Medium Term Financial Plan 2016 – 2019 (P.72/2015): fifteenth amendment (P.72/2015 Amd.(15)) – comments.

STATES OF JERSEY

MEDIUM TERM FINANCIAL PLAN 2016 – 2019 (P.72/2015): FIFTEENTH AMENDMENT (P.72/2015 Amd.(15)) – COMMENTS

Presented to the States on 5th October 2015 by the Council of Ministers

STATES GREFFE

2015   Price code: A  P.72 Amd.(15) Com.

COMMENTS Deputy G.P. Southern of St. Helier proposes –

The Health and Social Services Department's revenue expenditure be increased by £500,000 in 2016 and offset by a transfer from the Health Insurance Fund of an identical amount to increase the Department's revenue income, for improvements in dental services delivered in the Hospital Dental Department.

The Council of Ministers strongly opposes this Amendment and urges States members to oppose it.

Summary of Council of Ministers' Comments

• The  package  of  measures  presented  in  the  MTFP  has  been  proposed  to re-prioritise resources by reducing spending in some areas to invest in other, higher priorities for Health, Education, infrastructure, economic growth and improving productivity.
• Each  department  has  considered  its  priorities  and  submitted  requests  for additional funding alongside a spending review which requires savings and efficiencies across the States.
• The Amendment is premature, simply seeking to direct further public money into the existing central services provided by the Health and Social Services Department. A Dental Action Group' is being established to take forward actions  from  R.91/2015  (Dental  Health  Services  and  Benefits:  Review  – June 2015).
• Funding  requests  emerging  from  the  Dental  Action  Group  (supported  by stakeholder  engagement  and  an  evidenced  business  case)  will  need  to  be considered and prioritised, alongside a wide variety of other health-related work streams.
• A thorough review of funding for health services is underway, and this will include the future role of the Health Insurance Fund. Until such time as this review  is  complete,  it  is  premature  to  consider  any  additional  annual expenditure to be taken from the Health Insurance Fund.

Detailed Comments

The proposition refers to the Dental Health Services and Benefits: Review – June 2015' published as R.91/2015 and presented to the States by the Minister for Social Security. This report included 2 independent studies. The first, a survey of the dental health of 5 year-old schoolchildren, concluded that their dental health was good, exceeding the standards observed in the U.K. The second report reviewed States' spending on dental health and benefits, and was undertaken by independent external experts who conducted open engagement with local health managers, HSSD and community dentists. Their report identifies areas to be addressed to improve services, and offers 3 main themes: Management  Information,  Governance  and  Strategy.  While  States'  spending  on community dental services may be in the region of £1 million, their report concluded that it was not possible to assess whether that spend is sufficient or reaching the people most in need.

The dental health of the children enrolled on the Jersey Dental Fitness Scheme is also good – but in this area, knowledge is also lacking on the unmet need. Funding for the Jersey Dental Fitness Scheme is shared, with HSS funding any treatment needed to accept the child onto the scheme, but Social Security supporting the more significant ongoing cost of children who are already on the scheme. The proposed transfer of funds to the Health Department would not, on its own, allow for any extension to this scheme.

The independent report recommended that efforts are made to direct States' funding to areas of need and that this can be achieved with the development of a needs assessment.

For this reason, P.72/2015 Amd.(15) is premature, simply seeking to direct further public money into the existing central services provided by the Health and Social Services Department (which cover both primary and secondary care). These services have grown up over many years and are not necessarily well targeted. The broader dental system currently has limited understanding of patient requirements, lacks governance and strategic direction.

Progress is being made: A Dental Action Group is being established to take forward actions from the R.91/2015 review. Separately, the Social Security Department is consulting with stakeholders regarding the provision of the 65+ Healthcare scheme, and has already identified options to increase overall funding by £200,000 per annum, which will include additional dental provision for this group, subject to States approval.

The Amendment also fails to consider the impact on the Health Insurance Fund. As has been previously reported, this Fund is no longer receiving sufficient contributions to meet the existing benefits that it provides on an annual basis.

A thorough review of funding for health services is underway, and this will include the future role of the Health Insurance Fund. Until such time as this review is complete, it is premature to consider any additional annual expenditure to be taken from the Health Insurance Fund.

Funding requests emerging from the Dental Action Group (supported by stakeholder engagement and an evidenced business case) will need to be considered and prioritised, alongside a wide variety of other health-related work-streams. Sustainable system improvements will be more valuable to the people of Jersey than a poorly-targeted gesture to fund more of the same.

Process of re-allocation and re-prioritisation in the MTFP

The Deputy is proposing additional funding that has been carefully considered as part of the Department's priorities and a wider spending review and prioritisation process –

• The Council of Ministers has prioritised the proposals in the MTFP on the strategic priorities of the States.
• The  prioritisation  was  carried  out  alongside  an  ongoing  spending  review, supported by external advisers, to identify savings and efficiencies both across the States and within individual department programmes.
• The Council of Ministers conducted a series of workshops, and the prioritisation of available funding has evolved over a period of discussion and several iterations of the proposals before the final allocations were agreed.

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P.72/2015 Amd.(15)Com.

• Each department has prioritised the available funding, and we can't afford to cherry-pick certain savings or growth. We have to make decisions which align with our strategic priorities; this means that every department will be affected and has to contribute to the overall reprioritisation.
• Further work is required to develop the detail for 2017 – 2019, but the Council of Ministers believes that it is presenting a balanced and sustainable package in line with the strategic priorities.
• The  package  of  measures  presented  in  the  MTFP  has  been  proposed  to re-prioritise resources by reducing spending in some areas to invest in other higher priorities for Health, Education, infrastructure, economic growth and improving productivity.

Financial implications

The States' revenue expenditure for 2016 would increase by £500,000, and would be offset by the transfer from the Health Insurance Fund, resulting in an increase in income of an identical amount. The detail would appear in the Health and Social Services revenue income and expenditure.

A thorough review of funding for health services is underway and this will include the future role of the Health Insurance Fund. Until such time as this review is complete, it is premature to consider any additional annual expenditure to be taken from the Health Insurance Fund.

This additional expenditure may result in an increase in staff in the Health and Social Services dental department.