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26th April 1999
Minutes of Special Meeting of Strabane District Council held in the Committee Room, Council Offices, 47 Derry Road, Strabane on Monday 26 April 1999 at 7.15 pm
Present:- In the Chair:- Councillor I Barr Other Members:- Councillors Mrs A Bell, D A Bresland, J Donnell, D Hussey, T Kerrigan, C McHugh, I Murtagh, J O’Kane, E Turner MBE Total = 10
In Attendance:- Messrs T Frawley & M Gormley - Western Health &
Social Services Board
Dr C Hamilton - Medical College
Clerk & Chief Executive, Chief Administrative Officer,
Review of Acute Hospital Services for the Western Area
The Chairman of the Council welcomed the officials to the meeting and invited them to make their presentation.
Mr Frawley explained that Strabane was the first Council which they had visited to discuss the Review. He commented that this was the most important consultation procedure which they had undertaken as a Board. He advised that the Steering Group had put forward detailed analysis most of which was available to Members this evening. The Board had not taken a decision at this time nor had it a specific proposal but was seeking the voice of constituents on the preferred model. He explained that a public consultation response form had been prepared and would be submitted to the Council. The Council may wish to complete this or alternatively submit its own formal written submission/s.
With the aid of overheads, Mr Frawley stated that the key aims were "sustainability" and "quality". The Board at its meeting on 25 March 1999 accepted the report "Sustainable Services: Quality Care", produced by the Independent Steering Group, as the consultation document which will be tested through a formal consultation process up to 30 June 1999. The scope of the review was acute services provided in hospitals for residents of the Western area; future needs for acute services and links between services provided in hospitals and those provided in the community and by primary care teams. The main aims of the review were to examine current services and test them against the major changes taking place in acute hospital services; produce proposed models of acute services which could meet needs over the next ten years and analyse the strengths and weaknesses of these proposals and make recommendations to the Board. The main goal was to achieve a sensible balance between the accessibility of services and the sustainable provision of modern, high quality standards of clinical care. Mr Frawley commented that this was a difficult balance to strike and it was accepted that the Council area had already lost hospital services.
Feedback from the public indicated that effective emergency services are vital, travel for specialised care is acceptable, people want more care to be provided locally, there are concerns about service "style", there is a need for policy co-ordination on health and social care issues within Health & Social Services and between all agencies.
The Steering Group findings are that "status quo" is not an option. The Board is not saying that the status quo is not an option. Any change must lead to improved quality, effective emergency services are vital and strong interdependencies between specialties and between primary/community and secondary care was important. This would result in changes at all levels including how and where people work. Change must not be constrained by existing structures and boundaries. Teams of staff need to treat enough patients to maintain skills e.g. at least 30 to 50 operations per year are needed to build skills in cancer treatment and obstetrics where specialist teams are needed. The volume of work necessary to specialise is not possible in a smaller hospital.
The various models were outlined as follows:-
"Status quo" - Emergency, in-patient, daycare and outpatients on three sites in existing pattern - Altnagelvin, Erne and Tyrone County Hospitals. The strengths and weaknesses were outlined. In the event that this model is the preferred option, the Board will have to investigate it.
Model 1 - Altnagelvin, Tyrone County and the Erne. Both the TCH and Erne would continue to have a range of in-patient and day care core specialties, some specialised services and full out-patient services. The organisation of A&E services would need to be agreed. There would also be increased integration and collaboration between the Erne and the TCH e.g. sharing in-patient services between the two sites and further development of the established clinical networks with other hospitals. The strengths and weaknesses were outlined.
Model 2 - Altnagelvin and ‘Greenfield’ site in the Southern Sector. This would result in no clinical activity at the TCH and the Erne in this event. The only ‘acute’ service provision available within the WH&SSB, outside Altnagelvin and the ‘Greenfield’ site would be that developed within Primary care. The strengths and weaknesses were outlined. Spatial studies were undertaken and a "triangle" of a suggested location for a new hospital was shown to Members. New patient catchment would be required and would subsequently influence the chosen location. The Northern Health Board has put in a proposal to close the Mid Ulster Hospital and the Southern Health Board has put in a proposal to close the South Tyrone Hospital and this would have a major impact on overall plans . The capital cost is a major issue and it is anticipated that the Assembly will have to make a number of important decisions on health issues alone. The Ambulance Service has a budget of £19m in comparison with the Fire Service which has a budget of £48m.
Model 3 - Altnagelvin, Tyrone County Hospitals plus day provision at the Erne Hospital. The strengths and weaknesses were outlined.
Model 4 - Altnagelvin and Erne Hospitals and day provision at Tyrone County Hospital. The strengths and weaknesses were outlined.
Model 5 - Centralisation of all inpatient and A&E Services at Altnagelvin with some non-inpatient provision at Tyrone County and Erne Hospitals. The strengths and weaknesses were outlined. The Board has not endorsed this model.
The Steering Group concluded that Models 2, 3 and 4 meet the requirements of quality and sustainability. Status quo is not sustainable and single inpatient/A&E site is not acceptable. Model 1 would evolve to provide the bridge between the present position and the implementation of the long-term model. The Steering Group’s preferred option is Model 2 (Altnagelvin and Greenfield site).
Mr Frawley stated that the Strabane area has one of the most successful primary care systems in the Western Area and particularly Strabane town with GPs working collaboratively. He noted from written comments from Council and press reports etc. that there were real concerns regarding the operation of Co-operatives. He pointed out, however, that doctors etc. were no longer willing to work the same number of hours as had been the practice in the past. The medical profession generally had very strong feelings about this and underpinning this was the proposed development of a human resource training strategy for the new Millennium.
The building blocks for the future were emergency response arrangements; formal managed clinical networks; development of primary care and effective human resources/recruitment and training strategy. The public was becoming more and more demanding and better informed than ever before.
The Steering Group recommended that the Board uses the report as the basis for consultation; reviews the results of the public survey and focus group work in regard to the "style" of services and initiate discussions with Trusts and professional groups; refers the report from the Ambulance and Transport Sub Group as evidence to the NI Ambulance Review; initiate further work with appropriate bodies on the development of managed clinical networks, of new models of primary care and of a range of pre-hospital emergency response systems; explore the opportunity for cross border flows of patients with the Northern and Southern Boards and with the Republic of Ireland through CAWT and work with Sperrin Lakeland and other key stakeholders to secure the bridge to a sustainable future. In relation to the pre-hospital emergency response systems, Mr Frawley pointed out that paramedics operated successfully on motorbikes on the mainland and this practice was being investigated at a local level.
The period of consultation will run until 30 June 1999. The Board hopes to agree its recommendations at its meeting to be held in August 1999. The Board’s recommendations will then be sent to the Minister and perhaps also the Assembly.
The Chairman of the Council thanked Mr Frawley for his informative presentation and then invited Members to put forward their views.
Councillor Murtagh remarked that newly recruited doctors and specialists were perhaps career conscious and favoured larger hospitals. In relation to Model 2, he remarked that the "triangle" on the map suggested for the "greenfield" site needed to be restructured on a wider basis. Mr Frawley advised that the suggested location would be subject to extensive discussions with all the relevant bodies. He also pointed out that any developments in relation to the hospitals in Dungannon and Magherafelt would have a major impact on any proposals.
Mr Frawley outlined his experiences when the Craigavon Hospital opened and explained that it took some time to become established and accepted that this has to be taken on board in relation to a "greenfield" site.
Councillor Kerrigan spoke of the closure of the Castlederg and Strabane Hospitals and the fear that the TCH and Erne Hospitals would also close or be downgraded. He referred to the transportation of patients to Scotland for operations and felt that this work could have been carried out within our own area. He spoke of the continuous reviews and was of the opinion that there was a general decline in health care. He felt that the out-of-hours service provided by Mournedoc was not satisfactory, as was demonstrated in the high volume of complaints received, and it was essential to build up our areas and make them more serviceable. He commented that Fermanagh and Tyrone were vast areas and it was essential that this was borne in mind. He stated that he would not be supportive of Altnagelvin Hospital and a "greenfield" site. He felt that the feedback from the public which the Steering Group had obtained appeared to differ from that which himself and other Councillors received.
Councillor Kerrigan voiced support for the TCH and the Erne to continue to operate and upgrading of Altnagelvin Hospital to be undertaken. He expressed concern at the volume of complaints which he received regarding the ambulance service. In taking Councillor Kerrigan’s comments on board, Mr Frawley pointed out that medicine is changing across Europe and the UK. It had been suggested in research that three hospitals would service 1.5m population and this would have a major impact if considered in the NI context. Sustainable service in the future is the key element. Specialisation and social aspects were also important and small hospitals would not attract the appropriately skilled staff required. He explained that the operations carried out in Scotland was successfully managed as there was not the capacity to cope in NI and those who underwent surgery benefited immensely. He felt that the closure of the hospitals in Strabane and Castlederg were replaced with other types of support and care. He urged Members to look to the future and develop a framework of service that is of high quality and sustainable.
Mr Gormley explained that he had been involved in the review and he reassured Members that extensive consultation had taken place with the public and staff, as outlined in the report previously circulated. He remarked that there was an emotional attachment to buildings, such as hospitals in this instance, but a greater attachment to high quality service.
Dr Hamilton remarked that every aspect of medicine requires high technology and re-learning. Consultants frequently moved to other hospitals in order to broaden their experience and it was becoming increasingly difficult to fill posts due to specialisation i.e. 9 vacancies in Orthopaedics in the Province were not filled. Projections were being made for 10 years ahead and it was becoming increasingly difficult to attract appropriately trained staff and to keep them up-to-date.
Councillor Kerrigan reiterated his concerns regarding the after-hours service in the Castlederg area and also sought clarification on the ambulance cover provided. In response Mr Frawley advised that Castlederg cover was as follows:-
8.00 am to 5.00 pm - 1 crew - 6 days per week
11.00 pm to 8.00 am - 1 crew - 7 days per week
5.00 pm to 11.00 pm - 7 days ) Cover provided by Strabane
8.00 am to 5.00 pm - 1 day Sunday ) and Omagh stations
Mr Frawley explained that the Board was concerned at week-end cover in Castlederg. He further explained that requests had been made for additional ambulance cover in Derry, however, he had indicated that priority would be given to the Castlederg area and he had received huge criticism from Derry City Council in relation to this. He stated that the response time for ambulance cover in this area in total was better than any other part of NI. He remarked that there were some occasions on which the service did not meet the required standards but it was difficult to have absolute cover at all times. He accepted that public confidence in the service had been undermined in some instances and referred specifically to the case whereby a woman recently had to travel by taxi to the Erne to deliver her baby as an ambulance was not available. He explained that the circumstances surrounding this incident were being fully investigated as there were conflicting accounts of what actually happened.
Members were advised by Mr Frawley that the Castlederg station did not have the same level of demand as other parts of the system. He accepted, however, that as a result of the distance involved there is a need to support the community with appropriate cover. He undertook to provide the Council with figures of the monthly cover provided for each of the stations in the Western Board area from April last year to March this year. He accepted the need for further investment. He urged that the Council recognise the difficulty in providing the total level of cover expected by everyone. In overall national standards of response times across NI, the ambulances operating out of the Western Area has the best performance record of any ambulance service.
Councillor McHugh reiterated the concerns previously expressed regarding the out-of-hours service provided by Mournedoc in the Castlederg area. He stated that to the West of Castlederg there were over 100 patients who lived in excess of 25 miles away from the nearest medical centre. In relation to the stipulated response time of 21 minutes for ‘999’ calls, he commented that this was impossible to adhere to for some of those patients living in the area referred to. He referred specifically to a recent case whereby a young woman, despite needing urgent medical attention, had to wait a lengthy period for an ambulance which caused further distress. He was concerned that ambulance cover was not provided in the Castlederg station from 8.00 am to 5.00 pm on Sunday or from 5.00 pm to 11.00 pm seven days per week. He contended that when cover was provided in the Castlederg station, the crew had to respond to call-outs from areas such as Strabane and Omagh etc. which he felt jeopardised ambulance cover for the Castlederg area. This subsequently resulted in ambulances having to travel from Strabane etc. to call-outs in the Castlederg area and, therefore, lengthened the response time. He pointed out that Castlederg is the furthest point from an Accident and Emergency Hospital in the Western area and this should be borne in mind. He welcomed the reassurance from Mr Frawley that Castlederg would be prioritised for ambulance cover.
Councillor McHugh welcomed the presentation and the review and acknowledged the effort put in. He felt that Mournedoc had been foisted on the community but acknowledged that the public were being consulted within the review and now had an opportunity to speak out. He referred to the affinity which currently existed with the Tyrone County Hospital and expressed the hope that its services would be retained and enhanced. He acknowledged the change in working practices for doctors with the aim of improving their quality of life but stressed that patients should not suffer as a result and should receive a high quality service. He welcomed the advances in pre-hospital emergency response systems such as paramedics on motorbikes and helicopter services etc. In relation to the "greenfield" site, he queried whether it was feasible for Omagh to be considered suitable. He referred to the suggested location highlighted on the map by Mr Frawley and commented on the speculation that Dromore was being considered.
In response Mr Frawley stated that there was a real challenge in terms of the more remote parts of this area and giving people confidence in the system. The availability of an ambulance as required and the response time for call-outs had to be addressed and this was the Board’s first priority in terms of ambulance investment.
Councillor Hussey remarked that Councillors Kerrigan and McHugh had already highlighted problems facing Councillors for the Derg area. He reiterated the concerns regarding the limited ambulance cover provided in the Castlederg station and that the 21 minute response time for ambulance call-outs was not being met on a number of occasions. He felt that satellite stations such as Limavady, Strabane and Castlederg should be treated equitably and 24 hour cover should be provided. He reiterated the point that the Castlederg area was the furthest point from an A&E Hospital. He accepted that the Castlederg ambulance should be fully utilised but was concerned that it was not on site in Castlederg when needed and this was particularly alarming in view of the comparative distances involved. He asked that the call-out figures specifically for the Castlederg area be provided. He commended the high quality of service provided by the ambulance personnel in the Castlederg station and pointed out that the lack of cover was no reflection on them.
Mr Frawley remarked that the Castlederg station had presented a tremendous challenge. He explained that calls were attributed to designated stations and these could be provided in respect of Castlederg. He explained that in 95% of all calls, the ambulance must arrive within 21 minutes in a rural area. He accepted that this target has not been achieved all of the time. On average twenty ‘999’ calls were received per month in Castlederg whilst fifty-two were received in Strabane. It was impossible to predict the number of ‘999’ calls which would be received at any station. He accepted the point regarding cover provided at satellite stations and accepted that the remoteness element had to be examined. He stated that ambulances are regularly moved right across the area and were often brought in from other areas, as required, and the fleet was maximised as much as possible.
Mr Frawley advised that a new development in the ambulance review is vehicle tracking technology with the emphasis on where the fleet is deployed rather than the location of a particular ambulance station. This procedure will be further enhanced with more advanced technology and communications as part of the review. There is a proposal to split patient care services from the front line ambulance service as it is currently being undermined by general transportation duties and would, therefore, retain the integrity of the ‘999’ emergency service. He accepted the need for better ambulance cover in Castlederg and reiterated the point that it would be given priority.
Reference was made by Councillor Hussey to suggestions that the Ambulance Service may be co-ordinated with the Fire Service. He accepted that the general public wanted a first class specialist service and it may be necessary to travel to avail of same. He was concerned what happened before and after these stages. He remarked that speed of treatment was essential. He felt that there was no reason why specialist services could not be provided in the West of the Province and that the Royal Colleges’ specifications could also be met. With regard to patients travelling to Scotland for treatment, he suggested that specialists could be brought into NI to augment and improve the service rather than people having to go elsewhere. He commented that there was a growing lack of confidence in the ambulance service and Mournedoc. In relation to Mournedoc, he remarked that the surgery facilities are excellent when they are available. He remarked that on occasions when a person travelled to Strabane for a doctor, a Castlederg doctor was often on call and he questioned why he/she could not have operated from the Castlederg surgery rather than Strabane. He questioned the reasons for the "one way" flow. Primary care and contact with patients was of the utmost importance. He queried whether one of the two Western Counties would be left without a hospital and this was a real concern for people in the West.
Councillor Hussey indicated that he would be in favour of the two site scenario and he failed to understand why this could not operate satisfactorily. He felt that the people of Tyrone and Fermanagh deserved to have their two County towns provided with an A&E facility. Within the dual site, specialist services could be retained i.e. the existing Renal Unit could be further enhanced. He stated that he was not in favour of all services "going East".
Mr Frawley commented that there were clear views being expressed by the Council and he suggested that these be incorporated in a response to the Board. He reiterated that the major difficulty was achieving sustainable services and delivering a high level of quality. He felt that one hospital on two sites is the most difficult to deliver but it would be examined.
Councillor Mrs Bell referred to the practice whereby the Strabane ambulance was used to cover Derry and expressed concern that Strabane was left without cover. Mr Frawley commented that the figures did not indicate that Strabane would be left without cover in an emergency. He reiterated the point that the use of the entire fleet was maximised.
Councillor Mrs Bell also voiced concern at the Mournedoc out-of-hours answering service. She explained that when a call was made a lengthy procedure ensued prior to any advice being given and also the calls were not answered locally. Mr Frawley explained that the Co-Operative concept was a decision taken by doctors’ representatives. In England, doctors could not be recruited to areas of high demand unless they worked in Co-operatives and this was as a result of social changes. There is a gap in what the people expect and what the doctors are willing to give. The call centre is operated out of Craigavon at present. Consideration was being given to operating a Co-operative system within the Ambulance Service. Investigations are underway to providing arrangements locally.
With regard to hours worked by doctors, Dr Hamilton explained that there was a health and safety aspect also and in particular with regard to new technology. 48 hours will be the maximum number of hours permitted for senior hospital doctors and this will have to be taken into account and will have a major impact with additional consultants being required. He stressed that part of the problem is that any new development in medicine tends to occur simultaneously around the country. The NI Cancer Initiative, for example, required an expansion from 8 to 13 surgeons over a five year period. The first year’s recruitment drive which extended to America and Europe etc. did not recruit anyone.
Councillor Hussey commented on the quality of life and queried why specialisation could not be moved to the West in preference to the East as at present. He remarked that it was the same distance from Strabane to Belfast as it was Belfast to Strabane. Dr Hamilton remarked that Altnagelvin Hospital has the only specialisation in a number of fields outside of Belfast.
Councillor O’Kane voiced his support for the "status quo" as an option and he felt this was widely supported. He welcomed the public consultation process. There was great concern regarding the economic consequences of the Erne and the Tyrone County Hospital in the event of a "greenfield site". Mr Frawley commented that the Board was very clear and did not accept or endorse any model. The status quo is not acceptable by the Royal Colleges, however, the people’s rights were crucial. There were economic implications for closure of either of the hospitals and Fermanagh District Council was considering the economic worth of health service work to communities.
The Chairman of the Council suggested that the catchment area could perhaps be widened. He stated that Strabane town was his foremost concern. In relation to Altnagelvin Hospital, he commented that the people of Strabane town took a number of years to form a strong bond with it. In the event that a "greenfield" site became a reality, he queried whether the Board would foresee the people of Strabane having to travel to the new site which would subsequently lead to the demise of Altnagelvin Hospital. In response, Mr Frawley commented that the "greenfield" site was perhaps 5 to 7 years away. He felt that hospitals which are established such as Altnagelvin and have an attachment to Strabane would continue to operate in this way. With regard to the suggestion that NI could ultimately be serviced by three hospitals, he felt that this may be the case in the future. He spoke of the downward pressure on hospital costs and the future implications. He was of the opinion that Altnagelvin Hospital will be an integral part of future infrastructure and could perhaps form part of a broader North/West context with cross border elements. He did not, therefore, foresee any concerns for the future of Altnagelvin Hospital.
Mr Gormley commented that Altnagelvin Hospital has a very important part to play in major networking and also specialties. With regard to the suggestion of specialist services coming to the West he commented that this was catered for under Outreach services and it was important that this was seen in the wider context.
Reference was made by the Chairman of the Council to the fire tragedy in Glenowen in Derry and the lack of ambulance cover which was highlighted at that time. He reiterated the concerns regarding ambulances from Strabane providing back-up to Derry which would subsequently increase response time for ambulances in the Strabane area. He sought clarification on whether Central Government is cutting back on the Ambulance Service budget resulting in inadequate ambulance provision.
Mr Frawley advised that there was a 30% increase in ambulance demand in the Derry area. He pointed out that the ambulance service has to compete with other services. The NI Fire Service is directly funded by the DOE and has a budget of £48m whilst the Ambulance Service has £19m. Mr McFall, Minister, has recently made available £15m i.e. £5m for the next three years. Significant investment would be required in order to deliver the building blocks as part of the foundations. He felt there were opportunities to collaborate with the Fire Service through sharing facilities and buildings etc. and it would prove cost effective.
Councillor O’Kane paid tribute to the services provided by Altnagelvin Hospital and as a member of the Western Health & Social Services Council had visited part of the hospital facilities. To this end he suggested that Mr Frawley could arrange for Councillors to visit the hospital in order to give them an appreciation of the excellent range of services provided.
In response to a query by Councillor McHugh, Mr Frawley advised that the cross border element did not form part of the review. The Board would, however, be presenting its analysis to the North Western Health Board. There was now a European funding project with joint training and protocol. He then referred to the Omagh tragedy last August during which ambulances in Sligo came into Fermanagh to release ambulances to Omagh. He felt that the nearest ambulance to an incident could respond to call-outs regardless of which side of the Border they were located. He explained that Altnagelvin is a Trust and payment had to be made for all its work. The Hospitals in the Republic, however, are operated through an annual budget and could not pay Hospitals such as Altnagelvin which makes co-operation difficult.
Councillor Turner apologised for having arrived late in the meeting and having missed the presentation and comments raised. He spoke highly of the service provided by hospitals generally but commented that difficulties arose with the transport arrangements to hospital. Councillor Hussey commented that in some instances patients who had received specialist treatment were asked to leave Hospital too soon and asked that this be investigated.
The Chairman of the Council once again thanked the officials for their informative presentation and taking the comments on board. He explained that the Council would be formulating a response in due course. With regard to the proposed structure for the response Mr Gormley indicated that, following requests from community groups, the Board had drawn up a public consultation response form to allow a structured response to be compiled. He explained that the Council may wish to complete this form or alternatively submit its response in a different format. This was noted. The officials thanked the Council for having received the presentation and left the meeting at this point.
Review - Community Consultation
The Chairman of the Council advised that the Chief Executive was seeking Council’s view as to whether it should engage in a community type consultation on the Review of Acute Hospital Services and, if so, the format which it would take.
Councillor Turner informed Members that he had spoken with a representative of North West Community Network who had extended an open invitation to anyone interested in attending the discussions on the above Review to be held in Castlederg. He also understood that contact had been made with the Council’s Community Services Officer and that the meeting would take place in the Visitors Centre in Castlederg, however, the venue may need to be changed to facilitate the numbers attending. The Chief Executive commented that he understood that the Network had organised a meeting in the Castlederg area and that discussions had been ongoing with the Spamount and Churchtown groups. Omagh District Council had set up an all-party panel, chaired by Professor Denise McAllister, University of Ulster, and submissions were being taken from interested organisations for consideration by Council.
The Chief Executive advised that in Fermanagh a public meeting, chaired by Professor McAllister, was scheduled for 28 April 1999 and the views expressed at the meeting together with the Council’s response would be combined and forwarded to the Project Manager. He queried if the Council wished to proceed in a similar way.
Discussion ensued during which Councillor Hussey suggested that the Council could bring the Network on board in the compilation of a joint response to the Review. Councillor Turner suggested that the Council set up a Committee to act as facilitator and/or liaison. It was felt that there should be Council representation for the entire Council area. The Chief Executive advised that the WH&SSB had invited community groups to a meeting in Strabane which had been facilitated by Mr O’Brien, Strabane Community Network, however, very little interest was shown. Reference was made by Councillor McHugh to the extensive press coverage and high profile which Omagh District Council had given to the Review and suggested that Strabane should adopt a similar approach. The Chief Executive pointed out that the response form prepared by the Board was broken into various elements and would require the consensus response to be broken down accordingly.
It was agreed, on the proposal of Councillor Hussey, seconded by Councillor O’Kane, that the Council set up an All-Party Committee and the representative of the Health Council to discuss the Review and formulate a response. It was noted that Councillors Barr, Kerrigan, McHugh, Mullen, O’Kane and Turner would represent their respective parties on this Committee.
It was further agreed that the Council through its Officers and Councillors play a lead role, through liaison with the North West Community Network, in determining the public response to the Review and compile a joint response as previously discussed.
It was agreed, on the proposal of Councillor O’Kane, seconded by Councillor Bresland, that the Council purchase a wedding gift for Councillor Hussey who was due to be married on 21 May 1999.
The meeting closed at 9.50 pm.
DATED this 26th day of APRIL 1999
Clerk and Chief Executive
DATED this 11th day of MAY 1999
Chairman of the Council