Proposed Government Plan 2024-2027 (P.72/2023): sixth amendment (P.72/2023 Amd.(6) – amendment (P.72/2023 Amd.(6).Amd) – amendment.

STATES OF JERSEY

PROPOSED GOVERNMENT PLAN 2024- 2027 (P.72/2023): SIXTH AMENDMENT (P.72/2023 AMD.(6) – AMENDMENT (P.72/2023 AMD.(6).AMD) – AMENDMENT

MEDICAL HOSIERY AND WOUND DRESSINGS

Lodged au Greffe on 5th December 2023 by Deputy R.S. Kovacs of St. Saviour

STATES GREFFE

2023  P.72 Amd.(6).Amd.Amd.

PROPOSED GOVERNMENT PLAN 2024-2027 (P.72/2023): SIXTH AMENDMENT (P.72/2023 AMD.(6)) – AMENDMENT (P.72/2023 AMD.(6).AMD) – AMENDMENT

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1  PAGE 2, PARAGRAPH 2 –

After the words "except that" substitute the remaining words with the following words –

"under the sub-heading "Health Insurance Fund" on page 87 there should be inserted the words "Additional funding of up to £1 million per year will be allocated to support the provision of hosiery dressings and wound dressings to those with a clinical need. The new scheme will be set up as soon as practicable and will provide products at no cost to the end user." and Table 44 on page 87 updated accordingly, to reflect the increased expenditure forecast."

DEPUTY R.S. KOVACS OF ST. SAVIOUR

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

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 under the sub-heading "Health Insurance Fund" on page 87 there should be inserted the words "Additional funding of up to £1 million per year will be allocated to support the provision of hosiery dressings and wound dressings to those with a clinical need. The new scheme will be set up as soon as practicable and will provide products at no cost to the end user." and Table 44 on page 87 updated accordingly, to reflect the increased expenditure forecast."

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 under the sub-heading "Health Insurance Fund" on page 87 there should be inserted the words "Additional funding of up to £1 million per year will be allocated to support the provision of hosiery dressings and wound dressings to those with a clinical need. The new scheme will be set up as soon as practicable and will provide products at no cost to the end user." and Table 44 on page 87 updated accordingly, to reflect the increased expenditure forecast."

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 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;
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 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;

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 underthe sub-heading "Health Insurance Fund" on page 87 there should beinserted the words "Additional funding of up to £1 million per year will be allocated to support the provision of hosiery dressings and wound dressings to those with a clinical need. The new scheme will be set up as soon as practicable and will provide products at no cost to the end user." and Table44 on page 87 updated accordingly, to reflect the increased expenditure forecast.

REPORT

This amendment seeks to clarify and simplify the approach to provision of medical dressings, subsequent to discussions with the Ministers for Social Security and Health and Social Services. It is appreciated that they have been open to working towards implementation of this scheme and have acknowledged the arguments set out in the report to the initial Amendment.

Further to these discussions they have identified a more straightforward approach, to avoid unnecessary additional primary legislation. The identified approach has been detailed by the relevant Ministers as follows –

"A  more  straightforward  approach  is  to  use  existing  powers  within  the  Health Insurance Law to create a contract with community pharmacies for the supply of dressings to individuals who have been identified as requiring medical dressings and need a product that is available through the new scheme. The full costs of the scheme will then be met by the Health Insurance Fund with all accounting processes undertaken within the Fund itself.

The clinical need for the dressing would be confirmed by an appropriate clinical professional - this would normally be a nurse or doctor working in an appropriate clinical environment. The range of products available through the scheme would be drawn up by experts in this area. The pharmacist would validate and record the request and provide the specified products. Data would be collected through the records within the pharmacies, to allow the scheme to be developed and adapted as needed."

The need for support in this area has existed for some time, and it is appreciated that, working together with Government, this can now be achieved.

Financial and staffing implications

After  discussion  with  the  Customer  and  Local  Services  Department,  they  have suggested that all financial costs associated with the scheme can be met through the Health Insurance Fund within the £1,000,000 estimate.

The Department have further advised that ongoing staffing resources will be required to manage the contract with community pharmacies and to develop the Scheme for implementation in 2024.