States Meeting Transcript - 2nd November 2011

STATES OF JERSEY OFFICIAL REPORT

WEDNESDAY, 2nd NOVEMBER 2011

PUBLIC BUSINESS – resumption ...............................................................4

1. Draft Motor Traffic (Third Party Insurance) (Amendment No. 12) (Jersey) Law 201- (P.134/2011)...............................................................................4

1.1 Deputy K.C. Lewis of St. Saviour (Assistant Minister for Transport and Technical Services - rapporteur):...................................................................4

1. Deputy A.E. Pryke of Trinity :............................................................4
2. Connétable K.P. Vibert of St. Ouen:.....................................................5
3. Senator S.C. Ferguson:..................................................................5
4. Senator S.C. Ferguson:..................................................................6
5. Deputy M. Tadier of St. Brelade:........................................................6
6. Deputy P.J. Rondel of St. John : ..........................................................6
7. Deputy A.E. Jeune :......................................................................7
8. Deputy J.B. Fox of St. Helier:............................................................7

9. Senator F. du H. Le Gresley:.............................................................7
10. Senator B.I. Le Marquand:............................................................8
11. The Connétable of St. Brelade:........................................................8
12. Deputy J.A. Hilton of St. Helier : ......................................................9
13. Deputy K.C. Lewis : ..................................................................9
14. Deputy M. Tadier :...................................................................11
15. The Connétable of St. Brelade:......................................................11
16. Deputy K.C. Lewis : .................................................................11
17. Deputy M. Tadier :...................................................................11
18. Deputy K.C. Lewis : .................................................................12

ARRANGEMENT OF PUBLIC BUSINESS....................................................12

2. Deputy G.P. Southern of St. Helier:....................................................12

2.1 Senator A. Breckon: ....................................................................12

3. Draft Health Insurance (Amendment No. 14) (Jersey) Law 201- (P.136/2011)........12

1. Deputy I.J. Gorst of St. Clement (the Minister for Social Security):....................12
2. Senator P.F. Routier: ...................................................................14
3. Deputy R.G. Le Hérissier of St. Saviour:...............................................14
4. Deputy F.J. Hill of St. Martin : ..........................................................14
5. Senator S.C. Ferguson:.................................................................15
6. Deputy M.R. Higgins of St. Helier:.....................................................16
7. Deputy A.E. Jeune of St. Brelade:......................................................17
8. Deputy G.P. Southern of St. Helier:....................................................17
9. Senator B.I. Le Marquand:..............................................................17
10. The Connétable of St. Brelade:.........................................................18
11. Connétable D.W. Mezbourian of St. Lawrence:........................................18

12. The Deputy of Trinity :..................................................................19
13. Deputy J.B. Fox:........................................................................19
14. Deputy I.J. Gorst : ......................................................................19

1. Draft Health Insurance (Amendment No. 14) (Jersey) Law 201- (P.136/2011): Amendment..............................................................................23

2. Deputy I.J. Gorst :....................................................................24
3. Deputy G.P. Southern : ..............................................................24
4. Deputy J.A. Hilton:..................................................................24
5. The Deputy of St. Martin : ...........................................................25
6. Deputy R.G. Le Hérissier:...........................................................25
7. Deputy P.J. Rondel of St. John:......................................................25
8. Senator S.C. Ferguson:..............................................................25
9. Deputy A.E. Jeune of St. Brelade:...................................................26
10. Deputy I.J. Gorst :.................................................................26

4. Ratification of the Agreement for the Exchange of Information relating to Tax Matters between the Government of Jersey and the Government of the Czech Republic (P.138/2011) ...................................................................28

4.1 Senator T.A. Le Sueur (The Chief Minister):...........................................28

5. Ratification of the agreement for the exchange of information relating to tax matters between the Government of Jersey and the Government of the Republic of South Africa (P.139/2011)......................................................................29

5.1 Senator T.A. Le Sueur (The Chief Minister):...........................................29

6. Draft Pharmacists and Pharmacy Technicians (Registration) (Amendment) (Jersey) Law 201- (P.140/2011)...................................................................29

1. Deputy A.E. Pryke of Trinity (The Minister for Health and Social Security):...........30
2. The Bailiff :.............................................................................30

7. Draft Poisons (Jersey) Law 201- (P.141/2011)..........................................30

1. Deputy A.E. Pryke of Trinity (The Minister for Health and Social Services):...........31
2. Senator J.L. Perchard:..................................................................32
3. Deputy D.J.A. Wimberley of St. Mary:.................................................32
4. The Connétable of St. Lawrence:.......................................................32
5. The Deputy of Trinity :..................................................................32 The Bailiff :...................................................................................33

7. The Connétable of St. Ouen:............................................................34
8. The Connétable of St. Lawrence:.......................................................34
9. The Connétable of St. Brelade:.........................................................34
10. Senator J.L. Perchard:..................................................................34
11. The Deputy of Trinity :..................................................................35
12. Mr. H. Sharp, H.M. Solicitor General:..................................................35

1. The Connétable of St. Lawrence:....................................................36
2. Senator F. du H. Le Gresley:........................................................37
3. Senator J.L. Perchard: ...............................................................37

8. Draft Shipping (Amendment No. 3) (Jersey) Law 201- (P.143/2001)..................39

1. Senator A.J.H. Maclean (The Minister for Economic Development):...................39
2. The Connétable of St. Brelade:.........................................................39
3. Senator A.J.H. Maclean:................................................................39
4. Senator A.J.H. Maclean:................................................................40

ARRANGEMENT OF PUBLIC BUSINESS....................................................40

9. Road Fuel Price s: display (P.146/2001).................................................40

1. Senator A. Breckon: ....................................................................41
2. Senator A.J.H. Maclean:................................................................43
3. Deputy J.A. Martin of St. Helier:.......................................................43
4. Connétable P.F.M. Hanning of St. Saviour : ............................................44
5. Deputy M. Tadier :......................................................................45

LUNCHEON ADJOURNMENT PROPOSED..................................................45 LUNCHEON ADJOURNMENT................................................................45

6. The Deputy of St. Martin:..............................................................46

10. Radon Gas Levels and Cancer Rates in Jersey (P.144/2011)...........................47

1. Deputy P.V.F. Le Claire of St. Helier : ..................................................48
2. Deputy A.E. Jeune :.....................................................................51
3. Deputy P.V.F. Le Claire: ...............................................................51
4. The Deputy of Trinity :..................................................................51
5. The Deputy of St. Mary:................................................................52
6. Senator F. du H. Le Gresley:............................................................54
7. Deputy J.G. Reed of St. Ouen:..........................................................54
8. Senator S.C. Ferguson:.................................................................54
9. Connétable A.S. Crowcroft of St. Helier:...............................................55 10.10 Deputy R.C. Duhamel: .................................................................55 10.11 Deputy A.E. Jeune :.....................................................................56

10.12 Deputy P.V.F. Le Claire: ...............................................................56

11. Land Development Tax or equivalent mechanisms (P.147/2011): .....................61

1. The Deputy of St. Mary:................................................................61
2. Senator P.F.C. Ozouf :..................................................................67
3. Deputy P.V.F. Le Claire: ...............................................................71
4. Deputy T.A. Vallois of St. Saviour:....................................................72
5. Deputy G.P. Southern :..................................................................72
6. Senator F. du H. Le Gresley:............................................................73
7. Senator B.I. Le Marquand:..............................................................74
8. The Deputy of St. Martin:..............................................................75
9. Deputy R.C. Duhamel: .................................................................76 11.10 Deputy A.K.F. Green of St. Helier:.....................................................77 11.11 Connétable J.M. Refault of St. Peter:...................................................78 11.12 Deputy M. Tadier :......................................................................78 11.13Senator T.A. Le Sueur:.................................................................80 11.14The Connétable of St. Helier:...........................................................81 11.15 Deputy T.M. Pitman of St. Helier:......................................................81 11.16 Deputy D.J.A. Wimberley of St. Mary:.................................................82

ADJOURNMENT................................................................................84

[09:31]

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

PUBLIC BUSINESS – resumption

1. Draft Motor Traffic (Third Party Insurance) (Amendment No. 12) (Jersey) Law 201- (P.134/2011)

The Bailiff :

Then we move on to the next matter on the Order Paper, which is the Draft Motor Traffic (Third Party Insurance) (Amendment No. 12) (Jersey) Law (P.134) lodged by the Minister for Transport and Technical Services and I will ask the Greffier to read the citation.

The Deputy Greffier of the States:

Draft Motor Traffic (Third Party Insurance) (Amendment No. 12) (Jersey) Law. A Law to amend further the Motor Traffic (Third Party Insurance) (Jersey) Law 1948. The States, subject to the sanction of Her Most Excellent Majesty in Council, have adopted the following Law.

Connétable M.K. Jackson of St. Brelade (The Minister for Transport and Technical Services):

Sir, may I ask that Deputy Kevin Lewis , who is the Assistant Minister with responsibility for D.V.S. (Driver and Vehicle Standards) matters, acts as rapporteur in this case?

The Bailiff :

Very well. Yes, Assistant Minister.

1.1 Deputy K.C. Lewis of St. Saviour (Assistant Minister for Transport and Technical Services - rapporteur):

The Motor Traffic (Third Party Insurance) (Jersey) Law 1948, which falls under the domain of the Transport and Technical Services Department, makes third party car insurance a legal requirement, thus helping protect against the risk of uninsured drivers. Existing amendments to that law make some provision for the Health and Social Services Department to levy charges against  motor insurance companies in relation to the cost of hospital treatment. Those charges are the subject of this new proposed amendment that I am bringing forward today. My colleague, the Minister for Health and Social Services, will provide more detail about the principles of this new amendment as it affects her departments more than T.T.S. (Transport and Technical Services), but I am pleased to propose the principles and ask Members to support them.

The Bailiff :

Are the principles seconded? [Seconded]

1. Deputy A.E. Pryke of Trinity :

I thank the Deputy for bringing this proposition to this Assembly. Under the Motor Traffic (Third Party Insurance) (Jersey) Law 1948, amended in 1989, my department can currently recoup some of the costs incurred in treating patients injured in road traffic accidents if they make a claim through their motor insurers. Under that law, these costs are currently set at a maximum of £2,000 towards the cost of treating an inpatient and £200 towards the cost of treating an outpatient. As you would expect, this does not come close to the actual costs incurred by my department. The taxpayers' car insurance premiums are already weighted to cover the significantly high charges imposed by U.K. (United Kingdom) hospitals. U.K. hospitals set their cost recovery at just over £44,000 for inpatient treatments, £600 for outpatient treatments and £181 for ambulance services. Regardless of whether you live in Jersey or the U.K., your insurance provider has already taken account of U.K. hospital cost recovery charges when calculating your premiums, not at the much lower Jersey hospital charges. This amendment seeks to address this by enabling the Minister for Health and Social Services, in consultation with the Minister for Transport and Technical Services, to alter these charges by way of an Order. This will allow our hospital to recoup monies already available through car insurance policies. The money is equivalent to approximately £250,000 per year. It is important to stress that these are not charges levied on the individual, but on the insurance company in the event of an insurance claim being made. No insurance claim, no charge. Pedestrians, cyclists and non-insured road users who are injured or who cause an injury will not be liable for these charges. This amendment would also make it a requirement for insurers to notify the Health and Social Services Department whenever they receive an insurance claim which includes the provision of treatment at Jersey General Hospital. This will allow Jersey to recoup costs via the U.K. Cost Recovery Unit. Negotiations with this unit are already underway and all that is required for us to seamlessly dovetail with that existing system already used by motor insurance is a few minor modifications to postcode and National Insurance validations. Insurance companies know about this proposed change and are accepting of it. Over 90 insurance companies, including U.K. underwriters and Jersey brokers, have been notified. Not one has raised any objection or pushed the panic button and claimed that the premiums will rise. As drivers, we are already paying these premiums that cover these costs. The Chairman of the Jersey General Insurance Group has publicly stated in the Jersey Evening Post: "Insurers have already priced these things into our rating structure because they are used to dealing with the U.K. system." This amendment will ensure that we have the ability to recoup what is already available to us and by enabling the Minister to make changes by order it provides flexibility, allowing the Health and Social Services Department, in partnership with Transport and Technical Services, to ensure that our cost recovery is always in line with the U.K. and insurance company margins. I recommend it to you.

Deputy A.E. Jeune of St. Brelade :

May I ask a point of clarification from the last speaker? The last speaker is saying that the benefit to Health and Social Services as a result of this proposition will mean income will be generated for the Health and Social Services Department. Can the Minister please clarify whether that saving will be returned to Treasury and not used for more expensive managers?

[09:45]

Deputy A.E. Pryke:

I am at a loss. It is recouped through those people who make a claim for their treatment in Jersey General Hospital. It is not going to Treasury, it is coming into our budget because the patients have either received inpatient care or outpatient care. It is as simple as that.

The Bailiff :

That clarifies the position. It stays in the Minister's budget. What the Minister does with it is up to the Minister.

2. Connétable K.P. Vibert of St. Ouen :

While congratulating the department on bringing this amendment forward, which I think is an amendment that is very much needed, I would like to raise an associated matter with the Assistant Minister that I think the department would do well to look at: that is, a review of the fines as far as insurance is concerned. It is certainly something that the public out there desire of us. Many people feel that driving without insurance must be one of the most serious offences that you can undertake and I would ask the Assistant Minister if he would maybe go back to the department and see whether the level of fines could not be increased in this area.

3. Senator S.C. Ferguson:

I am also curious, much along the lines of the Connétable of St. Ouen. What will happen with the costs of uninsured drivers? Will that be available from the fund (the name of which I forget unfortunately) which deals with accidents involving uninsured drivers? It is the Motor something or other?

The Bailiff :

Motor Insurance Bureau, I think.

4. Senator S.C. Ferguson:

Thank you, Sir. I knew somebody would know. The other thing, what happens in the case of a third party insured person where their insurance is for third party? What about their treatment? I would be grateful for answers to .. I think this is absolutely right and we should be bringing it up to date. I am just curious about these 2 elements.

5. Deputy M. Tadier of St. Brelade :

When I first saw the amendment I was slightly uneasy because I was worried perhaps that it would be a blanket insurance levy on every insurer at the point of purchase of the policy rather than only the sum being claimed in the case of an accident, which I have been reassured is the case. Nonetheless, I do think that we have to be realistic about this. This is perhaps similar to the V.A.T. (Value Added Tax) problems that we have been dealing with in the sense that for a long period of time Jersey insurance companies, which have had no business in levying this fee because it is not something that they are required to pay out up until now in Jersey, have essentially just been pocketing this money. That is something which needs to go on record as something which we cannot do much about now. It would be nice if we could claim that money back retrospectively but, of course, that is not realistic. So the issue I have is that certainly there is a sum of money that insurance companies were pocketing as profit and it seems perhaps unrealistic to say categorically that these insurance companies, at some point in the future, are not going to want to recoup that extra profit. So we have to be realistic about this and face the possibility that, sooner or later, some insurance companies, if not the majority, are going to put premiums up. Now, the thing that makes me slightly uneasy is that it targets the sensible drivers, the good drivers, as well as those who do get involved in traffic accidents. That is the nature of the beast. I do think there is some scope for using fines; the issue has been raised already. Why not have a 2-pronged approach where some of the money .. one example is exactly that: for those who do not have any insurance, any fines that would accrue from that should be going towards that fund as well so that money can be drawn, but not simply on those who drive with one headlight that is out; why should a portion of that money not be going into this fund so it can also pay? Because driving without a headlight, driving without a rear light, or whatever, these are all dangerous practices and it is only right, I think, that those who are more likely to be causing the accidents in the first place (which are costly to society, not simply on a financial level but also on a personal level) should also be the ones who are most likely to pay. It would also act as a disincentive, if you like, and encourage good behaviour. I am worried that what will happen is that we are tarring everybody with the same brush and people,

good drivers as well as bad, will be hit in the future with an insurance policy increase.

6. Deputy P.J. Rondel of St. John :

I must second what the Connétable of St. Ouen said. He is absolutely right. I have real concerns here. I hope the new Minister for Transport and Technical Services acts on this because it is a criminal offence in my mind. If somebody is driving around without insurance it is like somebody wielding a knife and yet getting away with a modest fine that is cheaper than paying a premium which, to me, is absolutely ludicrous. It mentions third party here but there are drivers who, under the law, I believe (and it was in my time) are covered solely under the Road Cover Act. Now, would this be part and parcel of any claim? Under the Road Cover Act I think they carry their own liability. So would the States have a claim on the person who is carrying his own liability? I would like that answered, if at all possible. I am 100 per cent behind this and it is a shame that when this Law was originally brought or put in place in the 1970s, whenever it was, that we did not follow it through then, in the good days, and we would not have to be doing this now when our back is against the wall. Anyway, I am fully supportive.

7. Deputy A.E. Jeune :

I, like others, feel that we have to have much more deterrence for uninsured drivers but I must come back again to the fact that the insurers, quite correctly .. I think this proposition being brought by the Minister is absolutely correct. When insurers are paying to the Health Department what has not been paid to the Health Department in the past for covering for emergency care like this, that going forward .. in the past it has been paid for by taxpayers' money. The Treasury have been giving the money to the Health Department. That will not be required any more. It seems to me that the Health Department, quite correctly, finds ways of generating income but is not passing anything back to the Health Department. I hope future Assemblies will keep an eye on this.

8. Deputy J.B. Fox of St. Helier :

To pick up the point of Deputy Tadier about premiums and not being paid out by local insurance companies and pocketing the extra premium, in fact, if one looks, most insurance companies base charges on a Jersey base locally or U.K. companies take into account the Jersey syndrome, which is far less in a risk factor weighted by age or the place, postcode numbers, et cetera. To give examples, recently it came to my attention that in some places, such as areas in the north of England, motorists can be paying £8,000 for an annual premium for their motor insurance, whereas here the premium can be a matter of hundreds. So there is a difference and that is taken into account. Yes, people driving uninsured, especially in the U.K., do so because it is cheaper to drive uninsured and pay the fines than it is to pay premiums. That is why the authorities in the U.K. have link-ups between the registration of cars and the insurance of cars and those cars that are not insured are checked by the authorities such as the police. Although there are varying levels of penalties, there is also a penalty of having the vehicle concerned crushed and, therefore, it cannot be used on the road again. That is probably the ultimate deterrent to stop people from continuously abusing their rights and, indeed, creating additional costs and penalties such as being asked for recovery today. I support this proposition.

9. Senator F. du H. Le Gresley:

I am a little bit disappointed because we are very quick in this House to criticise civil servants who are paid large salaries but I recall that this failure, if you like, of the States of Jersey to collect money from insurance companies was brought to the attention of the Minister by the new Hospital Director. I think I am correct in saying that. So I think it is only right that we should praise this gentleman today [Approbation] because he has, in the past, come in for criticism from some quarters. When somebody does their job well it is only right we should say thank you. That is the first thing. I do not want to labour the point about insurance fines or fines for not having motor insurance (and the Attorney General is in the House, so he can correct me if I am wrong) but the fine is level 3 and I believe it is a maximum of £10,000 and/or imprisonment for 18 months. I would suggest to people that if we think that people are getting away, if you like, with not having insurance it is because the courts are not using the fine system at its maximum in appropriate cases. So sometimes it is very quick to criticise the fact that the level 3, as it is, is inadequate, but I think a £10,000 fine imposed on some people is a very significant fine. But the point I stood up to say was with reference to ambulance services. Now, according to this paper, page 4, it says the maximum that you can claim for an ambulance service is £181. I would be interested to know (and I do not suppose the Assistant Minister would perhaps have this information) whether the Health and Social Services Department have costed the cost of a callout, an emergency call out. I am aware, and I think again I am correct in saying this, that in Guernsey they do charge for ambulance services and I would be interested to know whether £181 is cost recovery if you look to Guernsey's tariff. Also, a word of warning: is this going to be the thin edge of the wedge? Are we possibly leading to ambulance service charges being charged to everybody at some time in the future? I would be grateful to know that this is not going to happen but maybe somebody can reassure me.

10. Senator B.I. Le Marquand:

I also want to commend the Health and Social Services Department, the officers of that, for coming up with this excellent proposition and thank the Minister for Transport and Technical Services and Assistant Minister for running it through the House. This is exactly the sort of area where we should be seeking to maximise our income in a perfectly legitimate way. The debate has somewhat strayed into other areas and I hope the Chair will be tolerant with me in making one or 2 observations in an area in which I do have quite a great deal of expert knowledge. There is a need, and has been, in my opinion, for the last 10 years a need, for a review of the maximum penalties right across the board in relation to road traffic law. When I was Magistrate I was very much involved in such a review, which also involved you, Sir. We made a great deal of progress towards that but, unfortunately, it was one of these projects that subsequently got lost and did not proceed on.

[10:00]

It is not just this particular issue of penalties in relation to third party insurance that needs to be addressed. There are serious problems with the maximum level of speeding fine, for instance. I certainly will be wanting, in future, to work together with or urge the Minister for Transport and Technical Services, in whose area these are rather than in my own, to ensure that such a review takes place. Now, in relation to the actual use by judges of the penalties, the difficulty is that there is such a very wide range of categories. When Magistrate, I produced a revised sentencing guidelines document which reflected the different categories. At the very lowest level you have a situation where somebody may have a car which they have parked in a public car park and left there. They have not moved it. It has remained there for a time and it is the same offence, they are using third party insurance even if they do not drive it. So you have that range all the way up to, at the top, the person who is deliberately driving without insurance. Now, the person who is deliberately driving without insurance really deserves severe penalties but my view, certainly when I was the Senior Magistrate, was that the strongest penalty was disqualification and I believe that is a firm use of disqualification of drivers coupled with what was part of the policy which I designed, imprisonment for driving while disqualified, which is the most effective method. But, having said all that, there is this need for review and I certainly hope that future Ministers for T.T.S. will work with future Ministers for Home Affairs in order to take this forward.

The Bailiff :

Does any other Member wish to speak? Yes, the Constable of St. Brelade. Just before you do, Constable, we have strayed a little on to penalties [Laughter] and I allowed the Minister to reply as it had been raised but I think we have dealt with it and so can we now, in future, confine ourselves to this particular proposition.

11. The Connétable of St. Brelade :

Yes, I support the Minister's views. Moving on to the comments and if I may speak in support of the proposition. With regard to the comment made by my erstwhile colleague, the Deputy of St. Brelade No. 1, there are no doubts in my mind that this is angled towards the C.S.R. (Comprehensive Spending Review) process and I think we all have to appreciate that and it is a sensible move in order to make a contribution towards the necessary funding of H.S.S.D. (Health and Social Services Department). With regard to a couple of points, if I may just contribute. It is not the intention of the Minister for Health and Social Services to call upon the individuals to pay for the treatment. H.S.S.D. will liaise with insurers and all their legal representatives and not the client with regard to claims. So in answer to Deputy Tadier 's point, the communications will be directly with the insurer. Where no insurance cover is identified, this is likely to be a criminal matter and then we will stray into matters alluded to by the Minister for Home Affairs. Certainly, that will be in the first instance and, of course, civil action will await findings of such proceedings and be dealt with on a case-by-case basis. The other point with regard to the insurance costs, the Association of Insurance Brokers have advised  verbally that,  in their  judgment, based on the percentage of Jersey motor insurance policies in relation to the total of U.K. motor insurance policyholders, it is extremely unlikely that premiums will go up. Also, given that insurance underwriters are generally unaware of H.S.S.D. being outside the N.H.S. (National Health Service), they already calculate Jersey premiums to take account of the U.K. level of cost recovery claims forming part of the Jersey motor insurance claims settlement. That really confirms what has been alluded to before so, given that, I would ask Members to support the proposition.

12. Deputy J.A. Hilton of St. Helier :

I too would like to commend the Minister for bringing this proposition forward but other Members have alluded to it. The people who will end up paying for uninsured drivers will be the insured drivers, at the end of the day, and this matter really does have to be addressed. Very briefly, a member of my family was involved in an accident not of their making with an uninsured driver very recently, causing £1,500 worth of damage to a vehicle. The person was fined in the Magistrates Court I believe £300 and we have basically been left out of pocket to the tune of £1,500. So I would request, through your good officers, that this is a matter that really does need to be addressed rather urgently in the Magistrates Court: how uninsured drivers are going to be dealt with in the future. How we are going to recoup those costs I do not know, that is something I am going to be looking into at a later date.

The Bailiff :

Does any other Member wish to speak? Very well, then, I call upon the Assistant Minister to reply.

13. Deputy K.C. Lewis :

I thank Members for their comments. The Constable of St. Ouen would like a review of fines. I would be more than happy to discuss that with the Minister for T.T.S. and take that back to the department. Uninsured drivers, motor insurance, third party fees, this is a matter of law and if anyone is not insured, that is a matter for the courts. Deputy Tadier said we are all paying now. That is absolutely correct. A portion of our insurance is already covered here for such a claim. Most of the companies in Jersey we have our own insurance companies but so many are agents for U.K. insurance companies so that element for hospital, ambulance, treatment, et cetera, is already covered. The Deputy of St. John obviously mentioned uninsured drivers, as Deputy Fox mentioned in the U.K. for certain offenders' cars are taken away and crushed. I think that would focus the mind for repeat offenders but we all make mistakes and I think someone who is deliberately driving without insurance, that will be fine, but as long as that is in moderation. Deputy Jeune wants us to keep an eye on things and we are happy to do so. Senator Le Gresley, level 3 fines, I think £10,000 is more than adequate. £181 for ambulance treatment, I think that is about the going rate at the moment. The Constable of St. Brelade - the Minister - I thank for his comments. Deputy Hilton, I am very sorry for your losses but I would recommend recourse to the courts. I think that is more or less everything covered. The breakdown in provisions, I would like to move the proposition.

Deputy M. Tadier :

I just wanted to ask for clarification. I have looked at the manpower implications where it says the manpower implications are negligible and the question is about

The Bailiff :

I am sorry, that is a new matter, you cannot raise a new matter at this stage. Very well. Now, all those in favour of adopting the principles, kindly show? The appel is called for, then, in relation to the principles. I invite Members to return to their seats and the Greffier will open the voting.

The Bailiff :

Now, Deputy of St. John, this is a matter which falls within the purview of your scrutiny panel. Do you wish to have the matter referred to a panel?

The Deputy of St. John :

Not at this point, Sir.

The Bailiff :

Very well. Then, Assistant Minister, do you wish to propose the Articles en bloc? Deputy K.C. Lewis :

Yes please, Sir. The Bailiff :

So you propose Articles 1 to 6. Are they seconded? [Seconded] Does any Member wish to speak on any of the individual Articles? Very well, all those in favour of adopting Articles 1 to 6, kindly show? Those against? They are adopted. Do you propose the Bill in Third Reading, Minister?

Deputy K.C. Lewis :

Yes please, Sir.

The Bailiff :

Is that seconded? [Seconded] Does any Member wish to speak in Third Reading?

14. Deputy M. Tadier :

The point which I did not bring up the first time round, I do not think it is of major concern but the manpower implications say that they are negligible. But one consideration, I think someone mentioned the lawyers from the legal firms and what I do not think has been addressed here is that of course insurance companies have the might of in-house lawyers and what I am concerned about is that we do not know insurance claims are not straightforward. I think anybody who has dealt with that in a civil capacity knows that insurance companies are very reluctant to pay. While I understand that they will have an agreement in place with the States is that when they start getting their own lawyers involved and saying: "We do not think that we are liable to pay this" I wonder if the Assistant Minister can address those issues. Have those costs been factored-in, because they do not seem to have been, and maybe this is one area which will not be as straightforward as envisaged.

15. The Connétable of St. Brelade :

Just briefly, I would like to thank the Commercial Manager at H.S.S.D. for the enormous amount of in-depth work which has gone into this proposition in terms of briefing both my assistant and myself to bring us up to speed with this complex matter.

Senator F. du H. Le Gresley:

I rise to correct something I said earlier if I may for the record. The Minister for Home Affairs has pointed out to me that level 3 is a £2,000 fine and not £10,000, so I apologise to the House for that.

The Bailiff :

Very well, I call upon the Assistant Minister to reply.

16. Deputy K.C. Lewis :

Just to clarify, the local Jersey brokers, the Jersey general insurance group representing local insurance brokers has been engaged in face-to-face discussions with the Commercial Manager at Health and Social Services Department. Meetings have taken place at the office of the Islands Insurance Company on 10th August and the General Hospital on 13th September. The Chairman of this group, Managing Director of Islands Insurance, has been interviewed by the J.E.P. (Jersey Evening Post) and gone on record to say that he does not expect Jersey motor insurance premiums to increase if cost recovery tariffs are increased to U.K. levels. Just regarding cost recovery, I believe that H.S.S.D. are in discussions with the Cost Recovery Unit - the C.R.U. - in Newcastle, which processes all the claims for the National Health Service so the cost will be very, very modest and minimal.

17. Deputy M. Tadier :

I was wondering whether the Assistant Minister could address my concerns about the legal cost implications for the States.

18. Deputy K.C. Lewis :

As far as I can see it, there is no cost there; there is no cost. Obviously, in the legal disputes the lawyers would deal with it but I do not envisage that.

The Bailiff :

Very well. All those in favour of adopting the Bill in Third Reading kindly show? Those against? The Bill is adopted in Third Reading.

ARRANGEMENT OF PUBLIC BUSINESS

2. Deputy G.P. Southern of St. Helier :

Before we move on to the next item and in the light of the request from the Chairman of P.P.C. (Privileges and Procedures Committee) to take a look at the running order and see what business is not essential for this session, can I announce that I wish to defer debate on P.165, Price Control Investigation. It is a matter that is not urgent and can be debated in the New Year.

The Bailiff :

Thank you very much, Deputy .

2.1 Senator A. Breckon:

If I may, I have a matter there as well. I just wonder and I perhaps put this before the House and see how Members feel about another matter which could be deferred but then, if it is put to 6th December, I wonder what another Minister would say of the other Minister's comments because his comments are attached to that and it could well be that if Members do put things back, then things could be scuppered by a Minister saying: "Well, I have not really had time to consider this." So I would just put that before the House. I am considering withdrawing the matter that I have got but perhaps I will leave that until later in the day.

The Bailiff :

Well, obviously, when matters are deferred, as Deputy Southern has just said, he is deferring his. It is up to him when he seeks to bring it back. He may well decide January but Members may well seek to bring it back in January or something of that nature when the new Minister has had an opportunity to get his or her feet under the door. Very well, so Senator Breckon, just to be clear, you are not at the moment deferring? You are

Senator A. Breckon:

No, Sir, I will consider that but, as I say, there are comments from the Minister and it might well be the same Minister but it might be another Minister who might have other comments.

3. Draft Health Insurance (Amendment No. 14) (Jersey) Law 201- (P.136/2011) The Bailiff :

Very well. So we come next to the Draft Health Insurance Amendment No. 14 (Jersey) Law - Projet 136 - lodged by the Minister for Social Security and I will ask the Greffier to read the citation.

The Deputy Greffier of the States:

Draft Health Insurance (Amendment No. 14) (Jersey) Law. A law to amend further the Health Insurance (Jersey) Law 1967. The States, subject to the sanction of Her Most Excellent Majesty in Council, have adopted the following Law.

1. Deputy I.J. Gorst of St. Clement (the Minister for Social Security): I am very pleased to be able to propose these amendments to the 44-year old Health Insurance Law. They signify substantial progress towards a modern primary care structure in our Island.

[10:15]

As Minister for Social Security and as a patient, I am well aware of the quality of our local doctors and the personal supportive G.P. (General Practitioner) service that they provide. As Minister, it is my responsibility to ensure that this level of service continues into the future. A major reform of U.K. governance required by the U.K. General Medical Council (G.M.C.) means that change, however, is now inevitable. The light-touch regulatory framework that I am proposing today will satisfy the G.M.C. without imposing an unnecessary bureaucratic burden upon our local doctors and should ensure the continued success of our primary care sector. But if we fail to take this action now, we do, unfortunately, run the risk of creating a third-rate G.P. service within the coming decades. Last year, we debated P.36 on the future of primary health care in Jersey and this Assembly gave the Minister for Health and Social Services and myself a clear signal to continue with our joint work to create a modern governance structure for primary care. Earlier this year, a revised Medical Practitioners' Law was supported and today we are debating associated amendments to the Health Insurance Law. I am grateful to Members who attended a briefing session yesterday and took the time to understand the background and the details of these proposals and also had the opportunity to question the Medical Officer for Health, the Law Draftsmen and doctors from the primary care body which represent local G.P.s. The report that accompanies this proposition sets out the background to the current proposals in some detail. To briefly set the scene, there is currently no local governance of G.P.s working in Jersey. As I have said, recent changes in the U.K. mean that this system is no longer acceptable to the U.K. General Medical Council. All our local G.P.s are registered with the G.M.C. and to ensure that they can continue to be registered, a system of local governance must now be established. Self-regulation by G.P.s has been considered but it does not provide the arm's length governance structure required by the G.M.C. The only way in which local G.P.s can continue to be licensed by the G.M.C. is for the States to create this appropriate governance structure within which doctors can operate. This situation was originally set out in the debate on P.36 and at that time commitments were made by the Minister for Health and Social Services, by myself and by G.P.s to move forward in a number of areas to prepare for this new governance framework. Specifically, of course, that proposition increased the value of the medical benefit to enable G.P. practices to improve their organisation and infrastructure in advance of this new structure. Since May of last year, the 2 departments have continued to work very closely with local G.P. representatives and significant progress has been made in each key area. The States have agreed the Medical Practitioners' Law, as I have just said, which sets up a general framework to license and regulate all doctors working in Jersey, not just those in general practice. G.P.s themselves have been developing the way in which they record patient information and enhance their practice organisation and infrastructure and good progress has also been made on a specification for a central database which will hold clinical data providing important information both for individuals and in respect of the health of Islanders as a whole. This proposition represents another important milestone on the road to achieving that high quality modern primary care system. The changes proposed today cover 4 main areas. First, Performers List. A G.P.'s Performers List will be set up identifying doctors who are allowed to practise in this Island. To remain on the list, G.P.s must pass a regular appraisal and a periodic revalidation. The details, however, of the Performers List will be drawn up by the Minister for Health and Social Services who will return to the States with regulations outlining those details for approval by Members in 2012, which is next year. Second, patient registration. In future, local residents will register with a main practice of their own choice. They will still be able to visit a different doctor or practice whenever they choose. However, the main practice will be responsible for recording key information about those individuals. Thirdly, contracts. The Health Insurance Law will be expanded to allow contracts to be set up with G.P. practices. The first contract with G.P. practices will be the quality contract as proposed last year. The uplift in medical benefit will be withdrawn and an equivalent sum will be payable but only to those practices that meet the required quality level. My officers will take the best possible advice from both local, U.K. and international doctors to create a straightforward workable system. Future contracts could, of course, cover areas such as chronic disease management and child development and in future a G.P. could employ a nurse to undertake routine  monitoring of patients. I have also taken the opportunity of providing  for contracts with pharmacists as well as G.P.s. In other countries, much greater use is made of the skills, training and experience of qualified pharmacists. Fourthly, a governance team. This change is to provide for the cost of a primary care governance team funded from the Health Insurance Fund.  The team will maintain the Performers List and will draw up and maintain contracts with primary care providers. These initial regulations were lodged on 9th August but, since that date, I have had further discussions with colleagues in this Assembly and with local doctors and those discussions have led to an agreement to lodge various amendments to these regulations. I am pleased that we have been able to engage in positive negotiations with both G.P.s and others representing their views and I believe that the amendments that I am putting forward strengthen my original proposals. So to sum up, the proposed changes will ensure that patients in Jersey can continue to receive a good standard of care from their G.P. G.P.s will be able to work within an appropriate local governance framework and Jersey will be able to continue to operate under the overarching structure of the General Medical Council in the United Kingdom. I am pleased and quietly excited to be able to propose this proposition which I see as the foundation of a modern, high quality primary care service in Jersey and I ask that Members will support it.

The Bailiff :

Are the principles seconded? [Seconded] Does any Member wish to speak on the principles?

2. Senator P.F. Routier:

Only to say that I am very excited by this rather than quietly excited. [Members: Oh!] I think this is an amazing step forward for the primary care of our Island. It has been something that has needed to happen for a long time and I can only congratulate the team that have worked on this that have brought this forward and hopefully everybody will get solidly behind this and have a full endorsement.

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

Yes, on the scale of excitement, ecstatic to quietness, I am again in the Senator Routier direction. I know the Minister has treated this whole thing as "softly, softly, catchee monkey" because of the politics and because of the controversy over the insurance fund from whence it is being financed but I wonder if the Minister would tell us whether there will be any transparency to the whole notion of G.P. performance lists. I am not suggesting we move, as in Education and areas like that in the U.K., to league tables and become slavish adherents to them but I would like to know what will the public be told about the movement that is occurring on and off that list. His quiet excitement talked only of the possibility of nurses doing some of the work but as he well knows, of course the shift to practice nurses in jurisdictions like the U.K. and Guernsey has been a major issue and it has really started to bring down well, sadly, it has brought down medical costs because the costs of G.P.s are so horrendously high now in the U.K. because of what happened with a previous government. But could he tell us what his plans are because he couches that in terribly mild terms and can he up the ante on excitement in that area?

4. Deputy F.J. Hill of St. Martin :

The Minister made a comment about the fact that the proposition was lodged on 9th August and that he took notice of some of the concerns that had been raised by some of the Members but I do not think he filled all Members in with really what happened because again, bearing in mind yesterday my proposition was defeated on the grounds that there was this lack of consultation, and yet here we have quite a major piece of legislation coming to the House without, it would appear, the right consultation. It is all very well nodding heads but it is a fact because I was contacted soon after the lodging of the proposition by a group of doctors who claimed, of course, that their concerns had not been addressed. I did email the Ministers and all States Members that I was going to ask for the matter to be deferred to ensure that there was a proper consultation and I am grateful for at least 2 or 3 Members who are in the House who emailed their support because they too were concerned about a piece of legislation being rushed through at the behest of a larger group of doctors without every consideration given to the smaller group who, I believe, had a genuine right to express their concerns. Those concerns have now been addressed via the amendment and I compliment the Minister on taking notice of the concerns, certainly of mine and those raised by others. So indeed I am much happier now that we have a piece of legislation which is going through as a result of consulting with those who may have a minority voice but, at the same time, it was a very important voice because what we now have is a piece of legislation which will be monitored by the States and not by the Minister for Health and Social Services. It will come through via regulations and not by orders. Quite a simple piece of legislation but, at the same time, quite an omission when one considers the importance of this piece of legislation. But that said, again, I compliment the Minister for taking notice of the concerns that were raised. We now have a piece of legislation which I think is a far better package coming forward to the House. I did attend the briefing yesterday and I did not have enough time, or there was not enough time; I should have asked one question more from me, but I would raise it now and it was the infamous financial and manpower considerations. It always seems that when a Member or Back-Bencher brings a piece of legislation forward, the proposition is taken or torn to shreds by the lack of information from financial and manpower implications. Here again it is quite all right for a Minister to come forward and, again, just giving a lot of information here about the manpower implications. I just ask, it says: "As set out, the costs of primary care governance team is estimated to be up to £200,000 per annum. This cost will be borne by the Health Insurance Fund." Of course, it goes on to talking about another maximum £1.5 million but again there is not a lot of detail. But we also know that in the last paragraph it says: "The primary care governance team is estimated at 4 full-time employments which will be accommodated from within the Social Health Department overall manpower total." So does this mean that we are going to employ 4 new people to operate this and,

if that is the case, is it only going to cost £200,000? [10:30]

Again, if Members are looking to see what I am talking about, they may look to page 7 of the main proposition. Again I was subjected to quite a number of questions yesterday about the manpower implications when I said there were not any but here we have something which is going to cost £1.25 million plus and another £200,000 and yet it is only covered in a matter of a few lines without the full information, so maybe a bit more of that.

5. Senator S.C. Ferguson:

As the Minister for Social Security has stated, this is an enabling law and, as Wellington said: "The devil is in the details." As the Deputy of St. Martin said, there were problems when the law was lodged. It was not clear to all G.P.s that this was an enabling law and that the real meat of the subject will come when the details of the Performers List I wonder if there is another name we can have for that because it sounds like the list for the Opera House or something. It is perhaps an unfortunate title. The Q.I.F. (Quality Improvement Framework), the real meat will come when the details of these are thrashed out because superficially the concept of the Q.I.F. is somewhat draconian. Is it really fair to penalise the performance of G.P.s with regard to the behaviour of their patients? As we all know, unless I have misunderstood it in my discussions (the Minister is shaking his head) that if the quality of work is based on the performance of G.P.s which is the way they can deal with patients and we all know there are patients who will refuse to modify their behaviour until they are brought in by ambulance, so that there was a feeling among the G.P.s that they were going to be penalised for this. I have been in contact with both sides of the G.P.s to

discuss the concerns which have been addressed in the amendment which the Minister has brought because, if the changes that we are proposing are viewed as putting together information in order to make our primary health care even better, then this is absolutely right. But it has got to be remembered that the changes must incorporate the patient and his or her concerns. Modern thinking and evidence is that an informed patient yields better results. With the greatest respect to the profession, the days of doctors being God are over; the patient should be the centre of the treatment, it is their concerns that should be pivotal to any changes. We have spent many years ensuring that advisers in the finance industry know their client, it is even more important that G.P.s know their patients. In other words, it is also necessary that doctors should treat their patients holistically, particularly with the new demographics; in other words, treat the patient not the individual disease. Specialist work will be affected in the hospital. The object of primary care is to keep patients out of hospital, which is what most people want anyway. The importance of a viable primary care system cannot be overestimated and the work that has been done indicates that a good primary care system has generalist family positions, long-term person focused care, comprehensive care for most common conditions being met through the primary care and treatment for uncommon conditions co-ordinated through the primary care physician. We have got a very good system in Jersey but like all systems, it could be better. The important factors are that people receiving care for common conditions from primary care physicians rather than specialists are healthier, and areas with higher rates of primary care physicians to population have lower total health care costs, which is always good. This law will enable us to give our primary care system its correct emphasis. There is a great deal of work to done on the underlying regulations and it would be as well if we do not slavishly follow the U.K. The President of the Royal College of G.P.s, Dr. Claire Jackson , and other G.P.s have been highlighting the problems with the U.K. proposals. I understand (and Members will have had an email to this effect) that there will be a seminar on our new proposals in January when Dr. Iona Heath will attend. She has been one of the leaders in trying to make the U.K. system work and this input will enable us to tailor the system to suit the Island and not just cobble together a copy of the U.K. which is going nowhere at the moment, I understand. The information which we will get by the new information system will enable us to get a much better understanding of the pressures and attributes inherent in our primary care environment. There has been a lot of useful research into primary care systems and it is intuitive perhaps but not always understood, I think, within the industry. What they have found is that improving primary care reduces health costs, which is a win-win situation, but we have got to have good information in order to understand the system. As the Minister said, there is a very good information system which has been developed by the G.P.s themselves at a much lower cost than was estimated and it worked jolly well. I have seen it in operation. There has been work in Camden New Jersey and they found that careful analysis of patient information has improved outcomes for patients and reduced costs. They found that there were health hotspots in certain areas. There were certain areas where, for instance, every child was having its tonsils out or 63 per cent of the children. You go into the area next door which is 100 yards down the road and only 5 per cent of the children are having their tonsils out. What is the variation? Why is it there? John Vanberg in the U.S. has also examined the variation in treatments between G.P.s and the N.H.S. has now got the first geographic variation analysis for primary care trusts based on Vanberg's project and we need to be able to do the same kind of analysis here. For instance, why do we shift so many old people into residential homes? Are there no alternatives? This proposition will give us the information and structure to enable us to make a start towards an even better primary care system based on the evidence and I

thoroughly recommend this proposition to the House.

6. Deputy M.R. Higgins of St. Helier :

Although the main part of my question has been asked by the Deputy of St. Martin, there was reference in the paragraph that he mentioned that the primary care governance team would also be supported by an external specialist or external specialist support from 2 national bodies: the N.H.S. Primary Care Commission and National Clinical Assessment Service. I would like to know if they have entered into any contracts with these bodies and, if so, if the cost of the support is part of the estimated £20,000 cost or, if not, what it will cost for their specialist support. Another area that I would like the Minister in fact, I would draw Members' attention to (which I would love some elaboration on) is the reference in Article 20(b), which I know we will be coming on to Articles later, but it was to do with the cost of the allocation of drugs and whether we are going to be going to route of N.I.C.E. (National Institute for Health and Clinical Excellence) where some external body is going to be recommending what drugs doctors can or cannot prescribe. So I would like that [Aside] okay, that is fine, that answered my question for that one, thank you.

7. Deputy A.E. Jeune of St. Brelade :

I have to endorse a lot of what Senator Ferguson has said here this morning and I do understand some of her concerns but common sense has also got to take its place when assessing G.P.s. As a nurse, I will always advocate patient first and, in so doing, we have to ensure that practitioners are appropriately regulated and this proposition will do that. I would like to reassure Members that the Minister for Social Security has worked very closely with the General Practitioners here in the Island to ensure that we are all working together for the common good of the people of the Island. I would also like to pick up on the comment of Deputy Le Hérissier in relation to the Health Insurance Fund and I would like to remind Members of my understanding of what the F.P.P. (Fiscal Policy Panel) said at their last meeting with us in that, if I understood them correctly, they warned about - and to use my words - any raids on the Health Insurance Fund, and I ask Members to keep a close eye on that and I am sure the Deputy of St. John, who will be the Connétable of St. John, will do so.

8. Deputy G.P. Southern of St. Helier :

I have risen to my feet just to note that the Health and Social Security and Housing Scrutiny Panel have examined this issue and are appreciative of the somewhat urgent nature of the fact that we have to have some control mechanism quality control of our G.P.s in place if we are to co-exist with the U.K. regulations. This issue was brought to our attention, I suppose, by the furore over the use of the Health Insurance Fund earlier in the year, but it is now satisfied that this is an appropriate measure and a way forward which can deliver better outcomes for our Health Service on the Island. Obviously, it relies on the modernisation of G.P. practices to involve more nurses in primary care in routine monitoring, in doing prevention work and also, I was pleased to see here, the possibility of involving pharmacists in the administration of primary care especially, because they have a different type of contact with the public. So it is obviously important that we do deliver services properly in the community but in order to do that (and I do not think anybody has mentioned it yet) what we have to do is bring the price of that care down. The fact is that currently on this Island, may people live in fear of falling ill because of the size of the G.P. bill that they will meet and many people already on this Island avoid going to the doctor at all costs. They certainly do not go for routine check-ups and they do not go even when they fall ill. They cross their fingers and hope they will recover this time. That is the reality and the single thing that is doing that is the high cost of G.P. visits. Now, if this can deliver better health care in the community at a lower price, then it will indeed be a step forward. If it fails to do that, then it will be a failure because nobody will be able to on their own control their own health without assistance from the professionals. What I look forward to seeing in the future as this new scheme develops is that the Minister for Social Security, whoever he or she may be, along with the Minister for Health and Social Services, whoever he or she may be at the time, will be working towards the delivery of better health care at a lower cost. That is absolutely essential or else we will fail on this Island. I look forward to it, I expect it, it must happen.

[10:45]

9. Senator B.I. Le Marquand:

My colleagues on the Council of Ministers, I think, can confirm that I have generally been very good as a Minister in not trespassing on to their areas but in this particular area I did get involved and I thank them for their patience with me because I did become aware that there were concerns among some of the G.P.s in relation to this. I am pleased to say that by virtue of the amendments which have now been put in place, those concerns have now gone away for the present but there still remain issues which will need to be handled by the 2 Ministers with great care. I commend and I congratulate the Ministers and their colleagues on the work that they have done but there are issues which will need to be got right for the future and those are really in 2 different areas. Senator Ferguson has gone into much more detail than I propose to do on some of these areas. The very core of the proposals there are 2 aspects to it. The first aspect is the Q.I.F., sometimes called QIF standards, and it is absolutely vital that we get these right and that is why there is a need to take advice from people like Dr. Iona Heath and others from outside the Island who have a very good balanced experience in relation to this. If we get the standards too low, then they will merely be requiring doctors to do the blindingly obvious and will have no value. If we, on the other hand, set them at too detailed a level, then there is a significant danger of cutting across the ability of individual doctors to understand their patients and the needs of their individual patients, and that is where the tension will always lie: between quality standards on the one hand and the proper discretion of doctors on the other. So I flag that up again. I am well aware that the Ministers are both aware of these issues and I am grateful for that. The second area which has got to be got right is the procedural area which will now be covered by regulations. I believe that is absolutely right it be covered by regulations so that the whole of the States will have a say in relation to this. There are some difficult issues to get precisely right, particularly the key role of the responsible officer who is the person who will run the revalidation scheme. Now, I personally believe that it is very important. I had a conversation yesterday with the Minister for Health and Social Services and was very much comforted by her complete understanding of this issue. It is vitally important that that person be sufficiently independent, both from the management of the Health Service on the one hand and from the primary care body on the other so that there can be a proper and objective test of the competence of individual doctors. So I am wholly supportive of this. I am very pleased that we are now able to go forward with, I believe, agreement from all the groups of doctors and I will

support the amendment as well.

10. The Connétable of St. Brelade :

I think there is a risk of losing the old-fashioned G.P. who has developed a professional relationship with their patients over the years in that there will be an advantage to be a part of the big impersonal practices which we have seen develop over the last few years. There is no doubt that, as nurses are regulated, it seems logical that G.P.s are as well, but I know that G.P.s (I refer to the smaller groups) do not really particularly appreciate a continued increase in bureaucracy and I think this proposition does tend to lean that way. While I shall support the proposition, I would ask the Ministers involved to keep a close watch on the costs and I would urge that their departments conduct regular consultations with the G.P.s to ensure that the regulatory framework does not become too top heavy and that it remains effective.

11. Connétable D.W. Mezbourian of St. Lawrence :

I rise to support this new law. In my very brief time at the Health and Social Services Department, it was one area that was raised as being of importance and needed to be brought forward and I am pleased to see that it has indeed been done. But to follow on from my colleague, the Constable of St. Brelade, he has just mentioned the fact that we may lose the old-fashioned type of G.P. and medical service. I think that could become the case when the health care professionals are introduced into this primary care type of practice, the nurses that will be doing the blood tests and things like that, and I just wonder whether the Minister will be able to advise us how this has been planned for by the 95 or so G.P.s that are over here. Do we have enough registered medical health care people to undertake this work or will we have a need to bring professionals over to work in the G.P.s' surgeries?

12. The Deputy of Trinity :

I shall be brief. I just really wish to rise to thank people for supporting the Minister for Social Security and I add my thanks to him too. It is an important proposition and it just shows that the 2 departments over the last year have been working very closely together. As has been said by most people here, this proposition is vitally important. It is a piece of a jigsaw puzzle to really improve the future of primary care in Jersey. I know the Minister will be summing-up and then mention the points but there has been consultation with the G.P.s not only with the Social Security but also with my well, the States of Jersey Medical Officer of Health and myself we have gone round most G.P. practices. Deputy Southern is quite right that the aim must be to first of all improve the care of health within all Islanders but we also need to look at the cost. To pick up Senator Le Marquand's point about the responsible officer, his point he and I did have a chat about it yesterday. It is vital that that person is independent not only because of the G.P.'s point of view and the Health and Social Services point of view but also in his responsible role, and it is set by statute towards the G.M.C. to revalidate G.P.s. Just to finish, this House over the last 3 years has made a significant change in healthcare by putting all the pieces together and including the Medical Practitioners Law, and that law will change primary care where nurses and allied health professionals can prescribe and be more proactive in the primary care and that can be nothing but of benefit for all Islanders and I cannot stress that highly enough. So it is an important day and if it is approved, it is a great day for the health of all Islanders and I will leave it there.

13. Deputy J.B. Fox: