Proposed Government Plan 2024-2027 (P.72/2023): sixth amendment. (P.72/2023 Amd.(6)). Medical Hosiery and wound dressing funding.

STATES OF JERSEY

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

MEDICAL HOSIERY AND WOUND

DRESSINGS FUNDING

Lodged au Greffe on 20th November 2023 by Deputy R.S. Kovacs of St. Saviour

STATES GREFFE

2023  P.72 Amd.(6)

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

____________

1  PAGE 2, PARAGRAPH (e) –

After the words "Appendix 2 – Summary Table 3 in line with Article 9(2)(b) of the Law" insert the words –

 ", except that a new line should be inserted in Summary Table 3 to include a transfer of £1,000,000 from the Health Insurance Fund to the Consolidated Fund to allocate funds to support the extension of the hosiery dressings scheme and to expand it further to make provision for supplies of wound dressings to those with a medical need"

2  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) the Head of Expenditure for Health and Community Services should be increased by £1,000,000 to allocate funds to support the extension of the hosiery dressings scheme and to expand it further to make provision for supplies of wound dressings to those with a medical need;"

DEPUTY R.S. KOVACS OF ST. SAVIOUR

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, except that a new line should be inserted in Summary Table3 to include a transfer of £1,000,000 from the Health Insurance Fund to the Consolidated Fund to allocate funds to support the extension of the hosiery dressings scheme and to expand it further to make provision for supplies of wound dressings to those with a medical need;
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) the Head of Expenditure for Health and CommunityServices should be increased by £1,000,000 to allocate funds to support theextension of the hosiery dressings scheme and to expand it further to make provision for supplies of wound dressings to those with a medical need;
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.

REPORT

Summary

If this amendment is adopted, funds will be allocated to Family Nursing and Home Care (FNHC) for the medical service and supply of medical hosiery and wound dressings for their patients needing it.

By managing effectively, with prompt intervention, these patients with wounds or a chronic legs health condition, is of benefit to not just the individual but the Island as a whole. Having the cost barrier removed, most of these wounds and leg conditions, could be managed immediately at the point of need, with the appropriate products, reducing the risk of complications, speeding healing, and at socioeconomic level, not draining further on the already stretched health resources.

Background

Medical Hosiery pilot scheme through Family Nursing and Homecare (FNHC)1

Since 2020 FNHC has been running a pilot medical hosiery scheme with government funding of £40,000 per annum. Under the pilot, FNHC has been providing medical hosiery (stockings and wrap systems) as appropriate for all patients treated by FNHC for venous insufficiency leg ulcers. The aim was to provide patients with the most appropriate products in a timely fashion without the additional worry of the cost with the aim of increasing their independence and improving their quality of life.

Improving access to treatment for patients who might previously have refused treatment on grounds of cost and ensuring the provision of early preventative treatment would be expected to improve outcomes and reduce the need for hospitalisation or readmission to the service.

FHNC reports that in 2020 and 2021 the full amount of annual funds available was not utilised mainly due to the impact of the pandemic.

During 2022, the uptake of provision under the pilot scheme increased as the processes were embedded in FNHC's practice. The number of patients receiving funded hosiery or dressings from the service for the first time increased and so too did the provision of replacement hosiery and dressings. The provision has continued to increase in 2023, with Q1 2023 seeing a 60% increase in products supplied compared to 2022 and almost £26,000 of the £40,000 used within the first quarter of the year, this supplying only the basic necessities, but more would have been required for optimal treatment.

Health and Social Security Scrutiny Panel recommendation

In its Comments (p.97-2022 com.2 pdf) on the 2023-2026 Government Plan the Health and Social Security Scrutiny Panel queried the lack of funding for expanding the original pilot scheme and for the provision of free medical dressings in general with the both the Minister for Health and Social Services and the Minister for Social Security.

That Scrutiny report carries on saying:

"it was evident from the Public Hearings that both Ministers supported the future provision of free medical dressings for all patients. The Ministers also committed to taking the necessary steps to ensure funding was available in the future to cover this provision.

1 Information within the report provided by FNHC is correct as at November 2023 and is based upon their research to date.

The Minister for Social Security: It is something we are aware of and that it will need consideration and possibly a growth bid or a funding bid to get more money.

The Minister for Health and Social Services: One of the things that I have said is that I will bring this forward with the Minister for Social Security because it is again this anomaly about where the money comes from. This is part of the sustainable health funding model that we want to address.

The Assistant Minister for both Health and Social Services and for Social Security also added: Dressings should not have been seen as a separate clinical issue but should be completely intertwined with the whole view. So, if there is a way that we can made those dressings more accessible, and the money can be found then that is something we need to move forward on."

The mentioned Scrutiny panel's review made a recommendation that Minister for Health  and  Social  Services  and  the  Minister  for  Social  Security  must  work collaboratively to identify funding in Q1 in 2023 for the provision of free medical dressings to all patients.

The Social Security Minister's response to my WQ.417-2023.pdf (gov.je) indicates that this did not happen.

Conclusion

On a project started by the FNHC on revising lower limb wounds pathways, ongoing since March 2023, it shows "it has been recognised by clinicians working across multiple services that there is suboptimal treatment for lower limb wounds in Jersey, resulting in poorer patient outcomes increased costs and drain on nursing time. Locally, clinicians working in the area of lower leg wounds have highlighted the desperate need to review the pathway of care for lower limb wounds and the resources supporting it to enhance care, outcomes and better use of staff."

I believe this is an identified proven community health requirement that should be met from the HIF and passed to HCS for implementation under an extended Service Level Agreement with FNHC.

Improving the pathway and funding available will enable appropriate onward referrals, and the use of the right medical materials for the care for those patients with lower limb wounds, which will –

• optimise healing rates

• speed the healing process

• enable access to early treatment, not conditioned by cost

• manage more people preventatively when they present with early signs of venous disease, skin changes, early oedema etc. and reduce the incidence of leg ulceration occurring

• improve long term management of these conditions

• reduce the likelihood of recurrence and complications

• free up of nurse time and the reallocation of nursing resources,

• reduce unnecessary emergency hospital admissions

• enable more of the population of working age to stay in work.

Financial and staffing implications

In line with FHNC's cost estimates below, additional funding required for 2024 and the following years to meet the anticipated demand for medical hosiery following on from the pilot scheme and for the ongoing related demand for wound dressings, is:

Therefore, this proposal is asking for funding on the rounded figure of £1,000,000 per year to be made available ongoing from HIF, for such related provisions as presented in the report, and the related regulations to be put in place for such transfer to happen.