Development of Fostering and Adoption Services in Jersey (P.219-2005) comments

STATES OF JERSEY

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DEVELOPMENT OF FOSTERING AND ADOPTION SERVICES IN JERSEY (P.219/2005): COMMENTS

Presented to the States on 1st November 2005 by the Health and Social Services Committee

STATES GREFFE

COMMENTS

The proposition, originally in the name of Senator Shenton, but now in the name of Senator Le Claire, seeks to make available to the Health and Social Services Committee a total sum of £870,000 of new funds additional to the existing budget of Health and Social Services for the dedicated purpose of developing fostering and adoption services in Jersey. The case for investment in this area is well made in the Report accompanying P.219/2005 and need not be repeated here. These comments therefore focus upon the budgetary issues.

The total sum of £870,000 is proposed to be split over a 3-year period with £390,000 being made available next year, £330,000 in 2007 and £150,000 in 2008. These figures are drawn from the business plan prepared by officers of the Social Services Department for the modernisation of fostering and adoption arrangements in Jersey, and were supplied to Senator Shenton at his request.

The decision for the States is whether this area of investment merits additional funding above that already allocated in the budgetary processes of the States. The Health and Social Services organisation undertakes an internal decision conferencing' programme during which extremely difficult decisions are made as to which of the very many areas of growing demand and competing activity should receive additional moneys from the total Health and Social Services budget, which in itself is limited by wider budgetary pressures. Funding for the first year of the fostering and adoption service investment programme has been allocated from within the existing budget of Health and Social Services. However, to make available this sum of £390,000, a range of other areas of need within Health and Social Services failed to secure funding. Amongst these are –

• D ru g s: general and new drugs mostly associated with increased activity in theatres – £70,000;

• T r a u ma and Orthopaedic consumables in theatre: e.g., hip and knee prosthetics cost circa £2,000 per patient – £120,000;

• N e w junior doctors' structure: replaces SHOs and HOs. Increased requirement due to working time directive and Employment Law – £240,000;

• H ea r ing Aid Services: enhance service and replace analogue with digital hearing aids – £62,000;

• M e d ical Supplies: general increase in medical supplies related to increased activity. Reduction in waiting lists and sustained shorter waiting times – £93,000;

• R a d i ographer: additional radiographer to cope with additional levels of activity – £50,000;

• O rt h opaedic Surgical staffing and secretary: development in orthopaedic services to remove one in 2 on-call rota – £150,000;

• O b st etrics and Gynaecology staff grade doctor to cope with working time directive – £60,000;

• B o w el cancer referrals to the UK – £90,000;

• V is it ing Consultant Psychiatrist to assist people with learning difficulties – £20,000;

• C h i l d and Adult Mental Health Service: development of more on-island placements – £160,000;

• C a r d iologist and possible Catheter laboratory development: Consultant and possible development of catheterisation – at least £100,000, but cost likely to be circa £500,000 if cardiology review recommends catheterisation on-Island;

• S e x ual Health Research: health intelligence work to investigate HIV, HEP C, HEP B etc.– £15,000;

• S u i c ide Prevention Strategy – £22,000.

Were the States to decide that an additional amount of £390,000 was to be made available in 2006 for the specific purpose of funding fostering and adoption services, the existing sum in the Health and Social Services budget would be re-allocated to some of the areas of need, described above, which did not secure funding for 2006.

The satisfactory development of fostering and adoption services requires investment for the full 3  years identified in the proposition. However, no decision has yet been made as to the internal allocations of the overall budget of Health and Social Services for the years 2007 and 2008. The Children's Department is bidding for the sums of £330,000 in 2007 and £150,000 in 2008. These bids will have to compete alongside all of the areas of need already described above, which, having failed to secure funding next year, will be carried over to 2007. There is no guarantee that the funding for adoption and fostering services for 2007 and 2008 will be able to be made available from within the existing budget in competition with clinical and other needs.

In addition to the unfunded needs described above, an additional range of needs have been identified as arising in the years 2007 and 2008. For the year 2007, these include –

• A m b ulance Service, 2 additional FTE ambulance personnel ;

• A m b ulance Service, new Training Officer;

• A d u lt Social Work – for the visually impaired;

• A d u lt Social Work – for the prison;

• A d u lt social Work – for vulnerable adults;

• N ew Day Surgery Unit – revenue consequences;

• A cc i dent and Emergency redevelopment – revenue consequences;

• S p e c ial U.K. placements – special needs;

• R e c i procal Health Agreement with UK – deficit gap;

• C o n t ract Beds for the elderly.

These are just some of the competing investment areas for the year 2007. Some of these bids will not be successful and will be carried over into the year 2008. That year already has a number of further costs identified as likely demand areas, some of which will be a recurrence or growth of the above items and some of which will be entirely new costs.

Against this background Health and Social Services will also be striving to improve services, invest in new clinical techniques and drugs, should they become available, and possibly have to deal with contingencies, such as medical emergencies which would arise in the event of the outbreak of serious illnesses. The further development of fostering and adoption services in 2007 and 2008 will be competing against this range of other cost pressures.

The sums of money sought by the proposition are significant, and, it must be stated, are being proposed outside of the present budget allocation framework. Weighed against this, the Assembly needs to decide whether guaranteeing the 3-year investment in fostering and adoption services – and the consequent reduction in pressure on other areas of Health and Social Services activity – merits special consideration.