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A monthly overview of news and developments within the health sector in Northern Ireland.

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Welcome to the 7th edition of Health Matters

A Capacity Issue – The draft Mental Capacity Bill

Views in Profile Events Diary Assembly

Health on the Hill

News Review “The e-zine is excellent!” Gillian Creevy, Northern Ireland Cancer Fund for Children

Northern Ireland’s premium public relations and public affairs agency

After our summer break, Health Matters is back with its seventh edition. With the Mental Capacity Bill out for consultation, Dr Colin Harper of the Disability Action Centre for Human Rights discusses how the proposed changes will give more rights to those with mental capacity issues. As tensions mount surrounding the budget cuts in the Public Sector, we’re ending our series of interviews with party Health Spokespersons by asking how they would meet the challenge of health cuts.

We hear from SDLP Health Spokesman Tommy Gallagher, Alliance Health Spokesman Kieran McCarthy and Sinn Fein’s Michelle O’Neill. We’ve added a Dates for your Diary section offering all the important dates in the world of health. As always, we’ve rounded up the most interesting health stories from the past month in our News section, while Health on the Hill delves further into Assembly activity since session started back, including why calls were made for Health Minister Michael McGimpsey to resign.

News Review The European Commision has published proposals to relax rules safeguarding against BSE and human variant CJD, more than 20 years after it first emerged. A report has shown that people living in the most deprived areas of Northern Ireland are twice as likely to die from heart disease.

Scientists at the University of Dundee have discovered that ME, or Chronic Fatigue Syndrome, may be caused by a virus after tests showed white blood cell abnormalities in children with ME, suggesting there had been infection. Researchers from Univesity College Dublin have found a distinct genetic makeup for Irish people which differs from European genomes. The Health Protection Agency has released figures indicating that young women are more vulnerable

to STIs, with 88% of new chlamidya cases occuring in women under 25. In other news, a survey has revealed that nearly one-in-twenty British holidaymakers returned with STIs this summer.

A London-based study measuring pain response in babies has found that the traditional practice of giving sugar to a baby


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HEALTH MATTERS – October 2010

News Review (continued) before painful procedures does not act as a pain relief. Although the child’s facial expression will not indicate pain after receiving sugar, the study showed sugar had no effect on the pain response in the brain. A defective gene which responds more aggressively to environmental factors has been found in some migraine sufferers, suggesting the condition is DNA related. The think tank 2020health.org has criticised 33 NHS Trusts which provide pornography in IVF clinics, claiming that the provision promotes “adultery of the mind”.

Research has shown that taking certain vitamin B tablets can reduce the amount of brain shrinkage which happens with age and leads to mental decline. In related news, a study in America suggests that men are 1.5 times more likely than women to suffer mild cognitive impairment. The British Medical Journal has called for the immediate withdrawl of the diabetes drug Avandia after it emerged that the drug was still being prescribed two months after a safety body deemed it unsafe.

A new mental health centre for young people has been opened at the Forster Green hospital in South Belfast. It will provide 38 beds for mentally unwell children and adolescents. Researchers from the University of Warwick have found media coverage of celebrity illnesses has a positive impact on public health by prompting people to attend health screenings. The findings referred to the intense media coverage of Jade Goody’s cervical cancer and the subsequently increased numbers of young women using the NHS Cervical Screening Programme.

A large study has found that taking cholesterol-lowering statin drugs may prevent the onset of rheumatoid arthritis (RA) by affecting immune system pathways. The drugs reduce the risk of developing RA by more than 40%.

Research suggests that motorists could face long-term mental health problems due to raised blood pressure caused by delays and congestion, however the risk is reduced by up to a third for bus passengers. Psychologists at Queen’s University Belfast are investigating if noninvasive stimulation of the brain, combined with muscle contractions, can help stroke survivors regain the use of disabled limbs.

Scientists have found that mothers who smoke in the early stages of pregnancy increase the chances of their son being infertile. Their research shows the number of reproductive cells in male embryos were greatly reduced when exposed to tobacco in the womb. This finding coincided with a study which claimed men who smoke are less fertile than those who do not.

Figures released by the DHSSPSNI show that 320 children aged 11-16 attempted to quit smoking in 2009. Belfast City Hospital has opened Northern Ireland’s first Regional Prostate Brachytherapy Service for prostate cancer sufferers. Previously patients travelled to Leeds for treatment as NI did not offer this radical from of radiotherapy.

“It is very well designed and does draw you to the articles…I definitely think you have a good tool here and the good design would make it stronger than many others that cross my own desk.” Alan Walker, General Medical Council


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Assembly

The Health Minister Michael McGimpsey had little time to ease into the new legislative term when he was pressured into making a formal apology for misinforming the assembly in relation to the Donagh sex abuse case. This followed a controversial answer to an urgent oral question, in which the Minister wrongly stated that a doctor who had given evidence to the judge in the Donagh case was not a health trust employee. Mr McGimpsey faced calls to resign after he admitted the mistake at a joint meeting of the health and justice committees. In his statement to the house the Minister said it had been a genuine mistake for which he took full responsibility. The mistake overshadowed the Joint Committees meeting over the controversy in which two brothers involved in the abuse were allowed to return to live in their home village. Earlier in the Month the Health Committee had discussed a letter received by the Justice Minister, David Ford, from the Lord Chief Justice, Sir Declan Morgan, regarding the case. The letter revealed that the judge in the case spoke with the Western Health Trust seeking their opinion as to where best to place the brothers before he passed judgement. The Committee also discussed the Safeguarding Board Northern Ireland Bill and heard evidence from the NSPCC on the matter. Later in the month they criticised the Health Department’s advertisement for the Chair of the Safeguarding Board for Northern Ireland as premature and inadequate. The advertisement appeared in the Irish News offering a salary of £17,060 (2-3 days per week). Earlier in the month the Committee met in extra session to conduct a clause by clause review of the proposed Sunbeds Legislation. During his question time appearance the Minister also responded to other issues. William Irwin of the DUP asked for the cost to the health service of treating patients from the Irish Republic. Although the Minister could not give a precise figure he maintained they were certainly not large sums of money. Addressing the advertising of tobacco products, the Health Minister said almost nine per cent of children in Northern Ireland

HEALTH MATTERS – October 2010

in the 11 to 16 age group are regular smokers and about 2,500 people die from lung cancer each year in Northern Ireland. Finally, when questioned about the budgetary position of the Health Department the Minister insisted that if his health budget did not have the same ringfencing as health funding in England, Scotland and Wales then people in Northern Ireland would no longer have the same NHS as other parts of the UK. The DUP’s Paul Givan brought an adjournment debate on the future of Lagan Valley Hospital Accident and Emergency unit on 21 September 2010. Mr Givan said he hoped that the Accident and Emergency Department at the hospital in Lisburn was not under threat of closure. Sinn Fein’s Paul Butler said there was a strong case to be made for Lisburn to retain its accident and emergency service, a view supported by Thomas Burns of the SDLP. The Alliance Party’s Trevor Lunn said the pending decision was totally unwelcome and a minor injuries unit with limited hours would not be enough. The Health Minister said no-one should doubt his commitment to the future of the hospital. He added there were no specific plans for the accident and emergency facilities but there would be consultation for people to express their views. Sinn Féin brought a motion on outstanding medical negligence cases. Figures released by the Health Department showed that 55 such cases have been ongoing for over 15 years with one recently closed case spanning 27 years. The cost of negligence cases had reached £55m over 10 years. The motion was passed on an oral vote and called on the Department of Health “to bring in the 55 cases going back over 10 years and go through them one by one”.

DEPARTMENTAL

In time with the introduction of the new Sunbeds Bill, the Department has launched a campaign warning of the long term health effects of sunbeds. Research shows that the risk of developing melanoma skin cancer increases by up to 75% if sunbeds are used before the age of 35. Skin cancer, also the most common cancer, accounts for 28% of all cancer sufferers and the number of cases in Northern Ireland have almost trebled in the

last 25 years. The four UK Health Departments have commisioned a review of the Clinical Excellence and Distinction Awards for medical consultants, to be led by the independent Review Body on Doctors’ and Dentists’ Remuneration (DDRB). The awards give recognition for significant contributions to Health and Social Care, but the Departments believe that in the current financial climate it is important to ensure the scheme is affordable, transparent and sustainable. It is hoped that reviewing the awards system will allow the HSC to focus more of its resources on patients and establish a more productive health service. The DDRB are expected to submit their recommendations to the UK Health Ministers by July 2011. The Health Service has taken its first step towards introducing electronic referrals. A pilot electronic referral scheme will begin in January 2011 involving GP practices in the Southern Trust area and will then be rolled out to all 356 GP surgeries in Northern Ireland. Belfast City Hospital’s new regional Prostrate Brachytherapy Service was officially opened this month. Brachytherapy is a form of radiotherapy which delivers targeted radiation directly to the prostate gland through the implantation of small radioactive pellets. It was previously not available in Belfast and patients were required to travel to Leeds for their treatment. The Minister officially opened a new £15.6 million child and adolescent mental health unit at Beechcroft, Forster Green Hospital. The new facilities boast 33 inpatient beds and five daycase beds, dayrooms, education and therapy facilities for specialist mental health inpatient services. In addition Lagan Valley Hospital officially took hand of two new operating theatres. The theatres’ powdercoated stainless steel walls incorporate the anti-bacterial qualities of silver to inhibit bacteria in the completely sealed unit.

APPOINTMENTS

Councillors Oliver Molloy and Martin Reilly were appointed as non-executive directors (Local Government Representative Members) to the Patient and Client Council (PCC).


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HEALTH MATTERS – October 2010

Diary & Consultation Dates 6th October 2010 OCTOBER 2010

October 2 010 is Br east Canc Awareness er Month. Th e Public H Agency (P ealth HA) is enc ouraging Northern women in Ireland to make use availabilit of the y of Brea st Screenin to reduce g in a bid cases of b reast can cer. WEBSITE LINK

1st October 2010 International Older People’s Day. Health Minister Michael McGimpsey and Chief Executive of the PHA Dr Eddie Rooney are celebrating and promoting healthy ageing by encouraging older people to eat healthily and exercise regularly. WEBSITE LINK

Launch of the Seasonal Flu Vaccination Programme 2010/2011. All ‘at-risk’ groups are encouraged to avail of the vaccination programme, which for the first time will include Swine Flu vaccinations. WEBSITE LINK

2nd October 2010

“Advocacy Workshop”, Derry. The Patient and Client Council and DHSSPS have organised a series of workshops to develop ideas for support services in Northern Ireland for people with learning disabilities, mental illness, physical or sensory disability and older people. Following on from the workshop in Lisburn in September, there will be a similar workshop in Derry in October. WEBSITE LINK

“Priorities in Health and Social Care Workshop”, Belfast. This workshop, run by the Patient and Client Council, offers the opportunity to share your views on the Health Minister’s ‘Priorities for Action’ document. The workshops will be occurring throughout Northern Ireland during October, beginning in Belfast and Dungannon on October 6th, Newtownards and Newry on 18th October, Lurgan and Belfast again on the 20th, and ending on the 22nd October in Ballymena and Omagh. WEBSITE LINK

7th October 2010 “Five Ways to Wellbeing”, Bloomfield Shopping Centre. Run by the Patient and Client Council, this event offers blood pressure checks and information on a broad range of mental health issues. WEBSITE LINK

Livestrong Day. Founded by cancer survivor and champion cyclist Lance Armstrong, Livestrong day urges cancer patients to get all the information and treatment needed to tackle their illness. This year, the PHA has pledged their support for the day and invested in physical activity initiatives to both prevent cancer and help rehabilitate patients. WEBSITE LINK

14th October 2010 Final HSSPS Committee report on the Sunbeds Bill.


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HEALTH MATTERS – October 2010

Diary & Consultation Dates (continued) 27th October to 24th November 2010

22nd October 2010

“Focus on Health Inequalities Programme”.

“Guidance on the Termination of Pregnancy: The Law and Clinical Practice in Northern Ireland”.

Focus on Health Inequalities is a programme of events which highlights action taken by the Public Health Agency and partners to address inequalities in health and wellbeing across Northern Ireland. It will offer a full calendar of events with a focus on poverty, disadvantages, economics and a healthier society. WEBSITE LINK

Consultation Dates 1st October 2010 Launch of DHSSPS Consultation on

“Draft Tobacco Control Regulations Removing Displays of Tobacco Products at Point of Sale and Banning Sales of Tobacco Products from Vending Machines” which will run until 24th December 2010. WEBSITE LINK

5th October 2010 Launch of DHSSPS Consultation on

“Skin Cancer Prevention Strategy and Action Plan 2010 – 2020” which will run until 24th December 2010. WEBSITE LINK

15th October 2010 Deadline for DHSSPS Consultation on

“A Ten Year Strategy for Social Work in Northern Ireland 2010 – 2020” and “Draft Independent Healthcare Amendment Regulations”. WEBSITE LINK

Deadline for DHSSPS Consultation on

WEBSITE LINK

31st October 2010 Deadline for DHSSPS Consultation on

“An Equality Impact Assessment for New Mental Capacity Legislation”. WEBSITE LINK

26th November 2010 Deadline for DHSSPS Consultation on

“Outcomes of DHSSPS Equality Screening Exercises 2009/2010”. WEBSITE LINK

30th November 2010 Deadline for DHSSPS Consultation on

“Speech, Language and Communication Therapy Action Plan: Improving Services for Children and Young People 2010/11 – 2011/12”. WEBSITE LINK

Asitis Consulting can provide an in-depth weekly monitoring service for clients. Phone or email for further details


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HEALTH MATTERS – October 2010

Northern Ireland could lead the world on mental capacity issues if legislation currently under consultation is agreed by Assembly. The draft Mental Capacity Bill was born out of the recommendations of the Bamford review and has already been hailed as the most progressive piece of legislation our devolved administration has yet to produce. Dr Colin Harper of Disability Action’s Centre for Human Rights explains how the new legislation is a major opportunity to protect the human rights and dignity of those with a learning or mental disability that will reshape the way in which society acts towards those unable to make decisions for themselves.

issues are respected.” he says, “Northern Ireland is one of the first places to introduce capacity based legislation. Indeed it is one of the first places internationally where the rights of people with mental capacity issues of any kind will be enshrined in legislation.” “The current legislation covering people with a mental disability or disorder, in Northern Ireland, goes back to the 1980’s” (the Mental Health Order (1986) Northern Ireland) “so reform of the law in this area is long overdue.” The Mental Capacity Bill is part of a larger programme of mental health reform across the UK. In Scotland, England and Wales an individual’s rights in respect of their mental health and capacity are subject to two separate pieces of legislation, and the law is currently under review in the Republic of Ireland. The new bill in Northern Ireland proposes a single Act. “The Minister has moved away from introducing two parallel pieces of legislation covering mental According to Dr Harper, the proposed bill is health and mental capacity to a single bill covering leading the rest of the UK in reform of the law. them both. What this single bill introduces is the “This is a big step forward, it requires that the assumption that if a person has the ability to make a decisions of people affected by mental capacity decision they will generally have the right to do so.”

“For the first time people with a mental disability or learning disability will have the same rights as anyone else....”


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HEALTH MATTERS – October 2010

Currently if someone has a physical health issue, they have the right to make a decision to refuse treatment, even if the procedure is for a life threatening illness. However, if someone has a mental health problem and is subject to the Mental Health Order they lose the right to refuse treatment. “As things stand under the mental health law you would not have the right to refuse treatment. If you have a mental disability or severe learning disability you can be treated compulsorily against your will.” “For the first time people with a mental disability or learning disability will have the same rights as anyone else. It changes the presumption of the law, from ‘do you have a mental disorder?’ to ‘do you have a mental capacity issue?’” As Dr. Harper explained, mental capacity issues are not limited to those with a mental or learning disability . The new law would ensure the rights of those who at any time are unable to make a decision for themselves, including situations where someone is unconscious, suffering from a delirious fever or conditions like ‘locked in syndrome’ where someone is capable of understanding what is being discussed but unable to communicate their wishes. The provisions within the bill envisage a functional test of capacity to determine if someone is capable of making a decision for themselves. If the results of that test show that someone cannot make a decision due to impairment or disturbance of the functioning of their mind or brain it outlines safeguards to ensure that decisions taken on their behalf are made in their best interest. “The bill introduces a four part functional test to assess an individual’s capacity. It relies on assessing their ability to understand the information that is being presented to them; retain the information that is given to them; use or weigh up this information; and their ability to communicate their decision. “This test will also apply to decisions made in other areas of life, not just clinical situations about someone’s treatment, for example choices about someone’s financial or welfare circumstances.” He outlines a situation where someone with a mental capacity issue instructs a bank teller to transfer all their money out of their account to give to a gentleman sitting outside. “If their reason for doing so is because the person outside bought them a cup of coffee then it would be reasonable to be concerned that they have not understood or been able to weigh up the decision they are making.”

The bill includes a number of protections, including the right to nominate a person to make decisions on their behalf, should they at any stage in their lives be unable to make a decision. For some decisions, a person will be entitled to an advocate to ensure their rights are protected, and best interests considered. Certain kinds of decisions will still have to be authorised in advance by Trust or by the High Court, such as decisions about life threatening treatments.

“The main point of the legislation is to ensure that the persons voice is heard....” He continued, “The main point of the legislation is to ensure that the persons voice is heard; that the person has as much of an input into any decision as they can and that arrangements are made so that this can happen. For instance if a drug they are taking makes them feel unwell, and they can be treated with another, they should have the right to be treated another way. Or in other circumstances someone may be more capable of making a decision in the afternoon rather than the morning. The bill is about safeguarding that person’s right to be involved in decisions that affect them.” There are two groups who the legislation may not be applied to: some of those within the criminal justice system and children under the age of 16. In the first instance it has been argued that if a person with a mental capacity issue presents a significant risk to others and treatment against their will could reduce this risk, a decision could still be made against their will. Children on the other hand have the rights to accept a decision made on their behalf but not to refuse one made on their behalf by a guardian, and it was deemed unpractical to extend the legislation to them due to this existing parental authority. There are still questions to be answered about how the legislation will be complied with and whilst Dr. Harper is disappointed that the bill does not extend to these two latter groups he has welcomed the bill in its current form. “There is still a long way to go in the process, but as things stand the capacity based approach to mental disability within the bill is very positive.”


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HEALTH MATTERS – October 2010

Views in Profile

Budget Budget Budget has been the mantra all the parties have agreed to as the biggest challenge to Northern Ireland’s health sector in the coming months. To round off our series of interviews we have spoken to Health Committee Deputy Chair and Sinn Fein MLA Michelle O’Neill, SDLP Health spokesperson Tommy Gallagher and the Alliance Party’s Kieran McCarthy, and asked them to outline how they would meet the challenge.

Tommy Gallagher: Like all departments savings will have to be made. We have already seen in year cuts and GP’s were asked to save money out of their budgets. With practices having to make changes in the middle of a year it has been particularly disruptive, but these kinds of shocks will become even more common. My party wants to have a debate about what parts of the Health Service should be protected; we believe there are areas that should be cut like bureaucracy and bonuses for senior directors. One of the big spenders is prescriptions; it costs us £600 million a year. While people welcomed it at the time, the reality

is people are living in tough times and we have to question why people in good jobs have free prescriptions while other areas such as support for mental health or domiciliary care are under resourced. The cuts to the health service need to be approached in a co-ordinated way and there needs to be a debate about what ‘front line’ really means. Domiciliary care and disabilities have historically been asked to take the pain first. We need to move away from cuts where the weakest and the vulnerable are hit first. Michelle O’Neill: I think one of the best places we could start is to speed up the review of the Investing for Health Strategy. This was a radical policy, introduced by Barbara de Bruin, which goes right to the roots of the wellness agenda and currently the department is dragging its feet in completing its review. I will be pushing for that, we need to consider better long term planning rather than only dealing with acute services. Even if health can’t be ring fenced there are still opportunities to drive out inefficiencies. For instance people are still referred for consultations by snail mail. A recent pilot scheme in Scotland found that £17 a patient for every referral could be saved if they were issued electronically; it amounted to a saving of £100, 000 per annum.


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HEALTH MATTERS – October 2010

However, the most important effort should be on restoring a dedicated focus on wellness. The Public Health Agency should be given a real agenda with measurable targets. We can’t continue to have a short term approach to health. Investment in health should come from across all sections of government and it will require the Executive to back a long-term approach.

made if they were delivered in a different way by being provided by the independent or voluntary sector. The previous Executive made health its number one priority for government, this Executive has made the economy its focus, but what needs to be realised is that both work together.

Kieran McCarthy: We would be afraid that local frontline services will be affected. GP’s have already had to cut back on evening surgeries. I would be particularly concerned that people with disabilities and severe learning difficulties would be the most vulnerable to cut backs in services. If a hospital was to close there would be an immediate outcry, but not if services are cut for those with mental or physical disabilities and other groups like senior citizens. The 20th of October is in everyone’s mind and what decisions will be made are a big concern for people like carers. People are realistic that cuts are necessary, but the Health Service should be about being free at the point of delivery. Proposals such as £20 charges to see a GP or £100 to go to accident and emergency undermine that. There is money being wasted in unkept appointments and consultations, and areas such as social care services where savings could be

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