northern Ireland is facing a shorter life expectancy and health inequalities mean that people from deprived areas will not live as long as those in more affluent areas. The Troubles had a lasting impact on the physical and mental health of the population and this has to be factored into future care planning.

The draft Programme for Government includes plans to enrol people who have a long-term condition in a dedicated chronic condition management programme and to spend £7.2 million on tackling obesity.

John Compton’s review will shape health and care services for the next generation. Health Minister Edwin Poots has said that there is a need to encourage “greater personal responsibility among members of the public for their own health and well-being.” This will require “a sustained and growing investment in public health, early diagnosis and early intervention services,” he insisted.

A 2009 EU policy brief (on how health systems can respond to ageing) recommends better co-ordination of care across health and social services and across different levels of health care, ensuring more treatments are done outside of hospitals (to reduce inappropriate hospital stays), reducing the risk of disease through health promotion and disease prevention programmes, and funding programmes that keep elderly people active and get them out and about.

A report commissioned from PwC by Independent Health and Care Providers, and supported by Age NI found that some older people face nursing home bills of up to £500 per week which they cannot afford.

Esmond Birnie, PwC’s Chief Economist, commented that while approximately 10 per cent of the DHSSPS £4.4 billion budget in 2009-2010 was spent on the social care system for older people, “demand is rising fast, [and] the provision of care, both in terms of funding and care homes, is falling behind.” He said that “this situation cannot continue and, in a period of severe financial constraint, a comprehensive reform of social care delivery and funding is now appropriate.”

This is an unprecedented time for Northern Ireland’s health and care sector. The McKinsey report warned the province’s Health Service will run out of money in four years unless fundamental reforms take place. Its recommendations (including intensive rehabilitation before assessing someone for social care, ending non-essential treatments like aesthetic ENT surgery and increasing the use of generic drugs) are to be treated as “an à-la-carte menu” by Poots. A UN report on ageing highlighted the gravity of the situation, saying: “We are in a situation without parallel in the history of humanity.”

Overall population: projected increase (thousands)	% Increase in population 2010-2020

Demographic groups (thousand people)

	2011	2012	2013	2014	2015	2016	2017	2018	2019	2020
Children	383	384	385	387	388	391	394	397	399	400
Pension age	308	310	312	314	316	318	320	322	324	327

]]> http://www.agendani.com/overview-2/feed 0 http://www.agendani.com/age-ni-fixing-social-care http://www.agendani.com/age-ni-fixing-social-care#comments Wed, 21 Dec 2011 15:18:54 +0000 Agenda NI http://www.agendani.com/age-ni-fixing-social-care Age NI believes Northern Ireland’s social care system is broken and a new revised system is long overdue.

The Compton Review has provided a much needed platform to debate social care provision in Northern Ireland because the situation for older people in receipt of social care is already at crisis point and a new revised system is long overdue.

Age NI believes social care is the linchpin for wider health care provision, if we get it right everything else will fall into place. A system promoting low level services that enables older people to remain in their homes for longer and reduces hospital admissions, will ultimately be cost-effective and result in better outcomes for those in later life.

However the debate on social care provision cannot solely be lead by decision makers, it must also involve the wider Northern Ireland public because ageing affects us all. It is imperative that society takes the time to consider what quality of social care it can expect as we all grow older and what outcomes social care services must achieve.

Debate

The scope of care services also needs to be debated from ‘that little bit of help’, through to nursing and end of life care. The cost of the system must be factored into discussion but this cannot happen until we decide on quality, outcomes and the scope of services. Funding is important but it cannot be the only driver.

This debate must be framed in the context of our ageing population as the number of older people, particularly those over 85 who are most likely to need social care, is also set to increase. By 2021, the number of persons aged 85 and over in Northern Ireland is projected to rise by 67 per cent to 47,900.

Figures from the Department of Health, Social Services and Public Safety estimate that the cost of treating older people is expected to increase by 30.6 per cent over the next ten years.  Despite these inflationary pressures, planned funding for the Elderly Programme of Care (POC 4) only grew by £6 million or 1.1% in 2009-10.  With a real cut in the DHSSPS budget of around 2.7 per cent by 2014, it is unlikely that the funding needed over the next ten years to treat older people will be available.

Prevention

Age NI believes that with effective treatment, fair and equal access to services, appropriate levels of funding and prevention strategies, older people can continue to experience good health. By staying well and feeling good, older people are more likely to play an active role in their communities, contribute to society and live independently. The idea that preventing ill-health is a way of controlling costs is not new to health and social care. However, there has been no indication of a change in thinking or a shift in resources to give a higher priority to prevention.

There is clear evidence, however, that projects which promote early intervention and independence can produce early outcomes and greater efficiency for health and social care. A recent evaluation of the Partnerships for Older People’s Projects (POPPS) in Great Britain demonstrated that these projects led to cost reductions in secondary, primary and social care as well as an increase in health related quality of life. In particular, the projects lead to a 47 per cent reduction in overnight hospital stays and the use of accident and emergency departments was reduced by 29 per cent.

Vision

Through our work with older people and key stakeholders we have developed a vision of quality integrated social care that recognises the rights, aspirations and diversity of us all, and is based on the right to live with dignity, independence, security and choice. At the heart of our vision is a system that enhances well-being and independence, so that older people can continue to engage socially and maintain self-esteem, dignity and purpose.

To secure this vision, a shift in the language of care is needed, from one of services to one of needs and outcomes. This means that assessments should be a consideration of a person’s social care needs and the outcomes that they wish to achieve. The focus should not be on the person’s suitability for a particular service. Incorporating human rights and equality principles into social care can reinforce the importance of these broader issues.

Age NI believes that the outworking of the Compton Review affords decision makers a once in a lifetime opportunity to reform social care. We are calling on politicians to give the commitment and leadership that is needed to enact radical reforms to deliver the transformational change urgently needed in the provision of social care.

Age NI believes Northern Ireland’s social care system is broken and a new revised system is long overdue.

The Compton Review has provided a much needed platform to debate social care provision in Northern Ireland because the situation for older people in receipt of social care is already at crisis point and a new revised system is long overdue.

Age NI believes social care is the linchpin for wider health care provision, if we get it right everything else will fall into place. A system promoting low level services that enables older people to remain in their homes for longer and reduces hospital admissions, will ultimately be cost-effective and result in better outcomes for those in later life.

However the debate on social care provision cannot solely be lead by decision makers, it must also involve the wider Northern Ireland public because ageing affects us all. It is imperative that society takes the time to consider what quality of social care it can expect as we all grow older and what outcomes social care services must achieve.

Anne O’Reilly is Chief Executive of Age NI. For further information on the work of Age NI contact 028 9024 5729 or visit www.ageni.org. You can also follow Age NI on Facebook www.facebook.com/agenicharity or on Twitter @Age_NI

An Adoption (and Children) Bill is expected to be brought to the Assembly in 2013 aiming to speed up the process of placing children in care with a permanent family. It currently takes approximately three years and six months for a child to be adopted from care in Northern Ireland, while in England children wait an average of two years and seven months.

The Adoption (Northern Ireland) Order was passed in 1987 and is to be updated to recognise that it is no longer illegitimate babies, but often children from difficult or neglected backgrounds who need a home. An attempt to update the legislation failed in the last Assembly term.

agendaNi asked the DHSSPS why the new Bill will not be introduced for another year and it cited the primary legislation process which includes instructing counsel, ministerial clearance and public consultation.

Under direct rule, the 2006 ‘Adopting the Future’ draft strategy made 21 recommendations to improve adoption, including that unmarried and same sex couples be allowed to adopt. Of the 1,066 consultation responses, 1,025 (96 per cent) opposed same sex or unmarried couples adopting. Former Health Minister Michael McGimpsey took a previous Adoption and Children Bill (which didn’t contain that proposal) off the legislative table in October 2010. When asked why that Bill was delayed, considering the last Assembly’s four-year term, the department reiterated that the Bill hadn’t made it through clearance in time.

Unnecessary delays in care planning and court proceedings, a lack of adoptive families and poor post-adoption support have been identified as problems.

Potential adopters are made aware from the outset that there are very few new born babies available for adoption. Only two babies under one were adopted from April 2010 to April 2011. The average age of the children waiting to be placed is four years and eight months. They have generally been in and out of care and have suffered neglect or trauma.

When challenged on the low average adoption rate (2 per cent) a DHSSPS spokeswoman said that adoption is not the only option for children in care. She added that the department is currently considering special guardianship which is used in England and Wales; this gives legal parental responsibility to a guardian until a child is 18 but does not totally remove parental responsibility from the birth parent.

Barriers

Belfast’s Family Care Society Chief Officer Rosemary Hurl says more adopters are needed and that legislation must be “child centred”.

“The current process of freeing children for adoption can be a long and protracted one,” Hurl tells agendaNi. An average wait of 3½ years from entering care to being freed for adoption “is a huge amount of time for a young child” who needs stability.

Placement orders should be included in the Bill, Hurl proposes. This involves the court authorising a trust to place the child for adoption with prospective adopters (with or without consent from the birth parent). They replaced freeing orders in England and Wales in 2002.

Adoption practices across the five trusts must be standardised and adoption agencies need balanced information on the child. In addition, the trusts should have to adhere to a statutory timeframe, she suggested.

Stephen McVey, the Northern Ireland Development Manager of Adoption UK, adds: “While adoption is the last link in a child’s care plan and every effort must be made to try to return them to their birth parent, once a decision has been taken that adoption is in their best interest, then that should be done as quickly as possible.”

Post-adoption support is essential because adoptive children are likely to have behavioural problems stemming from their instable childhood. “A dedicated adoption budget would help because post-adoption services are practically non-existent or are piecemeal and dependant on where you live,” McVey contends.

Same sex and unmarried adoption has been allowed in the rest of the UK since the 2007 Equality Act but the average adoption rates have remained around 13 per cent for England, 3 per cent for Scotland and 4 per cent for Wales. The adoption rate in the Republic is lower, at around 1 per cent, with most families adopting from abroad.

It is unclear whether the new Bill will provide for unmarried and same sex adoption. However, it is unlikely that the DUP would support it (given its opposition in its 2007 Assembly manifesto).

The department will be bound by the outcome of a judicial review brought to the High Court by the Human Rights Commission, which is backed by a lesbian woman who wants her partner to be allowed to adopt her biological son.

DUP Health Spokesman Jim Wells said that it is difficult enough for married couples to adopt without “throwing the net wider” to include unmarried and same sex couples. He said many couples are put off by the “bureaucracy” and cited examples from his church of couples who have adopted Russian and Ecuadorian children.

However, Hurl and McVey point out that inter-country adoption incurs a cost and adopters must adhere to local legislation as well as that country’s relevant law.

Sinn Féin, the SDLP and Alliance support same sex and unmarried adoption. The SDLP wants an Adoption Bill to provide more support for post-adoption contact and look at the financial entitlements for adoptive and birth parents.

The UUP’s Health Spokesman, John McCallister, said the needs of the child must be paramount but regretted that reform will be delayed until the ongoing judicial challenge is resolved.

Placing children is “an onerous task for an adoption agency because it’s a choice for life,” but it does produce positive results, Rosemary Hurl reflects. Stephen McVey agrees: “When you speak to an adoptive family, they will tell you it has enriched their lives.”

Source: DHSSPS Community Information Branch

Palliative care is provided by five voluntary organisations in Northern Ireland: the Northern Ireland Hospice, Marie Curie Cancer Care, Macmillan Cancer Care, Foyle House Palliative Care and St John’s House Southern Area Hospice. They offer inpatient beds, respite care and bereavement services free of charge to patients referred by their GP or hospital.

Children with life-limiting illnesses receive nursing care and therapy from the Northern Ireland Children’s Hospice which has one 10-bed facility (Horizon House in Newtownabbey) where families are allotted day and respite stays and care in the home. Horizon West, a facility that will provide respite for four children and two families at any one time has been built at Killadeas, County Fermanagh, but will not admit patients until it has raised a further £500,000 for operating costs

(£1.2 million has been raised to date). Other charities work throughout the province to raise money for the treatment and support of children suffering from illnesses such as cancer or heart disease.

The five bodies received £5.58 million from the DHSSPS in the last financial year. The rest of their operating costs must be raised through fundraising campaigns. The only specialist palliative care beds in Northern Ireland’s health and care system are the 12 in Antrim Area Hospital’s new palliative care unit. A joint project between the Northern Health and Social Care Trust, Macmillan Cancer Support and the department, it cost £5 million. Other hospitals have contracts with the voluntary bodies.

Palliative care is defined as “the active, holistic care of patients with advanced progressive illness.” It aims to ensure a good quality of life from diagnosis to death for adults and children who will never reach adulthood. While each trust has access to palliative care beds, it is accepted that this is not always the most appropriate setting and that most people would prefer to die in their own homes.

A five-year palliative care strategy was released by then Health Minister Michael McGimpsey in December 2009. It aimed to develop a better knowledge of palliative care, identify the patient’s holistic needs and plan care so that a patient can die at home if they wished.

Over 6,000 outpatients were helped by hospital palliative medicine teams in 2010: 4,086 in hospitals in the west, 1,101 in Belfast City hospital, 810 in the six northern hospitals, 386 in the southern area and 26 in the Ulster hospital. Changing demographics (see pages 90 and 91) mean that people are living longer and often with one or more chronic condition.

Heart disease accounted for 31 per cent of deaths in Northern Ireland last year, cancer for 29 per cent and respiratory disease for 13 per cent.

“It’s a real challenge to keep the services running safely for the families who need it,” commented Tina McCrossan, Director of Children’s Services for the Northern Ireland Children’s Hospice.

Day care sister at St John’s House, Newry, Marianne Barry, has explained that “many of the patients come simply to avail of the company of others who understand what they and their families are experiencing.”

When challenged as to why the DHSSPS cannot fund all palliative care, a spokeswoman said that the £4.3 billion health budget provides “a wide range of critical services, all of which are rightly important to the public”. She cited an expected £800 million shortfall by 2014-2015 caused by price inflation and more demand on services which will make it difficult to maintain the current level of services.

Health and social care was one of three key areas discussed at a recent debate at Parliament Buildings, which was attended by around seventy Members of the Pensioners Parliament (MPPs). The debate, which took place in the Senate Chamber, followed on from the highly successful Northern Ireland Pensioners Parliament held earlier this year which saw twenty four motions being passed by older people from across the province.

The debate at Stormont, which took place at the end of November, was hosted by the Speaker of the Northern Ireland Assembly, William Hay MLA, and allowed MPPs to put forward three motions – on fuel poverty, fear of crime and health and social care – to the relevant departments in the Northern Ireland Executive. Each department then provided an official response to the motions through Social Development Minister Nelson McCausland, Stephen Farry (on behalf of Justice Minister David Ford) and Jonathan Bell (on behalf of Health Minister Edwin Poots).

The motion on health and social care called on the Health Minister to “increase funding for preventative healthcare programmes to help maintain the quality of life and independence of older people living at home; to take action to reduce hospital waiting times for older people and provide better support services for older carers”.

The Northern Ireland Pensioners Parliament survey, earlier this year, asked over 1,200 older people to select their top five concerns from a list of 16 issues. Almost one in three (31per cent) older people chose ‘access to health and social care’ as a concern for them, which highlights the need for action in this area.

Patricia Donald, Chair of Age Sector Platform, said: “Issues relating to health and social care become even more important as we get older, and it is clear from our dialogue with older people during the Pensioners Parliament that there is a lot that can be improved in our health and social care system.”

“Many older people are concerned about the current level of social care provision and its ability to meet the needs of older people now and in the future. Unfortunately, we heard many stories from older people across the province who have experienced cuts in home help provision, a lack of support for them as older carers and poor communication with them and their families from social workers. These issues must be addressed.”

“During the Northern Ireland Pensioners Parliament, there was a real recognition of the value of preventative healthcare in helping to ensure older people remain independent – something which older people want more than anything. Our health and social care system must ensure that older people who want to remain at home are able to do so. In the long term, social care as a preventative measure could save the Government huge sums of money by reducing the number of hospital admissions. The value of older people’s groups and their ability to prevent ill-health must also be recognised. These groups must be supported so they can continue the essential role they play in keeping older people active.”

“Some regional health issues which were raised during the local parliaments held in each county included concerns regarding the closure and downgrading of regional hospitals, inadequate transport options for older people travelling to hospital and health appointments, and concerns regarding the provision of food in some hospitals. These regional issues were discussed fervently at the local parliaments and must be explored by the Health Minister.”

“Unfortunately, age discrimination in our health service appears to be relatively common, based on the experiences of older people who attended the Pensioners Parliament. Many older people spoke of being ‘patronised’ and some claim to have been refused treatment purely because of their age. We are delighted to see that the Northern Ireland Executive has committed to bring forward legislation to outlaw age discrimination in the provision of goods, facilities and services. This legislation will mean that it will be illegal to refuse healthcare to someone simply based on their age.”

For more information on Age Sector Platform visit www.agesectorplatform.org or phone 028 9031 2089.

A Safeguarding Board for Northern Ireland is to be established in April 2012 after the Safeguarding Board Bill was taken forward by former Health Minister Michael McGimpsey and received royal assent on 10 February 2011.

While voluntary and statutory organisations currently work together to safeguard children (for example on the Regional Child Protection Committee), this is now a statutory requirement. The Safeguarding Board will replace the committee. It will be sited within the Public Health Agency premises and £750,000 has been secured within the existing departmental budget to set it up and cover running costs.

The objective of the board will be to co-ordinate and ensure the effectiveness of what is done by each person or body represented on the board to safeguard and promote the welfare of children. Policy development and reviewing information on the deaths of children will also be within the board’s remit.

Board members will include the Health and Social Care Board, the Public Health Agency, the five trusts, the PSNI, the Probation Board, the Youth Justice Agency, the NSPCC and district councils.

The former Director of Social Services in the Eastern Health and Social Services Board, Hugh Connor, was appointed as Chairman-designate of the Safeguarding Board by Edwin Poots on 30 June for a four-year term, receiving an annual salary of £34,333. As well as the above organisations, the board will include between two and four lay members appointed by the department, a safeguarding director, a professional officer and an administration officer.

The Safeguarding Board will be supported by five safeguarding panels, one located in each of the trust areas. It will also have a child death overview panel and a case management review panel.

An annual report will be given to the Health Minister who must then present it to the Assembly. Edwin Poots has said this represents a clear line of accountability between the Safeguarding Board and the Executive, adding that the board will also be open to scrutiny by the Assembly Health Committee.

Relevant bodies must comply as quickly as possible with requests for information from the board, only if they are responsible for that information and if it will help the board in carrying out its functions.

“Today many agencies are working with families who very often are overwhelmed by difficulties such as financial problems, domestic or sexual violence, physical or mental health problems, or because of dependence on alcohol or other substances,” the Minister has said.

Over 21,000 children are referred to social services in Northern Ireland every year. As of March 2010, there were 2,357 children on the child protection register, 2,606 children were being looked after by authorities and 1,653 were in care.

“It is important that we invest in the future fabric of our society so that fewer families reach crisis point and fewer children suffer harm. This Bill supports the wider safeguarding agenda which includes prevention and early intervention,” Poots stated.

England and Wales already have local safeguarding children’s boards which were set up in 2006.

In Scotland there is a children’s hearing system, which looks after children and young people who need welfare support as well as looking after those that appear before the courts. The Child Welfare and Protection Policy Unit carries out a similar role in the Republic.

Sinn Féin’s Assembly manifesto said it would “closely monitor” the implementation of safeguarding legislation for children. The SDLP’s manifesto welcomed the Bill and said it would encourage trusts to continue developing family support services for children in need. During the Bill’s final stage on 25 January 2011, Alliance’s Health Spokesman Kieran McCarthy commented: “Every family should welcome the Bill. This is what devolution is about, and it is a good news story.”