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

STATES OF JERSEY

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

(P.72/2023 AMD.(6)) – AMENDMENT

MEDICAL HOSIERY AND WOUND DRESSINGS FUNDING

Lodged au Greffe on 30th November 2023 by Deputy R.S. Kovacs of St. Saviour

STATES GREFFE

2023  P.72 Amd.(6) Amd.

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

AMENDMENT (P.72/2023 AMD.(6)) – AMENDMENT

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1  PAGE 2, PARAGRAPH 2 –

After the words "with a medical need" insert the words ", such funding to be held in reserve and drawn down quarterly as need is identified by the scheme;".

2  PAGE 2, PARAGRAPH 2 –

After paragraph 2 insert a new paragraph as follows –

"PAGE 2, PARAGRAPH (l) –

After the words "Appendix 3 to the Report" insert the words –

", except that, on page 21, after the paragraph entitled "Assurance on the quality and safety of HCS care" there should be inserted the following new paragraph –

"Wound care provision. During 2024 the Government will fund an extension of the existing hosiery dressing scheme and as part of that scheme, review the provision of wound dressing and medical hosiery to those with a medical need. Work will be undertaken to ensure, as soon as practicable in 2024 and whilst ensuring continuity of provision, such individuals will be supplied through a scheme similar to the diabetes ancillary scheme available through pharmacies, or through another route of provision, provided that there is no cost to the end user."

DEPUTY R.S. KOVACS OF ST. SAVIOUR

Note:  After this amendment, the amendment would read as follows – 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, such funding to be held in reserve and drawn down quarterly as need is identified by the scheme".

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, such funding to be held in reserve and drawn down quarterly as need is identified by the scheme".

3 PAGE 2, PARAGRAPH (l) –

After the words "Appendix 3 to the Report" insert the words –

", except that, on page 21, after the paragraph entitled "Assurance on the quality and safety of HCS care" there should be inserted the following new paragraph –

"Wound care provision. During 2024 the Government will fund an extension of the existing hosiery dressing scheme and as part of that scheme, review the provision of wound dressing and medical hosiery to those with a medical need. Work will be undertaken to ensure, as soon as practicable in 2024 and whilst ensuring continuity of provision, such individuals will be supplied through a scheme similar to the diabetes scheme available through pharmacies, or through another route of provision, provided that there is no cost to the end user."

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 inSummary Table 3 to include a transfer of £1,000,000 from the HealthInsurance Fund to the Consolidated Fund to allocate funds to support theextension of the hosiery dressings scheme and to expand it further to makeprovision for supplies of wound dressings to those with a medical need, such funding to be held in reserve and drawn down quarterly as need isidentified by the scheme;
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 Community Services should be increased by £1,000,000 toallocate funds to support the extension of the hosiery dressings scheme andto expand it further to make provision for supplies of wound dressings to those with a medical need, such funding to be held in reserve and drawn down quarterly as need is identified by the scheme;
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 21, after the paragraph entitled "Assurance on the quality and safety of HCScare" there should be inserted the following new paragraph –

"Wound  care  provision.  During  2024  the  Government  will  fund  an extension of the existing hosiery dressing scheme and as part of that scheme, review the provision of wound dressing and medical hosiery to those with a medical need. Work will be undertaken to ensure, as soon as practicable  in  2024  and  whilst  ensuring  continuity  of  provision,  such individuals will be supplied through a scheme similar to the diabetes scheme  available  through  pharmacies,  or  through  another  route  of provision, provided that there is no cost to the end user."

REPORT

This amendment to amendment (6) is intended to support the original document, by providing controls over the cash allocated and include planning for subsequent years.

Part 1 is added to ensure that the scheme is monitored and the funding allocated appropriately. Because this scheme has not been available on such a scale before, the funding request is, of necessity, calculated based upon available data of those who have indicated need. By ring fencing the funds to be drawn down quarterly there is an additional control in place over the spend.

Part 2 inserts wording committing the Government to implementing a scheme during the year to support those in need of medical hosiery and wound dressings. Whilst the wording suggest that this is undertaken in a similar way to the supply of diabetes products, the final decision is left to the Minister and the department. This is to ensure that the best, and most appropriate, scheme is put in place to support those who are currently paying out hundreds of pounds monthly on dressings.

Financial and staffing implications

There will be a small amount of additional staff time taken if the funding is drawn down in tranches.

Designing and implementing the scheme to support these individuals in the future will have some staff time implications and corresponding costs. It is considered that these costs would be substantially reduced if it is decided to replicate the existing process for diabetes products. Ultimately it is considered that the cost will be offset by the benefit of the preventative scheme in reduction of acute care.