States Meeting Transcript - 18th January 2012

STATES OF JERSEY OFFICIAL REPORT WEDNESDAY, 18th JANUARY 2012

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

1. Health Insurance Fund: transfer to Health and Social Services Department for 2012 (P.185/2011) - continued..................................................................4

1.1 Connétable P.J. Rondel of St. John : ......................................................4

1. Connétable J.M. Refault of St. Peter:....................................................4
2. Deputy R.G. Le Hérissier of St. Saviour:................................................7
3. Deputy J.A. Martin:......................................................................7
4. Deputy C.F. Labey of Grouville :.........................................................8
5. Deputy S.G. Lucas of St. Martin:........................................................9
6. Deputy J.H. Young of St. Brelade:.......................................................9
7. Senator P.F.C. Ozouf :..................................................................10
8. Senator I.J. Gorst :......................................................................12
9. Deputy M. Tadier of St. Brelade:.......................................................13
10. Deputy J.G. Reed of St. Ouen : ......................................................15
11. Deputy P.J.D. Ryan of St. John : .....................................................15
12. Deputy M.R. Higgins of St. Helier:..................................................16
13. Deputy J.A.N. Le Fondré of St. Lawrence:..........................................16
14. Deputy T.A. Vallois of St. Saviour:..................................................17
15. Senator F. du H. Le Gresley:........................................................17

2. Draft Cold Weather Bonus (Jersey) Regulations 201- (P.186/2011) ...................20

1. Senator F. du H. Le Gresley (The Minister for Social Security): ........................20

1. Deputy G.C.L. Baudains of St. Clement : ...............................................21
2. Deputy R.C. Duhamel of St. Saviour:..................................................22
3. Connétable D.W. Mezbourian of St. Lawrence:........................................22
4. The Deputy of St. Martin:..............................................................22
5. Deputy K.C. Lewis of St. Saviour:......................................................23
6. Senator F. du H. Le Gresley:............................................................23 Deputy K.L. Moore of St. Peter (Chairman, Health, Social Security and Housing Scrutiny Panel):..................................................................................24

2. Senator F. du H. Le Gresley:............................................................24

1. The Connétable of St. Lawrence:.......................................................25
2. Connétable J. Gallichan of St. Mary : ...................................................25
3. Deputy R.C. Duhamel: .................................................................26
4. The Deputy of St. Martin:..............................................................26
5. Senator F. du H. Le Gresley:............................................................26 The Deputy of St. Martin:....................................................................27 Deputy G.C.L. Baudains:.....................................................................27 Mr. T.J. Le Cocq Q.C., H.M. Attorney General: ..............................................27 Deputy M.R.Higgins:........................................................................27

STATEMENT ON A MATTER OF OFFICIAL BUSINESS ................................28

3. Statement by the Minister for Education, Sport and Culture regarding grants to St. Michael's and St. George's schools......................................................28

3.1 The Deputy of St. John (The Minister for Education, Sport and Culture):..............28

1. Senator L.J. Farnham :..................................................................29
2. Senator L.J. Farnham :..................................................................29
3. Deputy J.A. Martin:....................................................................29
4. Deputy M. Tadier :......................................................................30
5. Deputy M. Tadier :......................................................................30
6. Deputy G.P. Southern :..................................................................31
7. Deputy G.P. Southern :..................................................................31
8. Senator S.C. Ferguson:.................................................................31

PUBLIC BUSINESS - resumption..............................................................31

4. Draft Cold Weather Bonus (Jersey) Regulations 201- (P.186/2011) - resumption ....32

The Attorney General:........................................................................32 Deputy G.P. Southern :........................................................................32

1. Senator F. du H. Le Gresley:............................................................32
2. Senator F. du H. Le Gresley:............................................................33

1. Senator P.F. Routier: ...................................................................33
2. Senator F. du H. Le Gresley:............................................................34 The Deputy of St. John:......................................................................34

5. Planning Applications Panel: appointment of members (P.189/2011).................34

5.1 Deputy R.C. Duhamel (The Minister for Planning and Environment): ..................35

1. Deputy J.H. Young:....................................................................36
2. The Connétable of St. Lawrence:.......................................................36
3. Deputy M. Tadier :......................................................................36
4. Senator P.F. Routier: ...................................................................37
5. Deputy R.C. Duhamel: .................................................................37

6. Jersey Employment Tribunal: appointment of members (P.190/2011) ................39

6.1 Senator F. du H. Le Gresley (The Minister for Social Security): ........................39

1. Deputy J.H. Young:....................................................................40
2. Deputy F. du H. Le Gresley:............................................................40

7. Jersey Police Complaints Authority: appointment of member (P.191/2011)..........41

7.1 Senator B.I. Le Marquand (The Minister for Home Affairs): ...........................41

1. The Connétable of St. Lawrence:.......................................................42
2. Deputy M. Tadier :......................................................................42
3. Deputy B.I. Le Marquand:..............................................................42

8. Jersey Overseas Aid Commission: reappointment of non-States commissioner (P.194/2011)..............................................................................43

8.1 Senator P.F. Routier: ...................................................................44

8.1.1 Senator I.J. Gorst :......................................................................44

9. Jersey Financial Services Commission: reappointment of commissioner (P.193/2011) ...........................................................................................45

[Debate proceeded in camera] ................................................................46 The Deputy Bailiff :...........................................................................46 [Debate proceeded in camera] ................................................................47

ARRANGEMENT OF PUBLIC BUSINESS FOR FUTURE MEETINGS ....................48

10. Connétable A.S. Crowcroft of St. Helier (Chairman, Privileges and Procedures Committee): ............................................................................48

10.1 Deputy I.J. Gorst : ......................................................................48

ADJOURNMENT................................................................................48

[9:30]

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

PUBLIC BUSINESS – resumption

1. Health Insurance Fund: transfer to Health and Social Services Department for 2012 (P.185/2011) - continued

The Deputy Bailiff :

We now resume debate on P.185 - Health Insurance Fund: transfer to Health and Social Services Department for 2012 - and I call on the Connétable of St. John .

1.1 Connétable P.J. Rondel of St. John :

Like previous speakers yesterday afternoon, I have some real concerns over this particular item given the Health Insurance funds belong to the people of Jersey who have been paying social security. They are not there to be raped by the Minister for Treasury and Resources Department. As Members will know, in fact I took this a bit further but, although I am told by the Chief Minister that this has been resolved with the Privy Council, I have not been notified officially. When people pay social security we know what the money has, in the past, been put away for. It is for our health and also for our pensions. Listening to the Minister for Health and Social Services yesterday when she gave us a résumé of the work the department undertakes and said everything had been audited, when somebody goes and sees a G.P. (general practitioner) who has never paid social security but they are getting their hands indirectly on some of these funds, I have got some real concerns. We are talking about the smoking strategy, and so on, that the money is being used for and I do have concerns because this would be treating, in part I am sure, people who have never paid into our social security funds. You can audit things in a number of different ways and I do have some real concerns. I did not support the first tranche. I am definitely not supporting the second tranche because I believed, and I still believe in my heart of hearts, we are not working in the best interests of the people who put the money into these funds. It is their money and we are the guardians of it. We should not have taken any money out of that whatsoever to bail out the Treasury Department. It was for the Health Department, as far as I was concerned, to make sure that their budgets were such and for the Minister to fight her corner within the Council of Ministers to get the amount of cash she required to run her department. In another time or another place we are told, and I was told outside in the Members' room this morning, that this will be the last time this will be allowed to happen. This was told to me by the Chief Minister. In my book, it should not have happened in the first place. Over £12 million will have been transferred out of Social Security funds to bail out

another department. I cannot support this and I definitely will not support it.

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

I am pleased to follow my very good colleague and friend, the Connétable of St. John , as we shared the same view, but that was over a year ago when the previous Minister for Social Security did a presentation and I remember being quite aggressively against the principle at that time, not knowing the full implications. When it came to the vote, I grudgingly went with it because I was not prepared to see Health and Social Services not get the funding they required. Since that time Members will be aware that I have now become an Assistant Minister for Health and Social Services. I have seen the work that needs to be done and is ongoing from the inside and I appreciate where the spending pressures are much more focused now. I would urge Members that have not committed to coming along to the Health and Social Services presentation later this week to do so, so they can see for themselves the complexity of the work and the funding pressures that are required. Coming to the matter under debate, the crux of the issue is that the Health Insurance Fund is in place to fund aspects of primary care services, not hospital or social care services. There are a number of States Members, some of whom have already spoken, who fundamentally oppose

this transfer, seeing it as nothing more than a raid on Social Security monies that it is not entitled to and transferring them from the Health Insurance Fund to Health and Social Services. The fund was approved for 2011 and it was envisaged that the same would apply for 2012, subject to your agreement today. A key point I need to advise Members of is that Health and Social Services in fact provides a lot of services that, in other jurisdictions, would be considered to be primary services; in other words, services provided in a non-hospital setting and funded accordingly. Funds provided to hospitals and these places would not be used to fund primary care services. Examples of primary care services would include community nursing, for example district nurses, health visitors, school nurses such as those provided by Family Nursing and Home Care, which costs Health and Social Services around £5 million per year, vaccinations and immunisations, contraceptive services and community dental services. In preparation for last year's debate, Health and Social Services identified a wide range, considerably in excess of £6 million worth, of primary care services that we provide and fund from the H. and S.S. (Health and Social Services) budget. This list was discussed with the primary care body representing G.P.s on the Island and I have been awaiting that figure for 2011, because they have been audited and checked, but Health and Social Services has spent around £9 million in 2011 on what would otherwise be considered primary care services. By funding these primary care services from the Health Insurance transfer, we were able to free up some £6 million of Health and Social Services monies to invest in additional hospital consultants and middle-grade doctors' contracts, provided the general 2 per cent growth that deals with drug inflation, new drugs and pressures from an increasing number of overseas transfers, et cetera. The point to note is that, by transferring the responsibility to G.P.s under an S.L.A. (Service Level Agreement) for childhood immunisations, we saw in 2011 a significant increase in the number of children vaccinated and our levels of coverage now exceed the U.K. (United Kingdom) and stand in good comparison with other European states. We are, therefore, making good our commitment to move more service provision and funding into primary care. We expect to place

new S.L.A.s for smoking cessation services with primary care practitioners during 2012, this year. The only thing I would add is that it was agreed that the Health Insurance money would transfer from Social Security to the Treasury, not direct to Health. Treasury would then remit to Health based on certain verifiable information on the actual expenditure given. This is then fully audited at the end of the year and this was done in 2011 and found totally appropriate. In short, the H.I.F. (Health Insurance Fund) transfers are required to fund services provided in Health and Social Services that are effectively primary care services, the rationale being that they could legitimately be provided by primary care professionals in a primary care setting. These primary care services have developed in Health and Social Services over time because they are free to patients, whereas attending a G.P. has a cost implication for the patient. The consequences of Health and Social Services not receiving the £6.1 million from the Health Insurance Fund to compensate the reduction in the Health and Social Services consolidated cash deployment funding is that the Accounting Officer will not be able to provide the current range of services within the reduced funding. From a Public Finances (Jersey) Law perspective, once the Accounting Officer makes this assessment, a plan would have to be produced that clearly articulates which services will be reduced or expenditures constrained as a consequence of the funding not being available. This is required so that Health and Social Services remain within the law and deliver services within the approved cash limits. Members will also be aware of the considerable case for change set out in the Green Paper, Caring for each other, caring for ourselves, and will know of the significant pressure for

investment in Health and Social Services in order to continue to provide services in the face of growing demand and to modernise the service and buildings for the future. The removal of the Health Insurance Fund transfer would result in significant cuts to services that are already under considerable pressure. Moving now to respond to Members' comments yesterday on the Green and White Papers. We had a positive consultation process with strong support from the public, well over 80 per cent supporting Scenario 3. Since the end of the consultation in August last year, we have developed a draft White Paper setting out what we plan to do in some detail to make Scenario 3 a reality. This is not yet in the public domain for 2 reasons; firstly, the election and the formation of the new Council of Ministers and the development of the States' Strategic Plan which has, quite rightly, taken priority and which includes the modernisation of Health and Social Services, a chief priority for the States. Secondly, we are working with colleagues in the Treasury on the development of the Funding Options Proposal for discussion at the Ministerial Oversight Group of the Council of Ministers in order to inform a Health and Social Care funding policy paper to be issued at the same time as the White Paper.

[9:45]

However, while we await these outcomes, we have been busy during this period and have developed a 10-year transition plan that details what we will do, in what timeframe and what it will cost. This also sets out the underpinning cost-cutting work on workforce planning, commissioning, informatics and estates that will be needed to make a reality of Scenario 3. The transition plan sets out actions in each of the 3 medium-term financial planning periods of 2013 to 2015, 2016 to 2018 and 2019 to 2021. In addition, we have developed 7 key priority work streams and associated outline business cases to set out the actions and costing for specific early development in the 2013 to 2015 timeframe. These 7 include: healthy lifestyles, starting with the alcohol pathway; children, starting with early intervention and preventative services; adults: mental health, starting with increasing access to psychological therapies, cognitive behavioural therapies delivered in primary care settings - this has had good success in the U.K. in getting people off benefits and back to work; adults: community-based services, long care conditions, starting with the C.O.P.D. (chronic obstructive pulmonary disease) followed by heart failure and diabetes; older people: mental health, starting with dementia services; older people: community-based care, starting with intermediate care services such as "step-up, step-down" services and telehealth in the home; end-of-life pathway, developing primary community-based services and broader access to hospice-type care and beds. Some States Members may cite the absence of significant on-the-ground change as meaning the Health and Social Services Department is failing and will continue to fail to deliver. However, there are 2 points to consider here. We are asking the States to commit to finding a way to provide us with significant ongoing funding. There must be a comprehensive robust plan against which we can be held to account for delivery and to show we are doing the right things for the right people in the right places with good value for money and doing it safely. This cannot be rushed. Secondly, at the moment there is no additional money on the table and will not be until a funding stream is agreed and established. This will be challenging and will take some time. We are working closely with our colleagues in Treasury to try to ensure the business case at least can start to be implemented between 2012 and 2014 and, at the same time, work hard to deliver our White Paper in co-ordination with the Treasury's funding policy paper around the middle of this year. If I can just, finally, comment on the sort of pressures that come under the Health and Social Services budget. Those Members that were at the Home Affairs briefing yesterday lunchtime will recall I asked a question of the Minister for Home Affairs about the funding for criminal activity where the perpetrator has to end up in a special facility in the U.K. People in those cases suddenly spring a deficit on the Health and Social Services budget of £300,000 per person per year. We cannot plan for these unforeseen events of that sort of magnitude. If we were to go back to around about 2 years ago, we discussed in this house family X and about putting them in the U.K. at about £1 million per year to look after them. However, the last cost I was advised is nearer now £1.5 million. That is just for family X. While these things are relatively unique, it is not unfeasible to expect them to happen again in the future. These are pressures we have to face in Health and

Social Services.

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

I must congratulate the Constable of St. Peter on reading out that speech. I am not sure it was entirely his own, quite cleverly crafted but read at high speed. It was an attempt obviously to pull on the heartstrings and I do not deny that Health is under enormous financial stress. I did support this move enthusiastically when Deputy Gorst came with the first tranche of money and the reason I did is I thought it was wonderful - and I still do - that the health service was moving to primary care and the glacial speed or non-speed with which we had dealt with G.P. reform was, at long last, history and we were moving to primary care through practice nurses and people like that. There was going to be a different way of addressing care and the fear that people had of going to the doctor, the continual charges that they faced, we would gradually start, like the proverbial oil tanker, setting that oil tanker in another direction, albeit very slowly. I thought that was great, so with a peg on my nose, as a previous occupant of this seat used to say, I decided to vote for it because I thought those were good reforms, long, long overdue. But what I am worried about now is it is now being justified as primary care and I notice the Treasury have been elevated the experts in defining what primary care is, according to the audit arrangements outlined. It is now being defined as primary care but, as Senator Breckon said yesterday, who has made the decisions as to where the money will go other than dealing with an urgent C.S.R. (Comprehensive Spending Review) deficit situation as outlined by the Constable? Who will make the decision? There has not been a proper debate on whether we should be giving, for example, as Senator Breckon said, more support to dental care, dental preventative work, for example; whether we should be whizzing around the countryside in Deputy Breckon's mobile clinic to try and get to the root of the problem and so forth. There has not been that discussion. All this is it is a cover-up for a deficit that has been emerging, admittedly, for years and years and years. It is a cover-up for a deficit and I do regret that there has not been this proper debate. I am very, very supportive of the direction Health

is trying to take primary care in, but all we are doing is just cementing in place the current system. We are not using this opportunity by launching a proper discussion, which I have no doubt the Minister will say will come through the Green Paper, on where the money should go. We are just filling a gap very urgently. As I said, I regret having to say this because I was really supportive, for mixed reasons, of phase 1, but phase 2 looks a lot more uncertain and the rationale for it, quite frankly, I get the impression it is being put in place as we go along, so to speak; that there is not a solid policy rationale.

3. Deputy J.A. Martin:

It is always good to follow the expert on everything and obviously now he is the expert on primary care. Of course, we will be discussing what we should be doing in this House, as we usually do. I will leave that expert there because he accuses Health of just filling a hole. Well, if we were filling a hole I am telling you now we would be asking for a lot more than £6.1 million because the hole we have created in a law that is 47 years old was very, very narrow. I think it is in the title. It is the Health Insurance (Jersey) Law. Years and years ago in Jersey, and we have just got them coming this way now, you had one practice with one doctor in them and they did not do anything else. Senator Ferguson and Deputy Le Hérissier said, in both speeches, it is taking too long. It has taken a long, long time to get this body of people to work together, to have proper presentation and talk to Health. They work as a business. We have come a long, long way since Senator Ferguson was on Health. She knows the difficulties, but we have come a long way. Deputy Le Hérissier and Senator Breckon talk about: "What should we be doing?" Well, we do primary care. We do free dental care in the hospital for any child under 11. We do dental care through orthodontists up to the age of school leaving. This would not be done in any hospital in the U.K. It would be done by primary care. Senator Ferguson, amazingly, thought yesterday that antenatal check-ups have suddenly gone over to G.P.s. G.P.s have always done antenatal and postnatal checks. They cost the price of a consultation and sometimes double the price, because of the length of the

consultation, and a lot of people choose not to pay the full £80. They go to the antenatal clinic and that is done at Health. Again, we have mentioned the immunisation. Everything we are doing good at Health, but it would be done out in the community. It would be done by primary care. Now, I have got to follow on from the Constable of St. John because, if you follow his argument through, he has a worry that there are people gaining from this fund who have never paid in. Well, then, sorry, none of your children should have had anything to do with the hospital or a G.P. up until now because they have not paid in. You have got non-working mums who probably have never paid in. Are you going to deny them any sort of health care? That is what you get if you follow the Constable of St. John's, I think now, desperate argument through because he is also still muddling the Health Insurance Fund with the Pension Fund and we cannot get it through to him that it is not the same money: "Health is raiding." Now, Senator Ferguson said Health have not done the core checks. Well, if you really want us to do the core checks what do we stop doing tomorrow? It will be £6 million worth more of services we provide and Senator Ferguson is nodding and says we should do that. Well, I would like to see us turn away people at the hospital because this is how it has grown up. As they say, if you were inventing a new services now - and we are working with the White and Green Paper - you would not start here. So we need a transition. This money, because the law has been so tightly worded, has to be a States decision. You can believe what you like. Whether you think this money is to fill a gap, I believe we should have looked at this law years and years ago. To me, the Social Security Department are a collecting agency and the Health Department, the professionals, are the ones who decide who spends this money where it is needed and this primary care needs a lot more work doing. It should be out in the community. Our hospital is getting smaller. Maybe that is also because our population - and nobody has come on this - we have just found another 5,000 people that we are trying to deal with in Health; now, whether that is primary, in hospital or for the elderly. I am watching the law on the long-term care because I have some great concerns about who that will be for, who pays in, who decides when they are too ill to be on long-term care. I will have problems with that if Social Security is deciding that, but that is for another day. What I am saying, we could look at our core services tomorrow. We could stop doing at least £10 million worth of work. It is not possible, not in this society. We are where we are. The money is there and the money has been collected from people who pay Social Security, but if you went out on the streets today and asked somebody: "What part of your tax, your Social Security or anything is paying for you to go to this or that provision when you need it," I would be surprised if anybody knew and especially if you turned around and said to them: "Well, I am sorry. We do not think we could deal with your children because they have not paid in social security or the non-working mum who has never worked, or the father." It may be a father. It is a very desperate argument from the Constable of St. John. He did not get the reply from the Privy Council because this is internal. Again, I will say, if we cannot deal with this here we should not be elected to Government. I will leave it there but it is not a dip-in. It is not a raid on the social security Health Insurance Fund; we can stop doing it

tomorrow. If that is what States decide, tell us what we stop doing. We will stop doing it at Health.

Senator S.C. Ferguson:

I would just like to make a correction. I was not agreeing with the Deputy . I was intimating that there were some quick wins that they could do to move stuff into primary care which they are not doing.

Deputy J.A. Martin:

Maybe the Senator could let the Minister for Health and Social Services know.

4. Deputy C.F. Labey of Grouville :

I voted for this transfer the first time round but I am going to change my mind. I am a woman, after all. I will try and explain to you why this is. I am going to change my mind because the first time we had this debate I had been convinced that these monies were going to be used for primary care. Not even a week later there were J.E.P. (Jersey Evening Post) headlines saying that £800,000 was going to be siphoned-off for a report produced by accountants on the state of our health care, £800,000, and I felt quite cheated after having made the decision to transfer these monies, which I felt uncomfortable about in the beginning anyway, because I feel if people pay into a fund .. I mean, nobody minds paying if they know what it is for; if it is for elderly care, if it is for a pension and they pay throughout their working life.

[10:00]

These funds were collected and I was convinced that Health was in desperate need for these monies for primary health care and then you read £800,000 goes to an accountancy practice. We can argue that what the accountancy practice produced was a good report. I am not saying that, but I do question - we have highly-paid directors and managers within our health service - why something could not have been done in that area in-house or internally. So I felt quite cheated after having made the decision to vote in a certain way. Making this decision here by, as I say, siphoning-off these funds into a different area could have the potential of opening up a can of worms. We heard yesterday the Constable of St. John saying about the state of our sea water, on environmental issues. Why should not some of these monies go towards that? That has got potential health issues. Deputy Baudains: dental care. I think, until we have decided exactly how our health service is going to be structured, we should not be switching funds from one side to the other. I cannot support this today.

5. Deputy S.G. Luce of St. Martin :

As a new Member, I did not understand fully the background to this debate, but when I read the report and proposition some weeks ago now I just wrote my comments on the front page, as I usually do. Those comments in this case were: "Decision already taken, no debate necessary." Also as a new Member, I obviously had under-estimated the ability of the Assembly to maybe find a debate where there was not one immediately obvious. Yes, it is very right that we question all spending and question that it is spent properly, but I think we need to remember that this is taxpayers' money and it is being spent on primary health care. Provided that is well and properly spent, I do not have a problem with which account that money comes out of. The fact that it is also properly audited and that this payment we are being asked to approve today is the second of 2 tranches, which is going to take us forward to a new system, also gives me assurance. This is money that is being well-spent on front line health services and I cannot really believe that Members seriously want to question spending on issues such as immunisations for our children, family nursing and health care and antenatal services. I would strongly urge Members to support this proposition.

6. Deputy J.H. Young of St. Brelade :

Having, myself, worked in the health services in the Island in the 1980s, I know that primary health care is absolutely vital expenditure to the community and also I am very familiar with the lists of valuable organisations providing the work for us - the third sector teams on page 12 of the report, which lists those funding subjects from a 2010 proposition, which up until yesterday I had not even heard of. I rise to express my concern about the funding mechanism and I am really surprised both reading the papers through and Members have emphasised it today. I question whether the way of dealing with this is good governance. It may seem, this transferring from one pocket to another, that this is just like moving wooden dollars, that it does not matter; but I think it does. Moving wooden dollars between funds will be very material to the overall position of the States financially

of whether we show, correctly, our surplus or deficit that our economy is running on public-sector spending. I will return to that in a minute. I have also been surprised in today's debate - I suppose this is influenced by being a civil servant in a previous life - of the paucity of information that has been provided to us to support this transfer. I think Senator Ferguson summed it up perfectly. We have got nothing for 2011. We have got nothing for 2012, no detail there. The detail is provided from a 2010 report, which I accept is reliable, but I would like to have more than just an undertaking that this going to be audited and, presumably, at some stage we might get to see a certificate to say it is okay. The first question I had in looking at it - I suppose it is my kind of nit- picking propensity to dive into detail - is, do those figures include the I.T. (information technology) costs, the costs of the new primary care computer system which is mentioned at page 10 of that report? I do that obviously because it is well-known that I.T. systems in the health care arena are pretty risky beasts. It is well-known that some of these are black holes into which massive amounts of money can be consumed. I see in that report - again it is a 2010 report - it says a figure of over £1 million for the costs of implementation. I would like to know, do these transfers include this or is that extra? Is that also coming out of the Health funds? I suppose I return now to the point of the deficit. I am going to raise this on another occasion but I will flag it up now and I will be listening to hear what the reply from the Minister is. In the report that the C.A.G. (Comptroller and Auditor General) recently published on the performance of the States of Jersey it shows a comparative set of figures from 2005 to 2010 and there are 4 lines there. The first line is the net general revenue income, in order words it is all of our income altogether. The next one is the net revenue expenditure, underneath that. The third line, and this is probably, I guess, where these transfers are: "other expenditure," and it says in the note: "This is spending incurred by a Ministerial or non- Ministerial department, including capitalised spend, that is subject to approval by the States." So that says to me that these are decisions by this House and then the last line is the rub: "surplus or deficit" and in 2010 the deficit is shown as £229 million. That compares to 2009 where there was a surplus of £46 million and all the other years have got a £46 million surplus. So I thought: "My word, what is going on" when I first saw that. That is a question that I will come back to and obviously seek some replies from the Minister for Treasury and Resources of what explanations are in there, but if it is right that this transfer is part of the pot of monies that is transferred over and above normal budgetary processes and budgetary disciplines, I have a concern about that. One last point: I accept all the points made that the primary health care fund .. life has changed and I think the Constable of St. John is absolutely right to tell us that the purpose of a fund was obviously to equate the income and expenditure of a vital area of public expenditure over a very long period because those liabilities do not occur in one year, 3 years, 5 years. They are long term. That is why you have a plan, to iron-out the peaks and troughs of short term and long term, but life has changed and there is no question that the way that fund is set up will need a review and some new accounting treatment. If, as a policy, that fund has to be supported by the States then it should be done properly as a budgetary subvention item including, as has asked today, projected budgets, properly planned. I think those are the things which I would like to see and I hope that the States sets its standards of governance by. I will support this transfer today because it would be very destructive, I feel, not to do so because those services are essential and have to go on. But I am really looking for some absolutely clear commitments from the Minister, on behalf of the Council of Ministers, that it will not be repeated; that this fund will be properly looked at and we will get a proper budgetary arrangement and a funding mechanism and a funding mechanism for this

absolutely vital service in the future.

7. Senator P.F.C. Ozouf :

I am very pleased to be able to follow Deputy Young. I recognise that there are strong feelings about the Health Insurance Fund but let us be frank in this debate. The necessary modernisation of our health care service took too long in order to commence. It was only since the appointment of

former Senator Perchard and then the Deputy of Trinity as Minister that the proper commencement of reform and modernisation, policy change in health care commenced.  New Directions had floundered. It made no progress whatsoever in terms of modernising our healthcare system and health care does need and was in urgent need of modernisation, not just in Jersey but around the world. Health care is changing, not only for demographic reasons. The bulging of the population of elderly people means the calls on hospitals are far greater. The advance of medical science means we have to limit, to the extent that we can, the use of secondary care by fortifying and strengthening primary health care. The frankness of this discussion is that the scope of the primary healthcare system in Jersey and the funding arrangement had not been modernised because of the absence of the necessary policy reform that did not happen in the early part of the 2000s. We have an excellent G.P. service, an excellent service that is well regarded by Islanders, but the scope of the primary healthcare system delivered in the community was not developed and not expanded. There have been many calls on the floor of this Assembly for the Health Insurance Fund to be able to pay for nurses in G.P. practices so that G.P.s did not have to do the basic immunisations or blood testing or screening. At the same time as the lack of advance of our G.P. primary healthcare system, there was, to some extent, some mission creep within Health and Social Services that filled the gap and started delivering, over a period of years, primary health care services. Because of the progress that was not made in the early 2000s, the last Assembly had a difficulty. At the same time, the Health Insurance Fund - money as the Constable of St. John should know by now, deducted from people's salary for the purposes of primary health care - was effectively rising in terms of the Health Insurance Fund and a surplus, almost an embarrassing surplus, started to be gathered on that fund; money from people's salaries not being directed towards primary health care services. Whether or not the decision was right in order to give free prescriptions, that dealt with some of the surplus - I still maintain the view that that was not the case - but what happened is 2 years ago in the business plan we had a serious crisis in terms of health care funding. We needed to find a solution and it seemed entirely sensible as a stop-gap in order to use some of the resources that had been deducted from people's wages for primary health care, subject to this Assembly's approval and subject to the law being changed, to be directed towards primary health care services that Health and Social Services was providing. It is a stop-gap solution. It is a 2-year solution, but while we progress the White Paper for the long-term arrangements for health care and we put the whole of the healthcare system on a sustainable footing. That is where we have got to and many Members will understand that that is the case. This is a temporary stop-gap arrangement which has strict controls. The Minister has asked me to agree that an Internal Audit memorandum from the Treasury on the deductions from the fund should be circulated and the Minister will address this in his summing up, but I have circulated it for Members. We do not usually release Internal Audits but Members will see this is the Internal Audit which did the review to ensure that the money that Health and Social Services was asking for, for the primary health care, was used. To the Deputy of Grouville , I must say that the £800,000 - necessary expenditure for the drafting of the White Paper; not just writing a report but building on a whole financial model for health care of the future - necessary expenditure, but not paid for out of the Health Insurance Fund. So she does not need to worry and it would be entirely wrong if it would have been used for that. It was not used for that. That was paid for out of Health and Social Services. It was not used. The money deducted from the Health Insurance Fund, as undertaken by myself and the previous Council of Ministers, was

properly audited and directed towards primary health care. [10:15]

I would say to Members, as they look down the list of the items which have been authorised, whether any Member would have any argument that this is not primary health care focused in terms of its resources. The nurses that are going out and the arrangements for family nursing and home

care, is that not primary care? Of course it is. The other out-of-hours G.P. services and the support that has been given to that, is that not primary care? It is absolutely primary care. That was the undertaking. That is the audit that has found that that is satisfactory and that will exactly be, again, the arrangements that are going to be put in place for this agreement in terms of withdrawal from the Health Insurance Fund. So Members need have no concern that there is no absolute proper independent assessment, proper oversight, proper audit, of the amounts that are paid. I accept that we should not have been in this position. We should have been in a position where we modernised the arrangements for the Health Insurance Fund and we had made a lot more progress than we had done until the new Minister has been in place in terms of modernising health care. We did not and it was a failure of the previous Assembly and the Assembly before that that they did not make progress - not the last Minister but the previous Assemblies - in terms of modernising health care. That is the reason why we are in this position. I ask Members to support the request by the Minister for Social Security to allow a further year of arrangements for direction of primary health care from the fund and that this Assembly sends the clear message to the Council that they want the White Paper for health care modernisation to happen, the new arrangements for the Health Insurance Fund, the new funding model for health care to be found during the next 12 to 18 months of the life of this new Assembly. I hope Members will support the Minister for Social Security in his request and support the Minister for Treasury and Resources in his request that if we do not find this funding mechanism for Health and Social Services, we are going to effectively cause a crisis, a problem, in health care funding. Health care is the biggest issue that faces this Assembly in terms of its funding arrangements. It was the biggest issue of the last Assembly and this was the solution, on top of the resources that have been already allocated, both in terms of revenue expenditure and capital, in order to properly care for the people that need care in our Health and Social Services systems. With those comments, I urge Members to support the Minister.

8. Senator I.J. Gorst :

I am pleased to be able to follow the Minister for Treasury and Resources because he is absolutely right and I support, 100 per cent, what he said. There have been some suggestions yesterday afternoon and this morning that progress has not been made and that Members would have liked more progress to have been made than they feel has been made and I just wanted to touch on some of the progress that has been made. I think it is only appropriate that I do pay tribute to the current Minister for Health and Social Services and her team because they have started a process which I now believe is unstoppable and it is a progress which, as the Minister for Treasury and Resources said, should have been started many, many years ago. We, as a legislature and the Government, perhaps are amiss in the fact that we have allowed health care, in many ways, to stagnate in our community in an unacceptable way. When I initially brought the proposition to transfer money from the Health Insurance Fund, I was aware of my responsibility, which now the current Minister has, of oversight and protection of the funds collected by the department and ensuring that they are appropriately used. Therefore, when I brought that proposition I time-limited it to 2 years and that was an amendment to the primary law and that is why I was able to, with confidence, tell the Connétable of St. John that this is the last time that money can be transferred from the Health Insurance Fund without another amendment to the Health Insurance Fund (Jersey) Law. It has been an open and transparent process. Every decision, initially to make a 2-year ability or 2-year window to transfer the money, was decided by this Assembly and sanctioned by Privy Council or Her Majesty in Privy Council and each amount of transfer - so the actual money that was going to be transferred - has also been approved by this Assembly. In that window the previous Council of Ministers and the current Council of Ministers gave a commitment that they would start the modernisation process, not only of the hospital and the work that Health and Social Services does but also of the primary care delivery within our community. Why am I more optimistic than some Members? It is quite simply this. We in this Assembly have made some very difficult decisions to

change laws which have been in place for many, many years and were starting to fail our community. The Minister for Health and Social Services brought forward amendments to her laws which will allow nurse prescribing, initially in the hospital but, in due course, in the primary care setting and in community clinics. The Social Security Department has brought forward legislation which modernises the way that G.P.s are able to provide care in the community. They are able to modernise their service and we have support them in that. In due course, the Social Security Department, working with the Health Department, will be able to contract with G.P.s to provide various services that we, again as a Government and Legislature, think is appropriate. The reason I raise that is because many Members in this Assembly are told often that the cost of access of G.P.s is too much. By entering into contracts on a wholesale level or contracts across the primary care community we will be able to match up the cost to the Health Insurance Fund with the benefit to the individuals across our community and perhaps move away, for the first time in the provision of various services, from paying solely for a visit and the unintended consequences that that might have to people's health. That is an exciting progression. We have also brought forward legislation which will allow us, in due course, to have contracts with pharmacists. Why do I think that is important and why do I mention that? Quite simply because it picks up on what Senator Ferguson was saying. She was saying that she believes there are some easy wins, particularly around smoking cessation. In other jurisdictions pharmacists provide smoking cessation services. Under our previous law we were not able to do that. We were not able to pay pharmacists to provide a service that probably most of us agree would be better provided by those pharmacists. The department will now be in a position where they can go away during the course of this year, I hope - and this is me pushing them forward, we will wait to hear what the Minister has got to say - and be able to contract with pharmacists to provide these services. There is an amount of service that could be provided in due course, throughout this coming year, in the way that I believe that we all want it to be provided. So a lot of progress has been made. The Minister for Health and Social Services is committed to continue to make that progress and continue down that line, as I know the current Minister for Social Security will, with the support of the Minister for Treasury and Resources and the Council of Ministers. This is one reason why the Council of Ministers believes that the reformation and the appropriate delivery and the first class health care services have to be one of our priorities over the coming 3 years. So I would ask Members not to walk away from the commitment that we have given of delivering the best possible health care at the most appropriate point to deliver the best possible health outcomes and, importantly, move from a delivery of dealing with symptoms to preventative care. These modernisations will allow us to do that. Yes, I understand the difficulty that some Members have with this idea of bailing out Health, but nothing could be further from the truth. These are services that our community wants, they deserve and by giving this money for this window of time will allow us to modernise it and deliver it in a much more exciting way, which will deliver, I am absolutely certain, far better health outcomes for every member of our community. I ask Members to continue down this road, finish this process; and we

will be able to finish this process if Members continue to support this proposition today.

9. Deputy M. Tadier of St. Brelade :

I will not speak for too long because I think this proposition and the debate has been a good one. It is also probably inevitable that this will go through and I think that is the correct decision. There are a couple of reservations and a couple of points I think it is incumbent upon the Chief Minister but moreover the Minister for Health and Social Services to take on board. Now, in this Chamber we can often be detached from reality. We think this is the centre of Jersey, the centre of the universe. In fact there is lots going on outside in the real world and I was just thinking how many people there will be working in our health care service, either at the hospital, St. Saviour's Hospital, in the various clinics around the Island. The staff involved there and those who are waiting in those clinics this morning do not care where this money comes from. They just want to know, many of the staff who, it has to be said, are already working under duress at point .. certainly I know staff who, if they were working in the U.K., would not have to necessarily have to work shifts back to back, et cetera, and they often make sacrifices in their own lives to provide a very good level of health care for Islanders. They do not care where this money is coming from and I think we have to dispel this argument. I have listened to this impartially yesterday and today. I have not heard any compelling argument as to why we should not be using this fund certainly today. What I have heard is many arguments which suggest that the use of this fund is not sustainable. I agree with that. I think the Minister needs to listen to that. We have received an assurance from the Minister for Treasury and Resources that this is a stop-gap and that put my mind at rest to some extent. That said, we do have a White Paper coming forward. Now, this is not the last time we will be having this debate, probably this year or even next year, because the White Paper .. and I would encourage all Members and members who are listening in the community to get involved in this White Paper because it is flawed, as many of our consultative processes have been. We have just got one option in this paper. We have been given 3 options ostensibly but the first 2, even in the paper the Minister for Health and Social Services ..

The Deputy of Trinity :

Sorry, could I just make a point? He should be talking about the Green Paper, not the White Paper.

Deputy M. Tadier :

I said White Paper because the Minister for Treasury and Resources use the word "White Paper", but the Minister is quite correct. At this stage it is just a Green Paper. Nonetheless, these are all essentially the same. They are consultative papers. They are there to give options. We have been given 3 options but in the paper it says that the first 2 are not viable and you would have to be an idiot to think that the first 2 are viable. So you have got one option and that is neither a Green Paper nor a White Paper. I would ask Members to have caution. When they are submitting their responses they should not fall into the trap and say: "What is it that we want?" Now, to talk very briefly about this idea of people who have not paid into the fund getting access to the fund. This is what happens in Government and taxation anyway. I do not have children, lots of people do not have children, and I am paying for somebody else's children to get educated, to go to school, people who may or may not have paid tax in their life, and that is fine. That is the way our system works because it is accepted that there are quid pro quos in our system and there are other things for which I will be cross-subsidised and, hopefully, in the round things work out. It is right that those who are least able to pay, for whatever reason, but contribute in other ways to our society are not excluded. So I think that argument needs to be put to bed once and for all. I think there is an underlying problem here that the Constable of St. John and others have partly touched on. What we do not hear, unfortunately, from the Constable of St. John is: where does the money come from? He said that this fund is sacrosanct. Again, I do not think that is true. So where is the long-term funding going to come from? This is the problem that we have in our Island because we do not have the same mechanisms or we refuse ourselves to have mechanisms to raise revenue and taxes that other jurisdictions have because we will not put the income tax rate up. Twenty per cent, apparently, is sacrosanct. We will not tax those who can afford to pay more. We will continue to have breaks. We seem to be very reluctant to increase or lift the ceiling for social security completely. Why is it that when Health admittedly needs more money .. I think Deputy Martin, the Assistant Minister for Health and Social Services, said this already, that the black hole, if there is a black hole at Health, could be filled many times over and they could keep on spending this money and it would still be sensible spending. It would not be nice-to-haves. So there is clearly a funding issue that needs to be grasped by this Assembly. I am quite happy if Members do not agree with my views on tax and spending, but what I would say is that Members need to get to grips with this in one way or the other because in the White Paper, as we are seeing today, we are going to have a choice, I think, between user pays or cross-subsidy and free access or at least cheap access for all to health care or somewhere in between.

[10:30]

Those are the fundamental problems that we are going to be looking at when it comes to health care in Jersey. So today I think this is just a taste of what is to come. To a certain extent we have made heavy weather of this. I think we do need to take on board the concerns of Members because this is a short-term stop-gap, but the problem is we have not heard anything else about what the long-term plan is for this and that is why there is so much concern. Deputy Young's speech today is pretty much the speech many Members would have been giving the first time here. They have reservations. They are holding their nose. They are going to let this happen once, but certainly, if this comes back to the House again, I think that the patience of Members will be tried one to many times. We do need to get a long-term funding plan in for this which is both equitable and sustainable.

10. Deputy J.G. Reed of St. Ouen :

Just a couple of questions really directed towards the Minister for Social Security because ultimately it is he that is bringing forward this proposition and it is he that is responsible for this fund. In P.125/2010 we are told that the effect of taking this additional money out of the Health Insurance Fund will place the fund in an in-year deficit for both 2011 and 2012. I want to know what he, as the Minister responsible for this fund, plans to do to deal with those deficits that are going to be created by re-allocating this money. I also concur with some of the comments that have been made previously, especially around the move towards G.P.s undertaking more primary care services, but there is a consequence that we are already aware of - or at least I am - and that is that many elderly, and pensioners in particular, are facing increased costs because they are now required to consult with their doctor more regularly than perhaps they otherwise were. Let us remember that this fund primarily was set up to support and subsidise the G.P. costs. So although we tend to pay £35 or more to visit our G.P., in fact there is an additional £19 that is going towards the cost of that visit. That is the issue and that is the question that perhaps needs to be addressed and has not been commented on by anybody and indeed the Minister for Social Security, as we move forward, in seeking to pass some of these services to the G.P.s, also needs to look at the impact that that will have on those with limited incomes, in particular pensioners who rely solely on their pensions. If we do not do that, then what we will find is, as we are already finding, that pensioners are making serious choices about whether they can afford to seek advice, which they are now directed to by the Health Department, to determine whether they need medical assistance of not. I would also like to remind Members that this is an additional sum of money that is being allocated, in part, to the Health Department. £6.1 million very roughly equates to 0.5 per cent G.S.T. (Goods and Services Tax). We are saying that this is the last time that we will use this money from this fund to support the primary care services. It means that some way or another, whether it is G.S.T. or another mechanism, additional money will have to be extracted from taxpayers to help and replace the money that we are now taking from this fund. There are no easy answers and I accept that the Council of Ministers have already recognised this, but let us be clear that there will be an additional

cost going forward for the taxpayers, for the Islanders, as we move forward to deal with this matter.

11. Deputy P.J.D. Ryan of St. John :

I am grateful for the explanation from the Minister for Treasury and Resources about the history of the budgets to do with Health and Social Services. For new Members, and in this context I think I include myself, leading up to this decision and from outside the Assembly it is difficult to understand the roots of the more complex decisions sometimes to be made by the States. But the perceptions of both new Members and the public in this particular area are clouded, I think, by a belief that excess funds have existed in the Health Fund at Social Security for some time. We need to go back to something like 2008 when these excess funds were quite openly talked about in the Council of Ministers' corridors. Perceptions were then influenced, I think, by a somewhat questionable decision that was made to abolish prescription charges and I think it was questionable both in terms of its timing, just before an election, and, in my view, also it was questioning in terms of the advisability of abolishing prescription charges itself. In hindsight, I think that people generally question the wisdom of that decision at this point in time in 2012. Now that I do understand better the background to it, I will be supporting this, but I think that we do also need to think about prescription charges again. I do not know if I am typical or not but, personally, when I go and get something from the chemist - I am relatively healthy - I feel quite embarrassed that I am not paying a prescription charge and I think that is quite common. So I would personally like to see that decision reversed and I think that will go a long way towards helping people's perceptions generally.

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

Just a very brief comment. It has been mentioned that this is only a 2-year stop-gap measure but, again, in one of the papers that was provided to us, the Draft Health Insurance Fund (Miscellaneous Provisions) (Jersey) Law 201-, in the comments it says: "There is no provision made for any further transfers and the Minister for Health and Social Services has made a clear commitment to address the issue of primary care health services within this 2-year period.  Legislation to replace or substantially revise the current Health Insurance Law will be brought forward before 2013." It says: "Given the continuing pressures on health services this is likely to include the requirement for increased contributions to fund a modern primary care health service." Now, I take it that that is to increase the amount of contributions. In other words, they are going to revise the Health Insurance Law regarding this fund and there will be calls for further money from that for re-alignment. To be honest, to hear that it is only a 2-year thing, this is going to be an ongoing thing. I have major concerns about the Health Department and I have done for quite some time; in fact, ever since I read the Comptroller and Auditor General's report when he stated that the health service could not even say what the cost of having a patient in a hospital bed overnight was. Now, if they do not have the basic statistics and everything else .. and I have not seen anything since that tells me that they have got the costs under control or they know what they are spending their money and, in fact, until they do have some measures like that, I am going to be a sceptic about anything that the Health Department comes forward with when it comes to funding. So just a word of warning to people; do not think this is it.  I think this fund is going to be raided continuously in the future, but I do want the Health Department to come forward with some statistics as soon as possible so that we can see that they have got their costs under control and we know what things cost.

13. Deputy J.A.N. Le Fondré of St. Lawrence :

I was semi-prompted to speak after the speech of the Deputy of St. John, all of which I agree with having been in the room on the day when one of the decisions he was referring to was being made. Really, the point about the actual proposition, it has been previously, if you like, committed to. It has been. As we have all been reminded, it is a time-limited decision. Therefore, on that basis, although there may be a degree of reluctance, I think we should be supporting this and certainly I will be voting for it. What I really wanted to say was in a broader context, which I think iterates a little bit what the Deputy of St. John has semi-referred to, I think there is a wider concern that this is precursor, if you like, to using reserves in different ways, to potentially using reserves to disguise increased revenue expenditure. Now, I will put it that way round and ask the question and I hope that .. The Chief Minister is shaking his head and the Minister for Treasury and Resources is shaking his head, so that is good. But I really just set the marker down. We have got to keep the emphasis on not disguising what we spend, but making sure we control it and its business

transformation and making sure we start doing things in different ways. That was the only reason I wanted to put the marker down. There are lots of heads going round, particular from Ministers which I am glad to hear. One minor comment I will say is some reference has been made to the Internal Audit report. It is very helpful, but what the Internal Audit report appears to say - and that is from my brief reading of about 30 seconds - is that: "We have checked the expenditure. We have checked it back to the invoices and it has been posted in the right place." What it does not tell us, it makes no comment on the value of the money. It does not say that the services have been provided in a different way to achieve the same aim but for less cost. That may not be the purpose. What it is saying is: "The invoices exist and we are happy." There is a degree of comfort it gives, but do not go away feeling totally happy and warm that all the £6 million has been spent to the 99th per cent level of efficiency. That is not what it says. So all I will say is it is something to keep an eye on, but in this instance I think we should be supporting the proposition.

14. Deputy T.A. Vallois of St. Saviour :

Just very briefly, listening to what everybody was stating with regards to the proposition. Just one area which I think that the Council of Ministers needs to look at when they are bringing forward requesting extra money, particularly from funds such as this, is that in P.125 the States and the public were promised a large amount of things in the report as to what they were going to do with regards to primary care services, the new system for Health and Social Services, the Jersey Quality Improvement Framework. Now, I can remember a large amount of this being approved by the States by amendments to legislation, et cetera, but what would have been useful was an update; like a list of exactly what has been agreed - what has been implemented in Health, how far have we come, what we are doing, where the money has been spent exactly in those areas - so that when you come forward for an extra £6 million then we know that it is going to tide over doing the rest of it. In actual fact we might not need that much money, but it is just, I think, a constructive criticism that needs to be made because this is a large amount of money. Although I agree with it, we need sustainable funding in the future and if we can see those monies being used in the correct manner when it comes forward to us like this then there may not be need for such debate in the future.

The Deputy Bailiff :

Does any other Member wish to speak? I call on the Minister to reply.

15. Senator F. du H. Le Gresley:

It may surprise Members to know that I inherited this proposition.  [Laughter] However, irrespective of the fact that I inherited it, I am fully behind it and I hope that came across in my opening speech. We have had a very good discussion about this and I think the Council of Ministers, myself and the Minister for Health and Social Services and the Minister for Treasury and Resources all need to appreciate that there is a lot more work to be done and that this is really a holding position. When I was preparing for this debate I was very much thinking of all the processes that Deputy Le Fondré, Deputy Vallois, Deputy Young .. all these people who have spoken have gone through the same thought process I went through. I went through the whole of the debate we had last time because last time we had a tough debate on this matter of transferring money. I read all the responses and I read the assurances that the previous Minister, now the Chief Minister, gave to this House and I said to my officers: "I am not going to stand up in the States and ask for this money to be transferred unless I personally believe that I can fulfil the assurances that the previous Minister gave to this House. I can say for you today that I do believe that what I have read, the audit that has taken place and with the progress that has been made, that it is the right thing today to make this transfer of £6.1 million. Now, I apologise for the lack of detail and this is a fair criticism. I have obtained permission, and I hope you have now seen it, to release this document, an internal memorandum from Internal Audit, which, on the final page - my copy is a little bit wet, unfortunately, but I think I can still read it - the list of primary care services which were paid out in 2011 - and you will see the document is dated December 2011 - are all there quite clearly to be seen.

[10:45]

Invoices were provided in respect of Family Nursing and Home Care, which received the vast majority, about 80 per cent. There is an S.L.A. in place, as there is with Brook Advisory Services. So there are checks and balances that, quite rightly, Deputy Le Fondré is seeking. I also have a document here that has not been released but this is a more detailed audit done by Internal Audit of the use of the funds and the transfers. If I get permission to release it, I will do that as well. So quite correct to pull me up on lack of detail, but I hope that, with the additional information, that has been released today and the assurances that you have received, Members will be able to support this. Now, a lot of people have spoken and I do not propose to deal with each speech individually, but some people, quite rightly, have expressed concern about the Health Insurance Fund being diminished when there are other uses that have yet to be put to the fund, such as dental care and optical services. As most Members know, I have already agreed with Senator Breckon that we will be reviewing the provision of dental services in Jersey during 2012. That is an undertaking I have made and my department will deliver and it may be that we will need to look to this fund in the future to improve the dental services available to the public outside of the current schemes that are in place. That is quite a strong possibility and something we will be looking at and engaging the public, States Members, dental practices, et cetera, in that process. A number of Members mentioned dental services, so I hope that has covered that point. Obviously the 2 Assistant Ministers and the Minister for Health and Social Services were supportive of this transfer for obvious reasons. It will help their departments' budget if they get money from the Minister for Social Security but, that apart, they are doing a lot of work in developing the Green Paper, moving towards a White Paper, on the future of health services and really there is a lot of work going on in the background. The Health Insurance Law may well need to be changed dramatically in its future use but, again, that will be a proposition that will come to the States and there will be discussion with States Members and the public before that takes place. The Deputy of Grouville mentioned the £800,000 paid to an accountancy practice. I think the Minister for Treasury and Resources corrected her. That has not come out of the Health Insurance Fund. It is true that the fund is being used to fund primary care services on 2 occasions, this year and last year. Again, this is subject to end of year audit, but the fund after transfer of the £6.1 million has a balance in the region of £79 million. So that is the position of the fund at the moment, the net assets, and if it was not for

the £6.1 million transfer we would have had an additional £2 million surplus of income over expenditure. So every year the fund effectively, excluding these transfers, is increasing by £2 million after allowing for, obviously, the fate of the investments of the fund through the Common Investment Fund. I think we are all agreed that the future of health is one of the biggest issues for this Assembly. It is in the Strategic Plan. A lot more work has to be done. I am getting up to speed on what is happening at the moment, but we really have to provide this transfer today. I am not saying it is going to be moved straight away but what I am saying is we have to agree that the £6 million is made available to the department for the primary care services that they provide. The Deputy of St. Ouen asked me a couple of questions and I think I have clarified about the actual position of the fund, that there is, year to year, a £2 million surplus and, just for these 2 years, because of £6 million, the result will be a £4 million deficit on that particular year. The impact on low-income groups if we start to move primary care services out of the hospital or out of charities that are currently funded is obviously an issue that we need to address and I do not know what the solution is. I have not got a magic wand, but I suspect - and it has been alluded to by some other people - that we will in time have to increase contributions to health insurance. There is no other option as I see it because we are talking about health insurance and if we are going to widen the use of the fund then almost certainly what will come down the line will be increased contributions. I do not know how much they will be, what percentage of increase, but I do suspect that that is the direction we will be moving in. I hope, in that very brief summing up, I have covered some of the main points raised by Members. I would just like to end with a very short speech that was made in this House about a year ago when we were dealing with the first of the £6.1 million transfers. It is a speech that was made by a respected Constable who is no longer in this Chamber who had a knack - and this is something I learned in the short time that I was in the States with him - of saying in a few words what some people would say in 20 minutes. So if you will forgive me, I will just very briefly read what the former Constable of St. Martin said in the same debate last year. He said: "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 ha'pennies" or halfpennies. I hope everybody know what they are: "There are 24 of them to shilling", if you know what a shilling is. [Laughter] I hope everybody is up to speed: "Now, ship halfpennies" - I had some of these, they are very nice coins: "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 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 ha'pennies 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 has got a headache let us try and make it better and I think that the paracetamol should come from the ship ha'penny pot, which I think is the Health Insurance Fund." [Laughter] [Approbation] I maintain