Health & Social Care Services

The Department of Health and social services and public safety (DHSS PS) is responsible for health and personal social services. The bulk of legislation is provided in a number of statutes, together with regulations made under the statutes’ directions. Authorities also publish guidance in relation to policy, practice, codes of practice, curricular, and advice notes. The status of the guidance varies, does not generally constitute legal obligations.

The Health and Personal Social Services NI order 1972 as amended and the Health and Personal Service NI order 1972 as amended, principally in 1991, 1994, and the Health and Social Care Reform Act NI 2009 are the principal pieces of legislation dealing with health and social services in Northern Ireland.

The order provides for a number of broad duties, including the duty to make arrangements as the Department considers necessary for the prevention of illness, care, and aftercare of persons suffering from illness.

• Duty to give advice, guidance, and assistance to the extent the Department considers necessary to make arrangements, and provide secure provisions for facilities as it considers suitable and adequate to discharge his duties.
• To recover charges as the Department considers appropriate in respect of assistance, help, and facilities.
• Duty on the regional board to make arrangements for the provision of personal medical services.

The 2009 Health and Social Care Reform NI Act 2009 provides the modernized health and social care structure. The Health and Social Service Council, Central Services Agency, Health and Social Service Boards, and mental health commissions were dissolved.The functions of the boards have been transferred to the regional Health and Social Care Board and the regional authority for public health and social well-being. The regional board may give guidance to the trusts in relation to the discharge of their functions.

Trusts have powers and duties. Trusts make a range of services available to persons in need of community care, including home help services, day center provision, respite care; domiciliary care services, community health services, residential and nursing care, hospital discharge arrangements, meals on wheels, assessment of care needs. A person with special needs may be entitled to the community care services. Needs may arise as a result of physical or mental disability or due to the payments on institutional care.

Under the 2009 Act, the Department has the duty to provide an integrated system of health and social care designed to improve physical and mental health and social well-being of persons. It is its duty to develop policies to reduce health inequalities between people. It has the power to provide and secure health and social care services as it considers necessary. Health and social care trusts must exercise their functions so as to improve the health and social well-being and reduce health inequalities.

The Chronically Sick and Disabled Persons NI Act 1978 provides duties in relation to persons who are chronically sick or have a disability. Persons covered include those who are blind, deaf, dumb, or substantially handicapped by illness, injury, or genetic deformity and his handicap is of a permanent or lasting nature or is suffering from a mental disorder within the meaning of the Mental Health NI order.

A range of services may be provided, including practical assistance in the home, assistance in relation to obtaining TV, library, recreational facilities. Provision and education, recreational facilities, games, outings/ travel arrangements for the purpose of participating in services. Facilitating holidays. Provision of meals. Assisting in arrangements for at work patients to the home. Provision of holidays, provision of assistance in obtaining a telephone.

1989 Act, Disabled Person NI Act 1989 requires health authorities to undertake assessments of persons who come within the definition of chronically sick or disabled. The assessments must be carried out when requested either by the person concerned or carer in the context of services which may be provided.

The Mental Health NI order 1986 places a general duty on the regional Health and Social Care Board and the regional agency for public health and social well-being to promote mental health, prevent mental disorder, and promote treatment, welfare, and care of a person suffering from mental disorder.

The Children’s NI order 1995 creates rights and duties in relation to children, many of which arise in the context of community care services. There is a general duty to safeguard and promote the interests of the children in need. A range of services may be provided.

Trusts may provide a wide range of services for children. The Carers and Direct Payment Act NI 2002 provides a duty to assess the need of child carers and carers of a child with a disability and to consider what services are appropriate. Information is to be made available to child carers and carers of persons with a disability regarding the right to an assessment of needs. Direct payments may be made.

The Carers and Direct Payment NI Act 2002 permits direct payments to persons with parental responsibility for children or a child with a disability aged 16 or 17.

The above 2002 act gives carers a statutory right for an assessment if needed if requested. An assessment may be triggered by way of application for a place in residential accommodation, a nursing home, or domiciliary service by GP reference, by reference by a voluntary organization, reference by an informal carer seeking assistance.

Once a person requires an assessment, a decision is made as to the level of assessment. The trust, having regard to the relevant factors, determines the type of assessment to be made.

The range of appropriate agencies and professions may be involved in the assessment. Assessments may cover physical and mental health, the capacity to live and care for themselves, housing finance, and environmental factors. Once an assessment has been completed, the person and his carer should be informed of the results and the name given for contact.

Once a person is assessed as having needs, the trust may have a duty to meet the assessed needs. In some cases, there is a statutory duty to meet the need, irrespective of resources. In other cases, there are powers to provide services. In this case, discretion may be exercised. A person may be placed on a waiting list where financial constraints apply.

Once an individual assessment has been completed and a decision made, the care can be arranged and should be arranged. The trust should design the appropriate care arrangements. This is to be done in consultation with the individual carers and care professionals.

The care package is to be reviewed and monitored from time to time. There is to be a care manager who is the principal point of contact.