Proposed Government Plan 2024-2027 (P.72/2023): thirty-first amendment. Vaccination Service.

STATES OF JERSEY

PROPOSED GOVERNMENT PLAN 2024- 2027 (P.72/2023): THIRTY-FIRST AMENDMENT

VACCINATION SERVICE

Lodged au Greffe on 20th November 2023

by Deputy A. Howell of St. John , St. Lawrence and Trinity

STATES GREFFE

2023  P.72 Amd.(31)

PROPOSED GOVERNMENT PLAN 2024-2027 (P.72/2023): THIRTY- FIRST AMENDMENT

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1  PAGE 2, PARAGRAPH (h) –

After the words "Appendix 2 – Summary Tables 5(i) and (ii) of the Report" insert the words –

", except that in Summary Table 5(i), to reflect the transfer of the Covid-19 vaccination scheme from Public Health to Primary care –

1. the  Head  of  Expenditure  for  the  Cabinet  Office  shall  be  reduced  by £300,000, such funding to be allocated from the Revenue Expenditure Growth Head of Expenditure for the Vaccine Scheme; and,
2. the Head of Expenditure for Health and Community Services shall be increased  by  £300,000  to  support  Primary  care  with  the  delivery  of vaccinations (including Covid -19 vaccines)".

2  PAGE 3, PARAGRAPH (l) –

After the words "as set out at Appendix 3 of the Report" insert the words –

", except that, on page 88, substitute the words "Details of the new service will be finalised in coming months and the Health Insurance Law will be amended to allow these costs to be met from the Fund." with "The vaccination service will be transferred back under the remit of Primary Care, with details of the new service finalised in the coming months and the Health Insurance Law amended to allow non-staff costs to be met from the Fund."

DEPUTY A HOWELL OF ST. JOHN, ST. LAWRENCE AND TRINITY

Note:  After this amendment, the proposition would read as follows –

THE STATES are asked to decide whether they are of opinion

to receive the Government Plan 2024 – 2027 specified in Article 9(1) of the Public Finances (Jersey) Law 2019 ("the Law") and specifically –

1. to  approve  the  estimate  of  total  States  income  to  be  paid  into  the Consolidated Fund in 2024 as set out in Appendix 2 – Summary Table 1 to the Report, which is inclusive of the proposed taxation and impôts duties changes outlined in the Government Plan, in line with Article 9(2)(a) of the Law;
2. to  refer  to  their  Act  dated  30th September  2016  and  to  approve  the application of existing resources for work on the development of user pays' charges  in  relation  to  all  aspects  of  waste,  including  commercial  and domestic liquid and solid waste;

3. to approve the proposed Changes to Approval for financing/borrowing for 2024, as shown in Appendix 2 – Summary Table 2 to the Report, which may be obtained by the Minister for Treasury and Resources, as and when required, in line with Article 9 (2)(c) of the Law, of up to those revised approvals;
4. to approve the extension of the use of the existing Revolving Credit Facility to include the provision of funds that would otherwise be implemented through bank overdraft or bank overdraft facilities under Article 26 (1)(a) of the Law, should they be needed, subject to the limits outlined in that article;
5. to approve the transfers from one States fund to another for 2024 of up to and including the amounts set in Appendix 2 – Summary Table 3 in line with Article 9(2)(b) of the Law;
6. to approve a transfer from the Consolidated Fund to the Stabilisation Fund in 2024 of up to £25 million, subject to a decision of the Minister for Treasury  and  Resources  based  on  the  availability  of  funds  in  the Consolidated Fund as at 31 December 2023 in excess of the estimates provided in this plan, or from budgeted underspends identified before 31 December 2024;
7. to approve each major project that is to be started or continued in 2024 and the total cost of each such project and any amendments to the proposed total cost of a major project under a previously approved Government Plan, in line with Article 9(2)(d), (e) and (f) of the Law and as set out in Appendix 2 - Summary Table 4 to the Report;
8. to approve the proposed amount to be appropriated from the Consolidated Fund for 2024, for each Head of Expenditure, being gross expenditure less estimated income (if any), in line with Articles 9(2)(g), 10(1) and 10(2) of the Law, and set out in Appendix 2 – Summary Tables 5(i) and (ii) of the Report, except that in Summary Table 5(i), to reflect the transfer of theCovid-19 vaccination scheme from Public Health to Primary care –
   1. the Head of Expenditure for the Cabinet Office shall be reduced by£300,000, such funding to be allocated from the Revenue Expenditure Growth Head of Expenditure for the Vaccine Scheme; and,
   2. the Head of Expenditure for Health and Community Services shall be increased by £300,000 to support Primary care with the delivery of vaccinations (including Covid -19 vaccines);

9. to  approve  the  estimated  income,  being  estimated  gross  income  less expenditure, that each States trading operation will pay into its trading fund in 2024 in line with Article 9(2)(h) of the Law and set out in Appendix 2 – Summary Table 6 to the Report;
10. to approve the proposed amount to be appropriated from each States trading operation's trading fund for 2024 for each head of expenditure in line with

Article 9(2)(i) of the Law and set out in Appendix 2 – Summary Table 7 to the Report;

11. to approve the estimated income and expenditure proposals for the Climate Emergency Fund for 2024 as set out in Appendix 2 – Summary Table 8 to the Report; and
12. to approve, in accordance with Article 9(1) of the Law, the Government Plan 2024-2027, as set out at Appendix 3 to the Report, except that, on page 88, substitute the words "Details of the new service will be finalised incoming months and the Health Insurance Law will be amended to allow these costs to be met from the Fund." with "The vaccination service will be transferred back under the remit of Primary Care, with details of the new service finalised in the coming months and the Health Insurance Law amended to allow non-staff costs to be met from the Fund.".

REPORT

Background  

The Government Plan 2024-2027 includes proposals for the ongoing funding of the vaccination programme through the Health Insurance Fund. This is explained on page 88 of the Government Plan as follows:

"As the central funding for Covid-19 costs comes to a close, the opportunity has been taken to review the organisation and delivery of a range of vaccination services, including an ongoing Covid-19 vaccination programme to targeted groups. Details of the new service will be finalised in coming months and the Health Insurance Law will be amended to allow these costs to be met from the Fund. Legislation to this end will be lodged to allow for debate immediately after the Government Plan debate,"

After this amendment, the relevant paragraph would read as follows –

"The vaccination service will be transferred back under the remit of Primary Care; details of the new service will be finalised in coming months and the Health Insurance Law will be amended to allow non-staff costs to be met from the Fund."

Currently vaccinations, (with the exception of Covid 19) are administered in Primary Care. This amendment seeks to allow Covid 19 to be administered in Primary Care when the current centralised service at Fort Regent ends.

Whilst there is no doubt that the centralised scheme has been of great advantage to Islanders at the height of the Covid 19 emergency, it is now time to return to business as usual' so that Islanders can receive their vaccine at their General Practice or at their local pharmacy. With Fort Regent no longer being available, it makes sense for Covid 19 vaccines to be available at local surgeries. This will free up qualified nurses currently employed solely in the Covid 19 team, to undertake other vital roles within HCS. It will also mean that nurses working in General Practice can be fully utilised. (General Practices have been encouraged by Government to employ ancillary Staff to undertake such tasks.) All vaccines are currently available to be administered in Primary Care, with the exception of Covid 19. This amendment seeks to consolidate vaccination care, as the previous requirements for specialised very low temperature fridges to store the vaccine is no longer necessary, and Covid 19 vaccines can now be stored in normal clinical fridges.

The HIF is an Insurance Fund, set up for the express purpose of helping Islanders to access Primary Care, to help with the cost of GP Consultations, prescription charges, and dietary requirements for patients with Coeliac disease.[1] It is a universal Insurance Fund, into which every working adult in Jersey contributes 2% Social Security Contributions, for the express purposes set out in the 1967 Health Insurance Law.  

Part 3A of the Health Insurance (Jersey) Law 1974 provides for a range of health services to be funded via contracts from the Health Insurance Fund. At present the Law

allows for contracts for the supply of vaccines. Article 20A extends the existing provision to provide for a definition of vaccination services. The administration of vaccines must be undertaken in line with the current requirements of the Medicines Law.

Taking money out of the HIF Fund for purposes other than described is inconsistent with the Law.

Ultimately, it is not just a pot of money' to be utilised by Health and Community Services for the payment of salaries for HCS and Public Health Staff.

Overall this amendment seeks to remove duplication and redundancy, using the existing vaccine infrastructure and supporting Primary Care.

Financial and staffing implications

There are no financial and/or staff implications arising from this decision, however, the estimated cost of the vaccination services is £2 million per year. This cost is provided for in the Health Insurance Fund estimates set out on page 87 of the Government plan report.