States Meeting Transcript - 03/11/2010

STATES OF JERSEY OFFICIAL REPORT

WEDNESDAY, 3rd NOVEMBER 2010

PUBLIC BUSINESS - resumption................................................................4

1. Draft Health Insurance Fund (Miscellaneous Provisions) (Jersey) Law 201- (P.125/2010) - resumption................................................................4

1. Deputy P.V.F. Le Claire of St. Helier : ...................................................4

1. Connétable A.S. Crowcroft of St. Helier:................................................5
2. Senator P.F. Routier: ....................................................................6
3. Deputy R.C. Duhamel of St. Saviour:....................................................7
4. Senator F. du H. Le Gresley:.............................................................8
5. Deputy A.T. Dupre of St. Clement:.....................................................10
6. Deputy A.K.F. Green of St. Helier:.....................................................11
7. Connétable J.M. Refault of St. Peter:...................................................11
8. Connétable S.A. Yates of St. Martin:...................................................12
9. The Deputy of St. Mary:................................................................12
10. Senator B.I. Le Marquand:..........................................................13
11. Senator T.A. Le Sueur:..............................................................14
12. Deputy M. Tadier of St. Brelade:....................................................14
13. The Very Reverend R.F. Key, B.A., The Dean of Jersey: ............................16
14. Deputy R.G. Le Hérissier of St. Saviour:............................................17 Deputy P.V.F. Le Claire: .....................................................................19 Deputy G.P. Southern of St. Helier:..........................................................19 Deputy C.H. Egré of St. Peter:................................................................20 Deputy I.J. Gorst of St. Clement:.............................................................21 Deputy J.A. Martin of St. Helier:.............................................................21 Mr. H. Sharp, H.M. Solicitor General: ........................................................21

2. Draft Health Insurance Fund (Miscellaneous Provisions) (Jersey) Law 201- proposed referral to Scrutiny under S.O. 79(1) by Deputy Le Claire............................21

1. Deputy P.V.F. Le Claire: ...............................................................22 The Solicitor General:........................................................................23
2. Deputy G.P. Southern :..................................................................24
3. Deputy I.J. Gorst : ......................................................................24
4. Connétable D.J. Murphy of Grouville :..................................................26
5. The Deputy of Trinity :..................................................................26
6. Deputy A.E. Jeune of St. Brelade:......................................................26
7. Deputy P.J. Rondel of St. John : ........................................................28
8. Senator B.E. Shenton:..................................................................28
9. Senator A. Breckon: ....................................................................28
10. Senator T.A. Le Sueur:..............................................................29
11. Deputy M. Tadier :...................................................................29
12. Deputy M.R. Higgins of St. Helier:..................................................30
13. Deputy T.M. Pitman of St. Helier:...................................................30
14. Deputy P.V.F. Le Claire:............................................................30

3. Draft Health Insurance Fund (Miscellaneous Provisions) (Jersey) Law 201- (P.125/2010) - resumption...............................................................32

1. The Connétable of Grouville :...........................................................32
2. Deputy M.R.Higgins:..................................................................33
3. Deputy I.J. Gorst : ......................................................................33 Deputy G.P. Southern (Chairman, Health, Social Security and Housing Scrutiny Panel):.....38

2. Reg's Skips Limited - Planning Applications (R.118/2010): compensation and further action (P.130/2010)......................................................................38

1. Senator B.E. Shenton:..................................................................39

2. Reg's Skips Limited – Planning Applications (R.118/2010): compensation and further action (P.130/2010) – third amendment (P.130/2010 Amd.(3)).........................41

1. Senator F.E. Cohen (The Minister for Planning and Environment):.....................41
2. Senator F. du H. Le Gresley:............................................................42
3. The Deputy of St. Mary:................................................................42 The Solicitor General:........................................................................42

LUNCHEON ADJOURNMENT PROPOSED..................................................43 LUNCHEON ADJOURNMENT................................................................43

3. Reg's Skips Limited – Planning Applications (R.118/2010): compensation and further action (P.130/2010) – fifth amendment (P.130/2010 Amd.(5))..........................44

1. The Deputy of St. John:................................................................44
2. Deputy F.J. Hill of St. Martin : ..........................................................45
3. Deputy P.V.F. Le Claire: ...............................................................45
4. Connétable M.K. Jackson of St. Brelade:...............................................45
5. Senator T.A. Le Sueur:.................................................................46
6. Deputy T.M.Pitman:...................................................................46
7. The Deputy of St. Mary:................................................................46
8. Senator B.E. Shenton:..................................................................47
9. Senator B.I. Le Marquand:..............................................................47
10. Senator F.E. Cohen: .................................................................48
11. The Deputy of St. John:..............................................................49 Senator B.I. Le Marquand:....................................................................50 The Deputy of St. John:......................................................................51

4. Reg's Skips Limited – Planning Applications (R.118/2010): compensation and further action (P.130/2010) – fourth amendment (130/2010 Amd.(4))..........................52

1. Senator F. du H. Le Gresley:............................................................52 The Solicitor General:........................................................................54
2. The Deputy of St. Mary:................................................................55
3. Senator F.E. Cohen:....................................................................56
4. Deputy P.V.F. Le Claire: ...............................................................56
5. Deputy J.M. Maçon of St. Saviour:.....................................................56
6. Senator T.J. Le Main: ..................................................................56
7. Deputy M.R.Higgins:..................................................................57
8. Deputy T.M.Pitman:...................................................................58
9. Senator J.L. Perchard:..................................................................59 The Deputy of St. Mary:......................................................................59 The Solicitor General:........................................................................59
10. Senator B.E. Shenton: ...............................................................59

11. Deputy J.B. Fox of St. Helier : .......................................................60
12. The Deputy of St. Martin : ...........................................................60
13. Senator T.A. Le Sueur:..............................................................61 The Solicitor General:........................................................................62
14. The Deputy of St. John:..............................................................62
15. Senator F. du H. Le Gresley:........................................................63

5. Reg's Skips Limited – Planning Applications (R.118/2010): compensation and further action (P.130/2010) - as amended........................................................65

1. Senator F.E. Cohen:....................................................................65
2. Deputy P.V.F. Le Claire: ...............................................................66
3. Deputy A.E. Jeune :.....................................................................67
4. Senator T.J. Le Main: ..................................................................67
5. Senator J.L. Perchard:..................................................................68
6. The Deputy of Trinity :..................................................................68
7. The Connétable of St. Peter:............................................................69
8. The Deputy of St. John:................................................................69
9. Deputy J.M. Maçon:....................................................................69
10. Deputy R.G. Le Hérissier:...........................................................69
11. The Deputy of St. Mary:.............................................................70
12. The Deputy of St. Martin : ...........................................................71
13. The Connétable of St. Brelade:......................................................71
14. Deputy I.J. Gorst :....................................................................72
15. Senator T.A. Le Sueur:..............................................................72
16. The Connétable of St. Helier:........................................................73
17. Deputy T.M.Pitman:................................................................73
18. Senator B.E. Shenton: ...............................................................73

3. Minister for Planning and Environment: powers (P.132/2010)........................77

3.1 Deputy R.G. Le Hérissier: ..............................................................78

1. Senator F.E. Cohen:....................................................................79
2. Senator B.E. Shenton:..................................................................80
3. Senator A.J.H. Maclean:................................................................80
4. Deputy A.E. Jeune :.....................................................................80
5. The Deputy of St. John:................................................................81
6. Deputy J.A. Martin:....................................................................82
7. Senator A. Breckon: ....................................................................82
8. Deputy T.M.Pitman:...................................................................83
9. Senator P.F.C. Ozouf :..................................................................83

ADJOURNMENT................................................................................83

The Roll was called and the Dean led the Assembly in Prayer.

[09:30]

PUBLIC BUSINESS - resumption

1. Draft Health Insurance Fund (Miscellaneous Provisions) (Jersey) Law 201- (P.125/2010)

- resumption

The Deputy Bailiff :

The debate now resumes on P.125, the Draft Health Insurance Fund (Miscellaneous Provisions) (Jersey) Law 201- and I call upon Deputy Le Claire.

1. Deputy P.V.F. Le Claire of St. Helier : Thank you, Sir, I think.

The Deputy Bailiff :

You indicated yesterday you wanted to speak. Deputy P.V.F. Le Claire:

I did, Sir, I had no idea I would be the first to go. So I will dispense with all the briefing papers I was about to collect and practice from my art of busking. [Laughter] Business as usual. It was interesting to listen to the debate yesterday and many of them seemed to dwell upon the fact that we were shirking away from touching ring-fenced funds. While I can appreciate that there can be concern in that regard, I cannot go along with supporting a notion that we are doing the best thing by shooting ourselves in the right foot rather than the left foot. We need, in my view, to support this today because it is an investment, and if we are to save money from the social security fund being squandered on people's ill health in the future we need to invest in primary care. I am afraid for too long now the States has managed itself and the affairs of Jersey as an accountant would, balancing the budget, without any desire to invest to save. While Deputy Southern who may pull this has an identified new method of funding social security and has reservations about how social security funding is spent and is cautioning us not to support this today, I would say it is absolutely the wrong thing to do back away from supporting this. Not only is a States decision that has already been taken but we have to reflect upon the fact that most recently Senator Ferguson and I asked questions of the Minister for Health and Social Services in relation to waiting periods in hospitals in Jersey. Although those in themselves are nothing new what was quite enlightening was the fact that Jersey's system of a 28-week waiting time did not mirror that of the U.K.'s (United Kingdom) 18-week pen to knife waiting time because of the lack of investment over the years that Jersey has made in comparison to that of the United Kingdom. Then one has to ask oneself, are we not lauding ourselves as a prime place to come and do business for the finance industry. Do the finance industry executives and their families not feel the need to have proper provision of healthcare in Jersey and are we giving them that, because at the moment the U.K. is what we are benchmarking upon and we are light years away from producing results that they are achieving now, especially with moves in the future and, most recently, with patient led care. We look at the World Health Organisation, the last time I looked .. and I was going to go down and collect my notes to give Members and updated version but in 2003 I believe the United Kingdom was 17th in the World Health Organisation league tables. Below that of Jamaica and below that Cuba. Cuba in itself may not be that surprising because Cuba does, as a measure of G.D.P. (Gross Domestic Product) invest significantly in doctors' education and its healthcare system is one to be admired. It is a decision that is made on social grounds in relation to what it provides its people as to what it gives in terms of dedication to the health service. I am sorry to say that we do not give as equal measure to the health service in Jersey as we do to the finance industry, and we should. For years now, 10 years, I have been involved with health and I have been on the back benches supporting health, and I have been in arguments with the Ministers for Treasury and Resources and the

Council of Ministers and the Presidents of Policy and Resources Committees - and Senator Le Main will back me up on this - we have had to come time and time again to the States for more money to make sure that health comes in on budget otherwise we will be breaking the Finance Law. Senator Le Main himself, a long-serving member of the Health Committee knows full well that more money is needed in health. I know he has made a very strong speech yesterday to say that we should not be doing this, and he called it the thick edge of wedge. I do not know how to take that. I would say it is not a very sensible approach to oppose this; thick is the comparison I would give. I would say if we do not get behind investing now in primary healthcare and supporting this proposition, we are just opening ourselves up for more money spent in chasing the problems that are going to develop in later years with a growing demographic elderly population. So I ask Members to really put aside their concerns about the social security fund. It is in the best position it has been in for years and that is congratulations to the Minister for Social Security. It has got a surplus now that can manage all pensions within the Island, in its latest report, for 5 years. We have got 5 years of secure pensions available. We are moving through a transitional period where we are trying to buffer the effects of a global downturn, we are trying realign ourselves through comprehensive spending reviews and fundamental spending reviews and the Council of Ministers, led by people such as Senator Maclean, are forming boards, as will the Minister for Housing through Deputy Power, to make sure best value for money is driven into these departments. I would say, and I am going to say it again, I have said it before, Health and Social Security in the future should be one. So these arguments about where the money is going within those 2 organisations should not even be coming to this floor in those terms because this is money that people have paid for their health. People have paid this money and I find it ironic and absolutely nonsensical that the Minister for Health and Social Services is sitting there with a begging bowl while the Minister for Social Security has his pockets overflowing with cash. £6

million he is willing to give to the cause and I would say to any Member in the States Assembly, if they go out to the public today and ask them if they would rather have the States of Jersey manage their money or deliver a healthcare system that they can rely upon, I know which answer they are going to get.

Deputy A.E. Pryke of Trinity :

Excuse me, Sir. Members would have received on their desks a letter from the primary care body of Jersey. This came to me last night and I have asked for it to be circulated.

1. Connétable A.S. Crowcroft of St. Helier :

It is quite hard to follow Deputy Le Claire. For an unprepared speech I thought he did extremely well. Perhaps he should not prepare them more in the future. [Laughter] I rise to both compliment Senator Le Main on a very spirited speech which closed yesterday's session and certainly gave a lot of food for thought, but to challenge him on his aspersions - more than aspersions, his criticism - of the family nursing professionals out there in the community. I am sure he did not mean to but I think the effect of his speech would be extremely demotivating for the morale of all of those people out in the community for family nursing. [Approbation]

Senator T.J. Le Main:

I would like a point of order, because I think it is important, what I did say was that I believe that Family Nursing are providing services that quite honestly go far beyond what should be done. That is all it was. I have never criticised the organisation or the staff. In fact I am a great supporter and a member of the association.

The Deputy Bailiff :

It is not a point of order but it is clarification. The Connétable of St. Helier :

I thank the Senator for his clarification. I did say that I am sure he did not mean to say anything that would be demotivating but certainly I was not the only Member who was concerned about those remarks. As a parish that relies heavily on the work of Family Nursing and Home Care in St. Helier I wanted to make sure that there was no doubt about our support for the work they do. Indeed there is an argument that Family Nursing should be doing more of the kind of work that Health are doing. I noticed on the table in the appendix that childhood immunisations has nearly 5 full-time staff from Health but I know that Family Nursing have always, in my book, been at the front line of immunisation and that sort of service in the community. Also, of course, Deputy Fox's speech about the diabetic situation I thought was extremely compelling and I think that challenges those who are concerned about the principle here of transferring money from one pot to the other.

[09:45]

Of course things do need looking at. No one is going to stand up and say that there are not efficiency savings to be made. I cannot believe we have 5 full time staff actively involved in smoking cessation. I hope they are not all involved in putting up anti-smoking notices but are dealing with people who genuinely want to quit, and providing that kind of support. I am sure I will be told it is much better to catch people at this stage than after they have developed lung cancer. Having said all that, I think Deputy Le Claire made the key point that this is public money we are talking about and to see this used for primary healthcare services makes sense. It does not make sense to leave it in a different department. This is silo mentality which we are supposed to be getting away from. Having said that, if Scrutiny are going to call this in, Scrutiny has an important role to play and I will certainly be supporting that.

2. Senator P.F. Routier:

When I first looked at this proposition my immediate reaction was fairly similar to a number of members who have spoken and expressed their concern about using the Health Insurance Fund in the way that is being proposed. Then I reminded myself exactly what the fund was established to do. The Government Actuary, when he reviewed the fund, supported the original committee decision that a fund should have 12 months worth of funds to act as a buffer against any annual variations in the cost of providing the primary care support. Some Members have spoken about the fund in the terms as if it was a pension fund, it is supposed to pay out in years to come but it was never designed to do that. It was designed in a way as a pay as you go system to help to pay for primary care. But also it was recommended that there should be 12 months worth of funds as a buffer above the annual running costs. So over the years the income to the fund has outstripped the expenditure and has built up an amount of £80 million in the fund. So when you compare the £80 million to the actual annual expenditure we quite clearly see that the existing buffer fund works out at 2 and a half years of fund as opposed to what the fund was designed to do, that is to have one year's expenditure, which was endorsed by the Government Actuary. When I looked at the forecast for the income and expenditure for this year of the fund it continues to show a growing fund. So the forecast income for this year is £29.1 million of income and the expenditure is less than that at £25.2 million. So that leaves another £3.9 million to be added to the fund yet again this year. This money belongs to the public to be used for their health costs and I would respectfully suggest to Members that we do not have the moral right to be able to be withholding it from them, especially when the fund is mounting up and it is exceeding the designed financial buffer amount by one and a half years. I ask Members to recognise that this fund is not like a pension fund to save money for

the future, it is a pay as you go fund but it has built up funds which do belong to the public. I understand that the Scrutiny Panel would like to progress a system which would bring in one of the other components which are permitted by the legislation, and that is dental care. When I was Minister I looked very carefully at introducing this at the time and it was proving to be very expensive to include this in the scheme and would have required an increase in contributions for it to have been funded effectively. Fortunately there are other schemes in place which helped with dental healthcare, some provided by the Health Department themselves and the dental clinic for

children and for those with disabilities. There is also the children's dental insurance scheme which is run by Social Security, and of course we introduced the over-65 scheme, which provides financial support for dental and optical needs for the elderly. So as we stand today there is support for dental care for the most vulnerable in our community with these schemes and, of course, income support also covers the cost of dental care for those in need. I mention this because there may be a view that the health funds could be diverted to dental care as opposed to supporting this proposition. There may be a case for introducing a new dental component within the Health Insurance Fund but I believe it would require an increase in contributions to the existing scheme. Supporting this proposition is the most appropriate way to make healthcare better for our Island. I will just pick up on a point that was raised by the Assistant Minister for Health and Social Services, Deputy Martin, regarding the increase in prescription numbers and her interpretation of the figures. I am afraid the conclusion that she reached that the number of prescriptions increased because they became free when I increased the average subsidy from approximately £9 for every prescription to the £11 average it is now, is a long way from being correct. The real reason for the increase in prescriptions being charged to the fund was because the Health Department negotiated that nearly 450 new drugs were put on to the list, which many were only previously available through the hospital. So that has increased the number of prescriptions, and quite rightly because those things need to be put into the public list. This increased the number of prescriptions and also the costs to the Health Insurance Fund considerably. This decision was made with our eyes wide open and it was absolutely no surprise that the number of prescriptions being charged to the fund increased in the way that they have. The decision was something that could be well afforded from within the fund and that is proving to be the case because the fund is still increasing. I was interested yesterday in Senator Le Main's comments about Family Nursing and Home Care and his view that the organisation had been growing and doing things that were generally outside of their remit. He obviously has great knowledge of the organisation because of his association over the years, however I would respectfully point out that even if there has been some creeping service over the years I would suggest that the core services that they do provide are very valuable and that with our ageing society the services of the Family Nursing and Home Care will be increasing even further. That is right and proper, and they will need our support not only verbally but financially as well. We are being asked today to agree that the health fund should be used to fund health matters. We need to ask ourselves what are we here for. I believe we are here to serve our constituents, whether they be in St. Brelade or any part of the Island. We are not here to block our constituents getting the health care that they desperately need. While I can see why Members are uncomfortable with the way Health are showing that they would use the funds, I can see that there are significant benefits to our community. Those health service benefits are in some jurisdictions ordinarily provided in the community by G.P.s (general practitioners). If Members want to see a modern primary care service which is safe and appropriate and is monitored correctly then we should support this proposition. If Members would like to have the opportunity to see a practice nurse for basic healthcare in the community then we should support this proposition. If we want to see continued support for diabetics then we should support this proposition. This is a great opportunity for Members to show their support for our health service which I think most recognise requires a significant uplift. At this time I do not believe that our constituents will thank us for sitting on the funds which are supposed to be used for healthcare. There are sufficient funds to pay for the 2

years that are being proposed and I urge Members to support the proposition.

3. Deputy R.C. Duhamel of St. Saviour :

Robbing Peter to pay Paul. Short-termism. That is probably about it. I am not really happy with this proposition. Why do we have a Treasury Department, why do we have a Minister for Treasury and Resources, why do we organise our finances? [Interruption]  That is a popular note, why indeed? Perhaps somebody can bring a proposition to remove him. He has removed himself anyway, he is not here this morning. Why do we have a Treasury Department, why do we organise our finances centrally? It is to bring long-term, sensible financial planning to the whole of the

organisation. So what we have got here? We have embarked with an enormous amount of upset, goodwill and work undertaken by our Civil Service Department for a comprehensive spending review which attempted, because I do not think it has got there as yet, to curtail the finances or curtail the spending of the larger spending committees. So what are we doing? Have we delivered that? No. Health and Social Services Department are still going to be growing in terms of the monies that they are spending and it might well be right that we want a health service that continues to be properly funded and to expand. We have not had that debate. It is here hidden in this report on page 5. Page 5 says: "It is considered to be reasonable in the circumstances to allow funds to be released from existing H.S.S.D. (Health and Social Services Department) budgets to meet the cost of essential growth in H.S.S.D. funded areas as set out in the 2011 Business Plan." So the release of this £6.131 million to the Health and Social Services Department by the Social Security Department is to pay for growth. But we have not had the debate and that is wrong. I do not like organisations or procedures which ostensibly are set up to do one thing and then we find ways to circumvent it and get around and do something entirely different. We had brought to this Assembly on a previous occasion monies to be raised by putting extra monies on alcohol to pay for health benefits in terms of cessation of smoking. That is daft. All right, if we think it is worthwhile spending money in that particular area it should have been funded by the Treasury and by the Minister for Treasury and Resources. In this respect, exactly the same thing should happen. What have we heard from the Deputy of St. Clement, he is suggesting that he is not going to be providing a funding stream for ever and a day, which is what is being called for, he is only going to put up monies for 2 years. Then what? So we are going to have to come back to this Assembly in 2 years' time, hopefully with a new set of Members who can read between the lines and do the jobs that this Assembly sets for us properly, to sort out once and for all whether or not we want to increase the monies into the Health and Social Services Department or we want to keep them the same or we want to cut them back, like everybody else. I do not know what the outcome of those debates will be but certainly this is no way to proceed at the moment. It is short-termism at its worst and it is what this House appears to do best. We clutch at straws, we come up with monies, we do not do ourselves any justice in adding value, which is really what this Assembly is for, to the decision that are going to be made in order to get the best out of them. I am not saying that I would begrudge the monies or would not want to spend any more monies on primary healthcare, indeed we had the work that was undertaken to look at primary healthcare and we did not fund it. We did not fund it so we parked all the work that was undertaken to come up with a new direction for the health service on the shelf because people could not stomach the costs. Well, we are going to have to look at at some stage. It is going to have to come back to this House or otherwise we are going to have to continue to accept that the vast majority of monies that are raised through taxation in this Island are to be spent on health. Which is fine, but let us have the debate. This confuses the issue. This shirks our responsibilities and does not get to the core of the issue which is we need a proper debate on the long-term of the health services that are provided by this Island. We have to decide as the whole community which way we want to go. We have to then instruct the Minister for Treasury and Resources to find the monies to pay for it in a way that is acceptable to us all through increased taxation or anything else. But until we go there and have this debate this is short-termism at its worst. As such, I do not think anybody in their right minds should be voting for it, we should be insisting that the Minister for Treasury and Resources funds the things that he agrees with or

otherwise changes his job.

[10:00]

4. Senator F. du H. Le Gresley:

I think I have got good news for the Minister for Social Security, by my reckoning, after the speeches we have heard so far, 33 Members will be supporting this proposition. I will explain later where I got the figure from. I will also pick up on the comment made by Deputy T. Pitman yesterday when he said some Members are suffering from schizophrenia. I would suggest that some Members are suffering from amnesia. The reason is that we had a big debate back in

September called the Draft Annual Business Plan 2011. I would remind Members that we were provided with the proposition 112 days ago. So we have had 112 days to make up our minds whether money should be moved from the Social Security Health Insurance Fund to Health; 112 days. So those Members who comment they have only just really discovered this I find rather amazing. Can I just point out to Members that I have brought along my Annual Business Plan and I will refer them firstly to page 20 which states - there is a table in here about expenditure: "Health and Social Services, additional funding £4.9 million" and it goes on to say: "The additional funding represents the proposed contribution from the surplus on the Health Insurance Fund to fund the growth in Health and Social Services." Page 20 of the Draft Annual Business Plan. Also I would remind Members about page 22: "Additional funding sources. Ministers are proposing that a contribution of £4.9 million from the surplus on the Health Insurance Fund is applied to fund the proposed growth of Health and Social Services in 2011." It then goes on to say: "Some minor law changes will be required to achieve this additional £4.9 million contribution from the Health Insurance Fund." Lastly, from the same paper, which I believe is page 30 under Growth Proposals: "A further proposal is to consider a one-off transfer of circa £5 million from the Health Insurance Fund in 2011 to provide funding for health growth and improve the financial position of the consolidated fund." Those are all documents we have had, as I said, for 112 days. Now, in addition, those of you who read through all the numerous amendments that we received for the Business Plan will recall that there was an amendment, which I hope I can find, from Senator Ferguson, who if she was here today would, I am sure, be telling you what I am about to tell you. But her tenth amendment, and I have it here, lodged on 27th August. So I have not worked out how many days you have had a chance to read this one but anyway she was querying the transfer of £5.83 million from the Health Insurance Fund to Health and Social Services, and also the movement of £301,000 representing reduction in the user pay charges, subsidy on certain health products and diabetic supplies. Now, Senator Ferguson, quite rightly, said - excuse me, Sir, if I read these things out but it is the easiest way: "The proposals in this Business Plan seek to shift payment for a number of activities which might or might not be attributable to private healthcare to health fund. Unsurprising this sum is £4.9 million." She also goes on to say: "It should be noted that the withdrawal is fund growth and to allow health to make its saving targets for 2011. The passing the Business Plan" now this is what I want to stress: "without at least debating the underlying principles means that when the proposition to amend the law comes to the Assembly we cannot object to it, it will be too late." So it is too late, folks, we have already agreed the Business Plan and could I tell you how many people voted for the Business Plan: 35 people pour, 8 contre. Now, a number of Members were absent, I am not going to into the reasons why they were not in Chamber, but of those absent on the day that we voted on paragraph (a) which was 17th September, which was the budget figures for all departments including Health and Social Services, absent on that day was Senator Le Main, who we have heard from already, who is obviously contre; Deputy Jeune , who represents the First District of St. Brelade, who is also the Assistant Minister for Social Security, she was absent; and the people who have so far spoken against this proposition as I see it also voted contre to part (a) of the Business Plan. So I feel that they are sticking to their principles, that is Senator Breckon, Deputy Southern and Deputy T. Pitman. I have failed to mention one person so far and that is the Deputy of St. John. The Deputy of St. John voted pour the Business Plan. So he was in favour of the movement of this money. Quite clearly he voted pour. I would also like to point out that Deputy Duhamel, who has spoken this morning, also voted pour. So he has changed his mind. The very strange thing is Deputy Le Claire speaks in favour this morning but he voted contre. [Laughter] I remain confused. Now, when I read the Business Plan back in July, 112 days ago, I also was concerned about this movement of money from the Health Insurance Fund because I understood it was a ring-fenced sum of money. So what did I do, I went to see the Minister and he gave me a very good explanation, I did not believe everything he told me but [Laughter] on reflection I felt that it was fair point that Health needed money for growth, Health were providing primary healthcare services, they were not going to get the money from the Treasurer because he was being very tight. So money had to come from somewhere. Surpluses in

Health Insurance Fund, obviously a good reason to move money across provided it was done openly with a proper debate about changing the law. Also when I went to see the Minister, and this takes me to - I hope I can find my papers - the part of the proposition that relates to the transfer of £301,000 from the Health Insurance Fund to fund diabetic supplies and dietary, oxygen and incontinence products. These 2 items were in the user pays savings for Health and Social Services in the Business Plan. They were there and the figures were £170,000 relating to diabetic supplies and £131,000 relating to the other products. I was very concerned when I saw these figures because I wanted to know what was behind them. So I did do some research with the help of the staff at the Health and Social Services Department. I would like to give you some background because we are going to be voting today on whether that money in particular should be moved across and I think it is very important we know a bit of the background there. The funding of the diabetic supplies is currently subsidised at approximately 85 per cent, which is equivalent to £170,000 per annum. Removal of the subsidy under user pays would have affected approximately 3,000 patients. Subsidised product scheme provides dietary products short burst oxygen and incontinence pads for patients in the community. This scheme is administered by the Family Nursing and Home Care. The scheme provides 70 per cent subsidy except for children under 5 years. Let me just stress that, except for children under 5 years who receive the product free of charge. The user pays proposal was to reduce the subsidy to 50 per cent thereby saving £131,000. Included in this figure was a new charge for the under-5s. Member should also note that responsibility for funding this particular scheme moved to Health and Social Services from Social Security in December 2007. So this scheme, the second scheme, was originally funded by Social Security. I believe that Members should have no objection for the movement of funds to cover these 2 particular schemes to avoid the introduction of user pay charges. As I see it in this proposition today, the only new expenditure that I was not aware of is the proposal to establish the new central repository of patient records and developing a primary care infrastructure which follows on from P.36/2010. Current surpluses: Senator Routier has explained about surpluses in the Health Insurance Fund and at the presentation that the Minister for Social Security did for Members earlier this week, he explained that the surpluses are currently accruing at about £3 million per annum. We also know that we can expect prescription charges to be reintroduced, probably in the New Year, so quite clearly the Health Insurance Fund is going to be topped up regularly. So what are we talking about? We are talking about moving about £6 million, just in excess of £6 million, from the Health Insurance Fund to help Health and Social Services deliver their services over the next 12 months and a possibility, quite likely I would suggest, that a similar figure will be required in 2012. Unfortunately the Deputy of St. John is not in the Chamber but I would like to comment on something he said. I may have misheard him, but he mentioned the proposed 2 per cent social security contribution from employees earning over the cap and from employers from January 2012. He seemed to indicate that some of that money would be going into the Health Insurance Fund, but my understanding is that money will only be used to reduce supplementation and none of that money will be going to the Health Insurance Fund. So I will finish by saying to Members what alternative is there to draw down from the Health Insurance Fund? I will give you 3. How about an extra half per cent on G.S.T. (Goods and Services Tax)? How about removing all subsidy for fee-paying schools? How about a £6 million cut in Health and Social Services expenditure for 2011? I say to Members the majority of you have already approved the Business Plan and that the Minister for Social Security is only carrying out the instructions of

this Assembly and therefore can proceed accordingly.

5. Deputy A.T. Dupre of St. Clement :

I am very pleased to follow the Senator's very well researched discussion there. I am between a rock and a hard place, sitting as I am between an Assistant Minister on my right who has very passionate concerns regarding this proposition and the Minister on my left with his calm and confident proposals. I support this proposition as I believe part of the Health Insurance Fund is for primary care and therefore this is where the money should be spent. This money will be available to Health for only 2 years so we will have to proceed with the governance, assessment and monitoring of the G.P. services in a timely manner. Without this the local G.P.s will not be certified by the G.M.C. (General Medical Council). I worked for a G.P. surgery - as Deputy Le Claire would say, in my previous life - for many years and I know that they provide excellent primary care. These proposals will help to further improve these services. I would advise everybody to agree with this proposal. Thank you.

6. Deputy A.K.F. Green of St. Helier :

I am pleased to follow the last couple of speakers. Like many, when I first heard of the proposal - and it was more than 100 days ago, I think, when it was first being talked about - I had the feeling that this was wrong, that the Social Security money should be ring-fenced. But at the invitation of the Minister I discussed my concerns with here and with the officers. Clearly the health service is undergoing, in common with all other health services a review of what needs to be done. We cannot keep up with modern technology, it is very expensive.

[10:15]

I go back to when my son was in hospital 20 years ago, the medication he was having daily was £5,000 a day. These things are ongoing. So we have some choices. We could take the short term choice, as mentioned before. Short term, to me, would be to do nothing about this, to continue to stumble through this mess that the Minister for Health and Social Services has to steer us through. That would be short term. But what are our choices? Well we could throw our teddies out of the pram and say: "Well C.S.R. (Comprehensive Spending Review) must apply to Health, they must make 10 per cent cuts." I voted against but we have already voted for the reduction in physiotherapy services, we have already voted for doing away with the hydrotherapy pool. If we force the Minister to make 10 per cent cuts on top of everything else that she has had to do then we will see further services deducted. So we could say to the Minister: "Go away and make your 10 per cent cuts." We could raid the rainy day fund, but I will come back to that in a minute. Or we could, as suggested, buy time using the Health Insurance Fund to keep and develop our primary services while the Minister and the officers have the way to look at the way ahead. If I can assist Members in deciding which of these options would be best. As I say, we could dig our heels in and make the Minister make 10 per cent reductions, but it will not be the acute appendicitis or the road traffic accident person that will suffer, it will be those that receive non emergency services, those in constant pain due to arthritic hips or knees. Those in the community who need support due to learning difficulties, brain injury, mental health, those are the ones, the less articulate, the less well off, the unheard that will suffer if we make the Minister go down that route. Be under no illusion, it will be the less well off that will suffer because those who can afford it, who can buy the services, will buy it. Furthermore, if we make the Minister go down this route of not having the funding that she requires then reductions will be made to charities, charities that get grants. The same charities that are providing many of the services to the vulnerable people that I was talking about, and I want no part of it. We could raid the rainy day fund, as I said, and find the money from there but, in my view, and I am not trying to be clever here, in my view it is not raining, it is just drizzling at the moment. We have seen nothing yet and we need to keep that money intact for when we do need it, when it really is raining and not just slightly drizzling. That brings me back to the only viable option, the option to use the Health Insurance Fund and the clue is in the words that Deputy Martin said: Health. Health Insurance Fund. We are not raiding the pension fund, we are not doing any harm there. What we are giving the Minister is a 2-year contract to sort out the primary care services and to look at the health service and to have a health service that is fit for purpose and fit

for all Islanders, not just those that can afford to buy the service.

7. Connétable J.M. Refault of St. Peter :

I am delighted to follow Deputy Green and his very eloquent speech there. The point I would just like to add to his points, and some of the others have already been made, is that on Monday we all had the opportunity of a briefing from the Minister for Social Security and the Minister for Health and Social Services and 2 or 3 of the Members were there to listen to that briefing. However, at that meeting I did set the hares running with my significant concerns about breaking into a hypothesised fund of very particular use, and those concerns still remain there. The Minister is going to need to speak very strongly in his summing up to ensure me that it is not going to become a sacrificial fund for somebody that wants to have a dip into it. Because if he cannot do that then he will not get my support and that will be very sad because I support the principle of what we are trying achieve here at the moment, and the principle is to improve the delivery of primary care back out into the community. In a similar vein to Deputy Jeune and her feelings about the constituents of St. Brelade, I will say there is a similar thing for St. Peter but also extend that when I think about the constituents of St. Peter I am also thinking about the whole Island, that there is many of the people, the elderly people in my Parish, who I have to make the decisions about whether they can continue to drive, and that may affect them coming in to town to hospital to get their blood pressures checked or whatever ongoing medication they require. If we can get primary care back out to G.P. surgeries where they can just pop down the road then I am totally supportive of this proposition, and my intention is to support the proposition here this morning and I hope the Minister will confirm that it is not going to become a raiding pot of the Health Insurance Fund.

8. Connétable S.A. Yates of St. Martin :

I will be really quite brief. Ever since yesterday afternoon I have had a series of flashbacks and the flashbacks were of my grandmother's accounting system which was a mantelpiece in her kitchen with a series of pots on top of it. There was one for the rent and one for the groceries, one for the Prudential, and I think there was probably another one but she also collected ship halfpennies. Now, ship halfpennies, why did she collect them - she liked them and they were a nice little coin with the head of King George VI on one side and a very handsome picture of I think it was the Golden Hind, Francis Drake's ship in full sail on the other. That pot was almost always full or three-quarters full. If she perchance had a headache and the doctor's tin was empty she would have to take the money for the Aspro from one of the other pots and reluctantly she would often take 3, 4 or 5 ship halfpennies out of the pot and say to me: "Please nip down to Donald Dodsley in Colomberie and get me a strip of Aspros because I cannot do anything else, you will not be having any supper, because I cannot do anything until I get my Aspros." Now, if Health and Social Services have got a headache let us try and make it better and I think the paracetamol should come from the ship halfpenny pot, which I think is the draft Health Insurance Fund. I will definitely be supporting this. [Approbation]

9. The Deputy of St. Mary :

I, like other Members, had doubts when I first looked at this because of the issue of hypothecation, this is a ring-fenced fund. But I think those doubts have been removed and what the Minister has to do in his summing up is persuade us exactly what the Health Insurance Law said that it covered and relate that to, and make it quite clear, that what we are doing with this money or what is proposed to do with this money now,  lies within the  intention of the original  law. He uses the word "reasonable" in his report on his proposition. It is a reasonable extension of the original aims of the 1967 law and he does have to prove it to us. He may have done that in his opening speech, but I think it is worth saying that is the key issue. Is this a reasonable extension of the original aims into a slightly, in my view, acceptable extension of the word health. The first observation I want to make is that this does signal a willingness among the Council of Ministers to be flexible and joined up when they are looking for solutions to financial problems and I just want to make the point that I hope that we can see this flexibility and pragmatism applied in other areas. I can think of other applications, not for this fund, I must stress, but I can think of other areas where a bit of flexibility and intelligence about how we fund things, particularly in the field of capital, an extraordinary thing where we fund all capital out of current account is bizarre. We really must loosen up and be a bit more intelligent about how we invest to save. So that is an opening comment. I do have one reservation about the practicalities of where this £6 million is going and that is in the field of I.T.

(Information Technology) and it does worry me on pages 6 and 7 of the report I see that reference is made on page 6 to the ability to collect vital information relating to the health of the Island's population, and that will be enabled by the new patient record system and so on and the new I.T. systems. Well Amen to that. Amen to that, we do indeed, I mean how can we devise effective preventative measures, how can we target those measures, how can we indeed monitor our progress if we do not have that sort of information? So that is a good thing. Then I read on page 7, and I know that there is a large program to digitise patient care records in Health and Social Services, and I thought that already included the fact that G.P.s and primary care professionals would have access to those records, of course in secure conditions. Then I read it is anticipated that such a system, being the primary care system and the G.P. system, will be integrated with the new Health and Social Service computer system. Well I thought that was part of the original deal, so I am just concerned that the I.T. and the care record system, there is a potential black hole there, and I do hope it is going to be done correctly and efficiently and with everything taken into account. I just wanted to flag that issue up as a potential danger area. My concluding remarks are that I am absolutely delighted in the direction of travel. We heard from the Minister for Health and Social Services yesterday that she agreed that the goal of making access to G.P.s and other primary and preventative healthcare, making that affordable to all, she assented to that. We have heard both her Assistant Ministers saying the same thing, that we have to make progress towards making primary care affordable to all. Really this is an issue, I have to impress on Members how important this is. Not only the social survey has pointed out that many people in our community do not go to the doctor because they say they cannot afford it, they are afraid of the costs that they might or would incur and that was borne out by the survey, I did myself when campaigning for election. I found people in my constituency in St. Mary saying they could not afford to go to the doctor, they dreaded the health costs on this Island and the dentist of course as well. So I am delighted that we are finally going to get to grips with the primary care system, as Deputy Green pointed out, they have got a 2 year contract, in effect, to come up with the goods. My only rider is that system includes the most effective way of tackling health, the most cost effective way, which is preventative. We do have to have built into that, to our primary care, the notion that having a healthy population is the first port of call, not the last. It is not about patching people up except when they have to be, it is about creating a healthy society and that does have implications that go slightly outside the silo of health, and clear implications for the transport debate we will have at the next sitting, among other debates. So with that proviso that there is sufficient emphasis on prevention and helping us and enabling us all to live healthy lives, I think that provided the Minister convinces us all that this is a reasonable extension of the use of the fund, I think I am

going to support this.

10. Senator B.I. Le Marquand:

I am going to begin with some bad French, but not of the type that need trouble you. It is well known to lawyers the principle in trust law, which is referred to as cy-près or something similar to that. Now, if you have set up a trust and you cannot legitimately pay out all the funds properly because the purposes of the trust do not allow for that, then you can go to the Royal Court and you can seek to have an amendment to the trust so that the terms of it are varied, so that they are widened, to that you could usefully use the money. That is a well understood principle. That kind of principle also applies when we are considering matters concerning the States farm, and Members of this Assembly will know that of course there was a covenant in favour of the donor, T.B. Davis, and that the benefit of that covenant is essentially in a trust which ensures that we do not move away from the original purposes too much. But, of course, they co-operate and recently we had a proposition to allow for a further amendment of the terms of that covenant to allow a continuing sensible use. So I am saying this in an attempt to retake the high ground, which is the moral ground, which is being claimed by some Members that we have a fund here which is only for very restricted purposes and should not be used for any other purpose.

[10:30]

The fact is that in any other area of law, trust law, covenants or whatever, it can be varied, particularly in trust law in order to apply the monies to a similar principle. There is absolutely nothing morally wrong, there is no lack of integrity in relation to doing that, it is only sensible common sense. In this particular case I would argue that undoubtedly the underlying central purpose of the Health Insurance Fund is primary care. Indeed, I would argue further that the purposes to which it is intended by this proposition to extend on a temporary basis it ought to use up the excess funds, which otherwise will not be used for the current purposes, is fully within the spirit of that and fully within this principle recognised by law in trust law of cy-près So that is the high ground issue, it is not quite as high in terms of the morality. Secondly, there is the downright pragmatic approach and this has been covered already by a number of Members. The fact is that without this £6 million a year for 2 years the aim of a majority of the Members of this Assembly, which is to balance the budget by 2013 and to work within the Stabilisation Fund without raiding the Strategic Reserve, could not be fulfilled unless we went down other unpalatable routes, and these have been already outlined. The fact is that would then either have to raise yet further taxes to cover this amount or we would have to find further savings, and none of those are in the least palatable. I wonder if Members would be happy to go to their constituents, the whole Island in my case, and explain to them that we are going to propose an extra tax increase, although we have spare money in this Health Insurance Fund, because we were not willing to use that for technical reasons and they are going to have to pay more tax. I do not think they will be very delighted. So I will be supporting the proposition.

11. Senator T.A. Le Sueur :

Since I indicated my desire to speak I have heard 2 excellent speeches, one the last one from Senator Le Marquand, earlier from the Constable of St. Martin, who reminded of ship halfpennies, something that was a dim and distant memory. I really do not need to add very much more except I think to say that I take exception to some of the comments of Members that we have set up a ring- fenced fund for one thing, and somehow we are doing something totally different and nothing to do with that fund. I think one Member suggested we were dipping our hands in the till. I would say really one has to ask what is the purpose of the Health Insurance Fund? The basic purpose of the Health Insurance Fund is to enable access to primary healthcare. Now, what is primary healthcare? Many years ago I was the President of Social Security and I can well recall in those days discussions which we used to have on an annual basis with G.P.s about the level of services they provided and the cost of benefits, and there was a feeling in those days that doctors were doctors and the Health Department was the Health Department and never the 2 should meet. That, I have to say, is an attitude which has changed considerably over the years since then and there is far more understanding and working together between G.P. services and hospital and health services, and there is far more that still can be done. What this proposition does do, among other things, is to help facilitate that change. To help bring primary services provided by G.P.s and others, like practice nurses, more into the 21st century. By doing that we would reduce the demands on the hospital services, reduce the demands on the health budget and, more importantly, have a better primary healthcare service for the patient, and it is the patient that is to me the important situation. It was also suggested by one or 2 speakers that his proposition is a short termism, and I would say to that, yes, it is and the proposition makes it quite clear that this is short-term funding, funding to facilitate and support the change that is necessary. But really much of this has now already been said by others and I do not intend to repeat that. This is a good and appropriate use of the Health Insurance Fund. It is right that we should get Members endorsements of the change that is being proposed, but it is an endorsement within the general policy to the general principles of the law and, as Senator Le Marquand says, it is very much along the lines of cy-près. So I do urge Members to

support this proposition.

12. Deputy M. Tadier of St. Brelade :

This is by no means a simple proposition, in the sense that there is a great division I think about what people feel is the right thing to do, and I quite like the Deputy of St. Martin's analogy of the coin, that was a nice analogy, and of the pots. But I think in some ways some of us almost feel like it is flipping a coin and that there are certainly 2 sides to this argument. The point has already been made that nobody really wants to be in this situation, we are not in an ideal situation and I think the Minister for Social Security himself knows that and has acknowledged that. I think my colleague, Deputy Duhamel, also has driven the point back home that, you know, this is not the way that a government should be doing business. How many propositions do we have to bring for ad hoc funding to the States and how many policies do we have to making up on the hoof which are reactive rather than proactive before we realise that there is something wrong? Because I think we are in danger of embarrassing ourselves and it looks as if we could not organise the proverbial knees up in a brewery. There are certainly questions which need to be asked here, and it is quite right that Members are concerned about due process, but on the other hand I think the point has already been made that we cannot simply make the wrong decision just because we want to be pedantic, and this is why many of us are feeling quite a difficult decision needs to be made here today. What I will say though, and the point has been made but it can be made again, is that there is a need for consistency. Now, as Senator Le Gresley has already made the point, I would perhaps suggest it is slightly simplistic to look at how one voted on the Business Plan overall and then infer particular facts from that. For example, I would say that if you voted against the Business Plan in its entirety, which I think I did because it is not my Business Plan it is the Business Plan of the Council of Ministers, it is not a policy direction I and others agreed with. That does not mean that you cannot support this of course. But you probably are in more of a difficult position if you did support the entirety of the Business Plan because it did have this provision included within it, although that is down to the conscience of each individual Member. But the point I would also make, and I think Senator Le Marquand commented on this, he said: "How can I go to my constituents [in his case it was the whole Island] to explain that they need to cough up extra money when there is money lying around in a pot already?" That is a perfectly valid argument. Now, I hope that Senator Le Marquand who is engrossed in his own dialogue at the moment will, when the amendment comes for G.S.T. to not increase it from 3 to 5 per cent, but rather to look for other funding streams, to look to take money out of the Strategic Reserve, to fund that in the short term, exactly the same argument. If he does not support that how is he going to go to his constituents to explain the need to cough up an extra 2 per cent when they already finding it tough, when they are already having to not be able to afford dental care, for example, and to pay an extra 2 per cent in G.S.T.? It will be interesting to see if those arguments are applied consistently. So what I would offer is a hand of compromise to the Ministers and say that if you are willing, through the Chair, to rescind the 2 per cent increase in G.S.T. and to use the money from the Strategic Reserve, then quite happily in the interest of consistency I will be supporting this proposition. So I look forward to the Ministers giving a categorical assurance that that will be done. This brings me to another point about good faith. We are being asked to accept a lot of this proposition in good faith. Now, fortunately I do trust the Minister for Social Security as far as I can, that cannot be said for certain other Ministers who seem to say one thing purely to get elected, it seems to me, then only to change a couple of years later when it is politically convenient to do so. But there is an issue of good faith because many questions about after the 2-year period what will be put in place remain, I think, unanswered. I can take a few examples. We are told on page 6 about this review and we are told that this is to be the subject of a detailed review that will form part of the Comprehensive Spending Review, but we are not really given an exact timescale, we are not given any real detail about what system will be put in place 2 years after when it does come to the States. Now I think any principle debate needs to happen as soon as possible. We cannot have a lacuna, and it is also worrying to have to rely on any future House, which we do not know what the composition of that House will be, they may have completely different opinions, more extreme one way or the other than the current House. There are also other areas that I underlined. We are told on page 7 that an exercise in respect of the scope of feasibility of such a project is currently underway, it is the second

paragraph from the bottom. However, the costs of the implementation are not expected to exceed £1 million. Well I certainly would hope that they would not exceed that, but it is still again very vague here and it is not satisfactory, I do not think, for Members to be dealing with such vagueness. Again, this is not a criticism of the Minister for Social Security, I think he has been put in an invidious position. He has been asked on the one hand to reduce his budget and we know that the Minister for Health and Social Services on the other hand has been promised extra monies for her department, even at a time when across the board we are making cuts. So this is, I think, the underlying problem that there is no overall vision. That is what we need and that is what any good government needs if we are to be leading people, otherwise we risk having a scenario where the blind are simply leading the blind. So all I would say is that I would simply ask the Minister for Social Security for as many undertakings as he can give and to back that up with an action plan, and I think that is what we need. To just comment again on what Deputy Le Claire said about the analogy of a begging bowl, we have the Minister for Health and Social Services here with a begging bowl. I am not sure if that is the best analogy to use but again I would ask whose fault is that in the first place? Because we do not have a proper joined up plan, about how we fund society, and how we fund things to do with health and other essential items. I can quite echo the comments of the Deputy of St. Mary and I think the Constable of St. Martin, when he talks about elderly people in particular, although it is not limited to the elderly, being scared to go to the doctor. It is not that they are scared of the scalpel or scared of the dentist's drill, they are scared that they cannot afford it, they may have to choose between, what is it, a £30-odd visit nowadays, or putting their heating on. Unfortunately I have known of people who have died of relatively minor conditions which if they were diagnosed on time they would still be here today. So this really is, in the round, about early diagnosis. There was a comment about this fund was meant to pay out in years to come but one sense, even if we used that money now, it is going to pay out now and in years to come because prevention is better than cure. If we can nip illnesses in the bud, if we can provide services for people now who would otherwise not be receiving those services, that can only be good, first of

all for the individual but also economically. It makes sense socially and economically. So I am in a bit of quandary here. I do want to see the right thing done in this debate. I also want to see the right thing done in the G.S.T. debate because I think that there is a genuine parallel to be made there.

[10:45]

I would ask for consistency and I would ask any Ministers who have not spoken yet what their feelings are about freezing G.S.T., the same principle we are talking about today, and seeing where we are in a year or 2 years when we are coming out of recession or otherwise. Because I think the 2 are intrinsically linked, we are talking about people's ability to pay for everyday services and to pay for survival, so I will keep my powder dry for the moment and I look forward to hearing from those who have not spoken yet.

13. The Very Reverend R.F. Key, B.A., The Dean of Jersey:

I am responsible, among other things, for attracting and keeping, recruiting and retaining the best people to staff the churches of the Island. That is not as easy across the Crown Dependencies as a whole as you might think. That is especially the case with younger people with families. The Isle of Man finds it almost impossible across denominations to attract such people to the Island to staff the churches. We have just made 3 appointments, one upgrading from temporary to permanent, one new rector for St. Ouen, one new vicar for All Saints, all of whom are young priests with families. When they sit down with my wife and me asking about life in Jersey they need no persuading about the beautiful beaches, they need no persuading that they would be coming to work for an incomparably brilliant Dean, we take those things as read. [Laughter] What are the questions they ask? Well they ask about education - what are the schools like, what are the G.C.S.E. (General Certificate of Secondary Education) results like, what is the University? They ask about cost of living. Is it really true that it costs £250 more to buy a television in the shops here

than on the internet? Those are concerns. They ask about the reliability of on-off Island transport, will there be a boat in the harbour, will there be a plane at the airport? They ask about health. They ask about the affordability of healthcare certainly, but more than that they ask about the quality of healthcare. Certainly I think we do have big questions to address about the affordability particularly of dentistry which seems, from my research, to be out of kilter even with that in the United Kingdom. But it is the quality of the health provision. If there is something moderately seriously wrong that needs further investigation, can I be convinced that either we have a world class consultant in that speciality in the hospital, or we have sufficiently robust links, whether it is with Oxford or London or Southampton, where the procedures can be carried out, that very often either save lives or change the quality of life beyond measure. Have we got those in place? But even if we have got those in place any healthcare system stands or falls by the quality of the general practitioner. If they cannot tell the difference between (inaudible), you are never going to get as far as the cardiologist who in this Island happens to be superb. You need that G.P. Have they got sufficient time to deal with their patients, or is it like some parts of the U.K. where they have got 8 minutes per interview and anything after that is not going to meet the targets? Have they got the resources, the quality of the surgery, the support staff, that attitude of those on the front desk? But here is where we come to this particular proposition. How up-to-date and ongoing is their training? I have a number of extremely highly qualified medical friends, a couple of professors and so on, who tell me that in their spheres the medical world is changing at a faster rate than for many years. If I go to the G.P., I want to know that they have read the latest material. I want to know that they know the difference between the rate of cure of providing drug A that they have written scripts for, for the last 20 years, and the rate of cure of the newest thing on the block. What is the difference, and that that is not simply what costs more or less. We need, therefore, to provide a framework where our ongoing G.P. training is at least as good as the rest of Western Europe and the United Kingdom. I did love the Constable of St. Martin 's homely illustration, may I end with one. When, in the recent storm that flooded bits of Beresford Street, the Deanery roof began to leak and I went up on the landing and there dripping down the electrical fitting was water from the loft. It was quite clear that there was a long term job that needed doing. Some lads from the Town Hall had to come and clear the valleys on the roof of seagull debris. It does seem to me that we could have stood there and said: "This needs a longer term project, let us set up a committee of investigation to see how we stop water coming through the roof." Or while we were waiting for that we could get a bucket and put it under the light fitting. In other words, to do the short term thing does not mean you do not need to do the long term thing, but knowing there is a long term job to be done does not mean it is not sensible to do the short term fix now. The assurance I, as other Members, will be looking for from the Minister, is that to have the short term thing now which will mean, among other things, that our G.P. training and primary care principles will get to the highest levels which our people deserve, it seems to me. The assurance I want is to know that when the short term is over the longer term work will have been done so that we then have something in place that lasts

for a generation.

14. Deputy R.G. Le Hérissier of St. Saviour :

I am not sure I entirely agree with the Dean's analogy of setting up experts on roof repair, and the thought of having a strategy on roof repair is slightly worrying. It is often said, well it used to be said and as you will notice it is slightly out of date, that there are 3 groups in Britain you should not upset, the Brigade of Guards, the coalminers and the B.M.A. (British Medical Association). Obviously there have been some changes along the way but working with doctors is notoriously difficult, and in Jersey we have the ultimate expression of that because they are independent practitioners and a lot of them are self styled refugees from the National Health Service and what they see is the overbearing bureaucracy of that service. So it has been, in fact, a remarkable achievement to have brought them together this far, to have got a degree of agreement. The Deputy of St. Mary was quite right to refer to the computerisation issue because that was promised years ago, has allegedly been progressing over years, and it now makes a guest appearance in this

funding request. There are questions to be asked about that, we all know about government I.T. projects and their almost inevitable propensity to go over budget, to lose focus and to wander in all sorts of directions costing millions upon millions of pounds, and I hope that the Minister can give us an assurance that this particular project which, as I said, keeps making constant appearances along the way, that this particular project is under some real control. I am very pleased that Deputy Tadier joined the fence-sitting club and that he is still to be convinced on either side, and he is suffering as a result. There are 2 issues that have worried me continuously about Health, and I echo a lot of the sentiments that Senator Ferguson would express were she here. One is the way in which money has, in a never-ending series of ad hoc requests, of ad hoc emergency request, the way in which money has been thrown and we have never been able to analyse how this money is being spent and what the true costs are of each service. This has been one of the real worries, and it is certainly not confined to Jersey because I know one of the things that - it did not bring down the Labour Government but it certainly helped - was that billions were put into the National Health Service, often with no discernable improvements in productivity. Money was just ploughed in and I get this impression constantly of this melange of where money is thrown at the service, we cannot analyse the costs of one aspect of a service versus another, and we lurch - as Deputy Duhamel said, although I will not ultimately agree with him - from one funding crisis to another with no sense that somebody has got a handle on this, and that we can make meaningful comparisons and we can look at a meaningful analysis. When you looked at the C.S.R. review, which was headed by no less an eminent person than the former Chief Executive of the States, I got the impression they gave up because there is no analysis there of what was wrong and what were the issues. There is just: "Oh, we just cannot work it out, things seem to be totally overwhelmed" blah, blah, blah. That was, in a sense, quite disappointing because I thought if people like them cannot get to the root of what is happening and put their finger on it, what hope does that give for us? So there is that issue. I would like to see from Health much more rigorous information and I would ask questions, I asked again yesterday a similar question, what are the costs, and again I got replies couched in the usual very well meaning warm generalities, but essentially they meant nothing. Essentially they did not give us that hard information and I would hope somebody like the P.A.C. (Public Accounts Committee) would follow. That then brings me to the issue of a strategy and Deputy Duhamel did, as I said, make a good point. We had New Directions and we have all become sadly a little cynical about New Directions. It was a highly aspirational document, at one point figures were attached to it and that is of course when people got very, very scared. Again, it was all this issue that postponed your aspirations for the moment because down the road we will all be incredibly healthy people, and we will not need to use services to the extent we had predicted. That was theory and, you know, there is a lot of benefit to that but it was not stated in clear, practical steps as to how we would get there, what the costings were, what the savings were on services that would be underused