States Meeting Transcript - 20th November 2013

STATES OF JERSEY OFFICIAL REPORT

WEDNESDAY, 20th NOVEMBER 2013

PUBLIC BUSINESS – resumption ...............................................................3

1. Dental Health Services: improvements (P.127/2013)....................................3

1.1 Senator F. du H. Le Gresley:.............................................................3

1. Deputy G.C.L. Baudains of St. Clement : ................................................5
2. Deputy R.G. Le Hérissier of St. Saviour:................................................5
3. Deputy J.H. Young of St. Brelade:.......................................................6
4. Deputy M.R. Higgins of St. Helier:......................................................7
5. Connétable D.W. Mezbourian of St. Lawrence:..........................................7
6. Senator S.C. Ferguson:..................................................................8
7. Deputy J.M. Maçon of St. Saviour:......................................................9
8. Deputy M. Tadier of St. Brelade:........................................................9
9. Connétable P.J. Rondel of St. John : ....................................................11
10. Senator P.F. Routier:................................................................12
11. Deputy S. Pitman of St. Helier : ......................................................13
12. Deputy T.A. Vallois of St. Saviour:..................................................14
13. Deputy A.E. Pryke of Trinity : .......................................................15
14. Deputy S. Pinel of St. Clement:......................................................16
15. Deputy J.G. Reed of St. Ouen : ......................................................17
16. Senator P.F.C. Ozouf : ...............................................................17
17. Deputy S. Power of St. Brelade:.....................................................19
18. Senator I.J. Gorst : ...................................................................19
19. Deputy G.P. Southern of St. Helier:..................................................20

2. States Members' remuneration: proposed increase 2014 (P.128/2013) - proposal of the Connétable of St. John to lift Standing Order 106 to enable P.128 to be debated.....29

2.1 The Connétable of St. John:............................................................29

1. Senator L.J. Farnham :..................................................................29
2. Deputy G.P. Southern :..................................................................29
3. Connétable M.P.S. Le Troquer of St. Martin:...........................................29
4. Senator P.F.C. Ozouf :..................................................................31

3. Ex Gratia payment to Mr. Terry McDonald (P.130/2013) ................................32

3.1 Deputy S.G. Luce of St. Martin : ........................................................32

1. Senator P.M. Bailhache : ................................................................35
2. Deputy S.Power:.......................................................................38
3. The Connétable of St. Martin:..........................................................40
4. Deputy J.A. Hilton of St. Helier:........................................................41

LUNCHEON ADJOURNMENT PROPOSED..................................................41 LUNCHEON ADJOURNMENT................................................................42

5. The Connétable of St. Lawrence:.......................................................42

6. Deputy R.G. Bryans of St. Helier:......................................................42
7. Senator B.I. Le Marquand:..............................................................42
8. Deputy J.H. Young:....................................................................43
9. Deputy R.G. Le Hérissier: ..............................................................44
10. Senator F. du H. Le Gresley:........................................................45
11. Deputy M.R.Higgins:...............................................................46
12. Connétable L. Norman of St. Clement:..............................................47
13. Senator L.J. Farnham : ...............................................................47
14. Deputy J.A. Martin: .................................................................48
15. Senator P.F.C. Ozouf : ...............................................................49
16. Deputy R.J. Rondel of St. Helier:....................................................50
17. Deputy G.C.L. Baudains: ............................................................54
18. Deputy M. Tadier :...................................................................54
19. Senator A.J.H. Maclean:.............................................................56
20. Deputy J.M. Le Bailly of St. Mary : ..................................................58
21. Senator P.F. Routier:................................................................58
22. Deputy T.M. Pitman of St. Helier:...................................................58
23. The Deputy of St. Martin : ...........................................................59

ARRANGEMENT OF PUBLIC BUSINESS FOR FUTURE MEETINGS ....................62

4. Deputy J.M. Maçon (Chairman, Privileges and Procedures Committee): ...............62

1. Senator I.J. Gorst :......................................................................62
2. Deputy M. Tadier :......................................................................62
3. Senator P.F.C. Ozouf :..................................................................63

1. Deputy J.M. Maçon:....................................................................63
2. Deputy M. Tadier :......................................................................63
3. The Connétable of St. John:............................................................63
4. Senator L.J. Farnham :..................................................................64
5. Senator P.F. Routier: ...................................................................64
6. Deputy A.K.F. Green of St. Helier:.....................................................64

7. Senator I.J. Gorst :......................................................................64

4. Deputy M. Tadier :......................................................................65
5. Deputy J.M. Maçon:....................................................................66
6. Senator L.J. Farnham :..................................................................66

1. Senator P.F.C. Ozouf :..................................................................66
2. Senator L.J. Farnham :..................................................................66

ADJOURNMENT................................................................................66

The Roll was called and the Deputy Greffier of the States led the Assembly in Prayer. PUBLIC BUSINESS – resumption

1. Dental Health Services: improvements (P.127/2013)

The Bailiff :

So, we return then to the debate on P.127. That is the proposition of Deputy Southern , Dental Health Services: improvements. Does any other Member wish to speak? Senator Le Gresley.

1.1 Senator F. du H. Le Gresley:

In July 2013 my officers produced for my consideration a written review of the Jersey Dental Fitness Scheme. This was 6 months later than the target my department had set when I made the statement to this Assembly concerning Senator Breckon's proposition, P.17/2011. I apologise for

that delay, but the policy team has been kept very busy this year, in particular making sure we deliver a Long-Term Care Benefit Scheme in time for the start date of 1st July 2014. I do not know if the proposer is interested in what I am saying, but I will continue when he is paying attention. The review of the Jersey Dental Fitness Scheme suggested 5 options for improving the scheme. One of which was to increase the subsidy in line with R.P.I. (Retail Price Index), taking the monthly States subsidy to £13.48. I was at first minded to adopt this quick fix. There are probably Members in this Assembly, like Deputy Southern , who think this is an idea. But handing more money to community dentists is not necessarily going to deliver improvements in the dental fitness of our community. The proposition we have been asked to consider today tells us you can make improvements to dental services by placing more money into existing schemes providing training in oral hygiene, for care assistance and undertaking publicity campaigns. On first reading many of these ideas might seem attractive and the right thing to do, but I urge you not to support any of these proposals. Briefly I will set out the reasons why and my concerns. Firstly, and most importantly, these proposals do not target efforts and benefits to the right places. Research conducted in 2008 with Jersey school children identified a different set of priorities. Rather than extend provision to higher income bands as suggested in part (c) of this proposition, research suggests we should be looking to target the poorer and more socially disadvantaged groups. My concern is will any of these poorer families be helped by increases in States subsidy for the Jersey Dental Fitness Scheme. Do we believe that families from minority community groups join membership schemes? Is it not more appropriate we should be looking at preventative activity with younger age groups, such as the "Child Smile" programmes being rolled out in Scotland, referred to in my comment and also by Deputy Bryans yesterday. Part (c) of the proposition suggests the Jersey Dental Fitness Scheme should be extended to the upper boundary of the fourth quintile of annual household income. So to explain this in numbers: the current Jersey Dental Fitness Scheme earnings limit is £46,000 and is already index linked and has been since 2001. The proposal is to increase this limit to just under £60,000. The research that we have suggests that there are problems that need to be addressed, but these problems are not among the children of middle Jersey. They are among the children living in the lowest income families, but not necessarily

households which qualify for special payments for dental treatment under Income Support benefit. The 2008 survey of dental health in children showed that 8 per cent of the children from the fee- paying schools included in the survey had a dental problem at the age of 5. By contrast one of our States Primary Schools with a catchment area including large numbers of low income and immigrant families reported 44 per cent of children with dental problems. The fact that there have been no further surveys since 2008 is a result of the decision of the Community Dental Department to allocate the Budget for further surveys to other departmental overheads. So, having cherry- picked from the Scrutiny recommendations of 2010, Deputy Southern is offering us some quick

time solutions and says: "We can fund these from the Health Insurance Fund." But that is not the case. Primary legislation restricts how the fund is used. It can pay medical benefits to local residents when receiving treatments from G.P.s (General Practitioners) and pharmaceutical benefits. But there is no legislation already in place which covers the employment of dentists or dental nurses or to run publicity campaigns. If we really wanted to push ahead, these activities could only be delivered by the Health Insurance Fund following amendments to the primary legislation, which cannot be rushed through. I ask Members: do we wish to prioritise that over the urgent work which needs to be completed next year to implement the Primary Care Governance Framework? Furthermore, I have another concern about this proposed use of the Health Insurance Fund. Up until now, health insurance benefits have not been means-tested. There is a risk that in pursuing these short-term fixes proposed by Deputy Southern we fail to consider the wider implications for the use of the fund. The Deputy says the Health Insurance Fund is healthy. On page 6 of his report quotes figures from the 2010 Scrutiny Report, which in turn refers to the financial position of the fund as at the end of 2009, some 4 years ago. Members need to be aware that as at the end of 2012 the assets of the Health Insurance Fund stood at £80 million and that contributions only exceeded expenditure by £600,000, compared to a surplus of £5 million, excluding investment income, in 2009. Furthermore, the reserve increased by £8.4 million in 2012 as a result of exceptional returns on investments which are unlikely to repeated in 2013 and the years ahead. Members must not forget that in the Medium-Term Financial Plan we have already agreed to make further transfers to the Health and Social Services Department from the Health Insurance Fund, totalling £14 million, which means that by the end of 2015 we could be running in a deficit position and needing to draw-down on reserves. We are currently awaiting a government actuary review of the funds for the 3-year period ending 2012. No decisions about introducing new benefits should be taken until this report is received. The implications for the long-term future of

the H.I.F. (Health Insurance Fund) are considered. [9:45]

My third area of concern is about the somewhat randomly calculated financial implications set out on page 10 of the report. This suggests that we increase our spending sixfold up to perhaps £770,000 a year. But the proposition does not demonstrate how this sudden surge in spending is going to help support the people who are most in need and why this area deserves more attention than any other. We all know the pressures on the Health Insurance Fund are only going to grow as our population ages and that the largest group of recipients of medical and pharmaceutical benefits are pensioners. I am happy to repeat the commitment that I made to the Assembly on 8th October 2013 when replying to an oral question from Deputy Southern that I am already looking into both the Jersey Dental Fitness Scheme and the range of pensioner benefits, including the 65-plus Health Scheme, commonly known as Westfield. I will bring forward proposals to address these areas in 2014. The Westfield Scheme is expensive to operate. We could achieve savings in administration by offering pensioners in the scheme more flexible ways of paying for the various health services available from local practitioners. An idea being considered is offering each member of the scheme a pre-paid credit type card, which would avoid the need for upfront payments. So I am already working with officers to improve the Westfield Scheme. I ask Members to allow me time to complete this work. Deputy Southern believes that both the Jersey Dental Fitness Scheme and Westfield are perfectly good schemes that just need, in his words, reviving. But I disagree. He wants action not more reviews. I can assure Members that I want action too. But the Scrutiny Report of 2010 cannot be the only basis for change, more research is required. I ask Members to allow me time to finish the work that has started. I hope my track record of delivering on promises is persuasive. Together with the Minister for Health and Social Services I can today give the following assurances that firstly in the first quarter of 2013 we will commission a survey of dental health to bring information on the status of dental health among primary school and pre-school

children up to date. Secondly, we will develop a business case considering a dental health education programme to increase awareness in schools. Thirdly, we will review State spending on dental health services and benefits, that is tax-funded spending, looking for ways to use that money more effectively. Finally, we will prepare an implementation plan for the delivery of enhanced public funded dental healthcare services or benefits in Jersey. So, in summary, this proposition has a hidden assumption. That the only barrier to improved dental health is financial and that putting money into the existing membership scheme is the solution. I hope Members having heard me will understand that this is not the case. I do not think the information we have, limited though it may be, allows us to make that assumption. I urge Members to reject all parts of the proposition and allow my department and the Health and Social Services Department to make positive action in a more measured, informed and balanced way. Thank you.

1. Deputy G.C.L. Baudains of St. Clement :

I was listening carefully to the opening speech yesterday and I have to agree with the proposer when he said that dental health comes behind other health issues. In actual fact it is really an important issue, because a poor degree of dental health can trigger other serious illnesses and it is not widely known. I will be supporting the proposition with the exception of paragraph (f). I know there is widespread belief that fluoride is good for teeth, but the actual information from trials and such proves the contrary. Fluoride is one of the most toxic substances known to man. It is used in drinking water to prevent tooth cavities. This practice has been discontinued in most countries. In my view it should be banned from toothpaste as well. It is a by-product of aluminium and it can encourage the body to absorb aluminium, mainly found in the brain and, of course, is a precursor to Alzheimer's. It is not a substance I would like to be using. For that reason I will not be supporting (f). In support of what the Deputy is trying to achieve, it is not long ago I recall one of my parishioners approaching me a couple of times, one of the younger members of our Parish was having severe toothache and simply could not afford the treatment that he required. In the end his employer had to pay for the treatment, which I found was completely unsatisfactory. I will be supporting the proposal.

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

As the Minister knows I very much respect him, but I thought he was a little hard on Deputy Southern , because there is no doubt whatsoever, as Deputy Baudains has said, that dental care is a major issue. It has been a major issue in Britain for years, with its rather unsure status within the National Health Service. It joins another issue, which I know the Minister for Health and Social Services is, as I speak, attending to, namely the price of visiting G.P.s. This is undoubtedly a passive time-bomb at the moment, but it is going to explode, because I simply think at some point we are going to have to face up to the fact you cannot run a universally accessed health dental service without a tax system that is commensurate with that service or a fee for payment service. The British are on the brink of having to look at payment for G.P. visits, nothing to the scale that is the case here, obviously, at the moment. There is no doubt that if you have full preventative programmes - and I am not sure I would accept all the arguments, although he is better informed than me about fluoride - you can do an awful lot to avert costs in later years and to establish the right habits. Having said that, I do accept that the Minister is a man of his word, he has pushed through an enormous amount of legislation. As far as I am concerned, he has shown himself as a committed reformer. I think he has been caught slightly on the back-foot in this case, but he has come up with an overall approach to the situation and I am prepared to wait for a fresh look at the situation. A clear delineation of what the current priorities are rather than throwing money at what I know from those early debates on the Westfield Scheme were seen by many Members at the time as a compromise that was hastily put together to try and prove we were dealing with dental care. But it was always seen as a very hastily put together compromise that had all sorts of bureaucratic

issues in the way people approached it, as the Minister has alluded to with his attempt to get some stored-value card working, for example. So if he stays to that promise, if the report comes up, hopefully when there is a bit of breathing space after the long-term care introduction, I would be prepared to accept his work. But, I think Deputy Southern has to be congratulated for ensuring that this is given a good airing. Thank you.

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

Like the previous speaker, from my days working in the Health and Social Services Department back in the 1990s, I could see the lack of access to dentistry in this Island was a major problem. I can recall a massive campaign in those days. The Health Department of the day went to the extent of equipping itself with a mobile dental caravan and employing dentists and going round to the primary schools. There was a lot of follow up and that then led to the birth of the scheme which the proposition now asks us to endorse or enhance. I am certainly not aware from my own grandchildren that that publicity campaign is there. I am certainly not aware of it. I do not know what happened to the dental caravan. Perhaps it got sold at our auctions or elsewhere in the Island or shipped overseas. I do not know. But, it illustrates that particular side of the problem. The other one, we all know, is simply that dentistry is just not available to a large proportion of the over-65 group. It is not an option. We have heard many times about that. So, I am very worried about the way this debate has gone. Deputy Southern did an excellent service reminding us of these commitments or the work done in the past. He has brought those forward. I am equally worried about being put in the position where the Minister is saying, a Minister who we know is absolutely as committed as we all are to achieving reforms, and I trust, as I know most Members of the House trust, the delivery on his commitments. But, I worry about him saying: "Look, reject everything. All or nothing." Because when I look at the proposition, I look, for example, at proposition (d). Deputy Southern has already said that he will allow us to vote on those separately. It says: "To undertake a publicity campaign to promote dental health services provided in Jersey." The Minister said he is going to do that anyway. He agreed with it. So, I do not see an argument at all for not saying yes to (d), for example. If other Members can see it, I would like to hear it. Secondly, (e): "To ensure that the need for upfront payments for dental treatment required by the Westfield Scheme is eliminated." Well, we have heard it is a problem for the over 65s. It is right that when you get your pension letter you get a letter telling you about Westfield. That is exactly what happens. I know that myself. But, of course, what you see is a whole set of qualifications there. The first one, it is clearly right, you have to be exempt from income tax. So, that is it. That is the level that the scheme is for. Yet, the current scheme says: "Well, you can have your dentist as long as you pay it up front, which clearly you cannot do. Again, the proposition says to ensure that that is eliminated. The Minister himself said he is doing it. So I cannot see another problem for not supporting (e). Then we come to (g). It says: "To examine the potential for expanding the range of those eligible to partake in the Dental Fitness Scheme and report back to the States for recommendations." Unless I heard wrong, the Minister told us he is going to do that as well. Have

I missed something here? If other Members will tell me, fine. But, what is wrong with (g)? Looking at the other ones I accept the Minister's assurance that the issue is more complicated than transferring the money. I accept that there is a complication there if we were to do Deputy Southern 's proposition (a). I think his point is valid there. Then point (b), uprating the current scheme. What we heard, I thought, was an indictment of the current scheme. What we heard was saying 44 per cent of children at certain primary schools or pre-school are suffering from dental problems. Yet 8 per cent of youngsters in private school are having that problem. I accept that if we are to have a targeted scheme, in a perfect world we would have universal benefits, universal health service, the point Deputy Le Hérissier made. We have not had that. The U.K. (United Kingdom) does not have it. We cannot achieve that. The Minister has made the point, and I think proposition (b) probably is going to have to await for what he comes up with. Similarly the

changes to the upper-earnings limit for the qualification. Because, obviously, he has pointed out that on the scheme for the 11 to 18 year-olds the qualifying thing is that the household income has to be not more than £46,000.

[10:00]

The interesting thing is that in order to get in the 11 to 18 scheme, the requirement is you have to be dentally fit. I ask: what happens if you are not? Well, you should be because the answer is you can go to the school health clinic if you are under 18. But does everybody know about it? How does that explain the 44 per cent of children in the schools? How is that explained then if that scheme works? Clearly there is a problem there. I think then that the Minister has made a good point that several of these parts of the proposition, we should trust him. He said he will come back in the first quarter. I will go with this commitment and I therefore shall not be supporting those parts of the proposition. But I really will be supporting (d), (e) and (g), as I have said and explained, unless others Members can point out to me where my logic is wrong. Thank you.

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

Like other Members, I do have respect for the Minister for Social Security. I do acknowledge some of the things he has done. On this particular one I almost get the feeling it is the standard material response to any criticism, in the sense that: "We have either been thinking on it, we are working on it, wait for us, listen to us, do not take on board what the proposer is putting forward." I will say again, I cannot necessarily support every single paragraph that is in Deputy Southern 's proposition. But, like Deputy Young, I feel there are those that I can support quite happily. What I am concerned about too are the comments that were made about the Health Insurance Fund and the health of it and so on. We have had 2 debates in this Assembly on transferring money from the Health Insurance Fund to the General Hospital. We were told: "Oh, it is no problem. Do not worry about it. We can transfer it." I would not be surprised if in the future we have another raid on the fund. So it really suits the argument on the day. The other thing too is, I was concerned with what he said about the investments: "Do not rely on the investments always being there and generating a return." We only had the housing debate 2 meetings ago and we were being told by the Minister for Treasury and Resources that we had these fantastic returns and we can afford all this housing expenditure we are going to make over the years, because of the fact that we are earning so much on our investments. I gave the warning then that you cannot rely on investments in the sense of the usual warning that is given by regulatory authorities: "Investments go up and down." That argument is being used today to us, but a month ago the opposite was being given: "We can rely on these future earnings." Ministers are inconsistent with their arguments in terms of finance. It almost seems to be: "If we do not like it we will put forward that argument, if we do like it we will put forward the counterargument." I would like to see some consistency there. What I will say is, as much as I admire the Minister for Social Security I will be voting for some of these items that I think are acceptable.

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

I just want to speak briefly on this, because as a member of the Scrutiny Panel that produced this report I have always had the sense that it is in fact the forgotten Scrutiny Report, because nothing ever seemed to happen as a result of it. I applaud Deputy Southern for his tenacity, because he will not let the Scrutiny Report be forgotten. [Approbation] What he has done by bringing this proposition has reminded us that we went through due process, the process of Scrutiny, the report, the findings were evidence-based. We are at the end of 2013 and the Minister seems quite proud to stand up and say: "Next year I will be doing something about this." If we read the report from Deputy Southern it is clear that what has happened since the presentation of the Scrutiny Report is absolutely nothing. He tells us that in 2 areas on page 4 the response from the Minister for Health

and Social Services was accepting recommendations. But what happened? Nothing. Senator Breckon met with the Minister for Social Security, because he intended to bring a proposition relating to this. He was given assurances that something was going to happen. Deputy Southern tells us: "I recently asked Senator Breckon what had happened. He replied: Nothing'." So, if it is not the case that nothing has happened then it is certainly the case that not very much has happened. Looking at the separate parts of the proposition, what struck me particularly was clause (d). A couple of other Members have referred to this: "To undertake a publicity campaign to promote dental health services provided in Jersey." None of us know what the dental health service provision in Jersey is. Why do we not know? Because nobody tells us about it. In fact, I know that the Social Security Department can make emergency dental payments to Income Support claimants. Yet, they do not know about it. I know of people who have suffered agonies, because they have had an abscess on their tooth and they cannot afford to go to the dentist, as an Income Support recipient. I have told them: "Go to the Social Security Department and ask for some financial help." It has not been forthcoming. What do they have to do to get the support to which they are entitled? I think the Minister for Social Security needs to make sure, so let us begin this at home, in his department. Let his department start promoting the facility that they have to help people with certainly emergency dental health. It is quite right that we should vote on this separately, because as Deputy Young has said, there are clearly parts of this proposition which not only should we support them, but we must support them, because we need to express to the Minister for Social Security and the Minister for Health and Social Services that we want something done about dental health over here. I was chatting to the Connétable of St. Helier a few moments ago. People can obviously see he is not in the House. They may be interested to know that he has gone to the dentist. So we were having a laugh about that. He has said that he suffered for weeks. I am assuming he is in a position to deal with it himself, but he has suffered for weeks. He has put off going to the dentist and he has now reached the stage where the pain has forced him to go out and have something done. He may be in a more fortunate position than those Islanders who suffer the pain, yet cannot afford to go and get the treatment that they need and that they deserve. As we know, it can lead to further health issues, and a number of Members have mentioned that. While not wanting to criticise the Minister for Social Security, because I think we all do recognise that he has certainly made a valuable contribution to his department. While he has been bringing forward legislation that needs to be done, I go back to my opening comments that this has been a forgotten Scrutiny Report. We have forgotten that dental health needs to be prioritised over here. I applaud Deputy Southern for bringing the proposition. I will certainly be

supporting most, if not all, of the sections in it. Thank you. Deputy M.R. Higgins:

Can I just correct something that I said a moment ago? I think I mentioned the inconsistency in terms of funding. I mentioned housing. Housing has been funded separately. It is the General Hospital that is being funded through the actual States' investments and that is the one that I was referring to.

6. Senator S.C. Ferguson:

In reply to some of Deputy Higgins' comments about the Ministers doing what they think. I think it comes under the heading of "Nanny knows best". The fluoride comment, fluoride is available in excess in Bahrain. They all have wonderful teeth, but their spines fuse and they go around almost bent double, so it supports Deputy Baudains. I do regret the department's comments, because the comments made by the Minister for Social Security and the department do not include a proper assessment of the costs. Basically, we are going to have to review how we fund all our health services. I have mentioned Singapore before, but there has been some excellent work also in New Zealand. We have to stop concentrating on developing a United Kingdom-type scheme, because it

is not going to work. It does obviously occur. We talk about early prevention. But if we put more money into early years' dental care then we are going to have fewer cases of older people having dental problems. Early prevention means later health. This is something we have to do. I agree with Deputy Higgins, the comments about the Health Insurance Fund are worrying. It does make me wonder whether perhaps the rush to take away prescription charges was a step too far and they are going to have to be reinstated [Approbation] except for certain Income Support categories. Certainly the Minister's comments raised question marks over the use of the Strategic Fund, as Deputy Higgins has said, to finance the General Hospital. Remember we have not had a cost- benefit analysis of that project. There is a great absence in all these papers from the department of cost-benefit analyses. I would like to see a little more rigorous analysis. I think perhaps I will not be supporting all the measures, but I will certainly be supporting some of them.

7. Deputy J.M. Maçon of St. Saviour :

I think in recent times we have been debating many things and we have been talking about things which perhaps people have said are not a doorstop issue. I think this is very much a doorstop issue, because this is something which my constituents definitely raise with me when I go canvassing. It is something which we all know there is wide concern about within our community. I thought that the speech by Deputy Young was very sensible. It got to the point on many of these things. Some of these things we should be doing anyway, as Deputy Young pointed out. Again, like other Members, I may not be supporting every clause within this. I would just like to talk to you about clause (c). Again, it is always another gripe which I get on the doorstop. Those people who perhaps are not quite poorest of the poor, but just earn a little bit too much, so they do not qualify for things which otherwise they could not afford. So, looking at point (c) I am minded very much to support that, because I think that targets some need there, which as a society need to work harder on and support. Again, many of these things are relating to the Minister's comments. I have great respect for the Minister for Social Security. I think that some of his points seem to address that. Some of these things are wrapped up in some of the work that he is doing already. Again, it seems a bit odd not to be supporting it. We have been in this situation before, I remember, when Deputy Higgins brought his amendment 2 Strategic Plans ago, where we were in the exact situation of: "Do not support this amendment, because we are doing it anyway." It just seems bizarre when we get into those situations. As I say, I think elements are very good. I am concerned about part (a), because I think there is a lot more detailed work that needs to be done here, much like Senator Ferguson, I think that the whole way that we fund social health care in this way must be done. Do we adopt perhaps the German model, which is to force everyone to have Private Social Care? The government picks up the insurance fall for those on, effectively, Income Support or low income households. I think that does ask some much wider questions. But, as I say, this is certainly a doorstop issue. This is something which all Members of the Assembly should be speaking on, because it is a very important issue to members of our community. I think it deserves that

recognition. Thank you.

[10:15]

8. Deputy M. Tadier of St. Brelade :

Indeed. Why these provisions and mean-testing always hit the lower to middle earners primarily is because that is what happens in our low tax, low spend, low provision, bare minimum system. We know that the very poor will always be looked after, the very wealthy have independent means - I am not sure if that applies to the Constable of St. Helier or not - and the ones in the middle are the ones who just do not bother either going to the doctor or the dentist because they cannot afford to. I will go when I am ill. There is no point in going to see the doctor when you are fit, is there? There is certainly no point in going to see the dentist unless you have managed to save up for 3 years and then you might go and have your scale and polish, discover you need a filling. I wondered to

myself whether the Constable of St. Helier has opened up a backstreet dental surgery at the old Police Magistrates Court and that he has seen an opening in the market to provide some cheap health care for St. Helier residents, who we know tend to be most impoverished. He will probably be using the old cells as operating theatres and Russian bootleg vodka as a cheap anaesthetic, which might prove more cost effective for many. We joke, but this is a real issue. I know individuals - I am sure we all do - who have just simply not been to the dentist for years. The doctor is one thing, but the dentist is perceived as a luxury. Is that really the society we want to live in? For me, I may be an idealist, I would like to think we could live in a society, where you can go to the doctor and to the dentist when you need to and cost is not an issue. Ideally it would be free at the point of use and it would be paid for by some other fair mechanism. But we do not seem to be at that point yet, but I hope we will be soon. I also do not understand why dental health care is separate to health care. Why are those 2 separate? It is no doubt partly to do with cost. But, teeth and oral hygiene are part of more general health. We do not seem to separate feet or elbows or other parts necessarily. The issue is we live in a low tax, low spend. Who does that benefit? Who does having low taxes or even zero taxes benefit? It benefits those who are super wealthy and who have independent means. In the meantime we have to run a society in Jersey. We have a community here of people who are not super wealthy, who have day-to-day needs and who are constantly being failed. The Constable of St. Lawrence is quite correct. Although I would beg to differ, this is not the only Scrutiny Review that has been shelved and ignored. That is par for the course when it comes to Scrutiny Reviews, particularly when they tackle difficult issues like this. The Parks and Gardens one is one that comes to mind, although it is not as serious, by any means. This is of critical seriousness, which is why it is more important. Looking back on the comments that were made, I may have to summarise. Essentially I was looking at 2010, the Ministerial responses from December. The issue was still there, saying essentially this needs to be addressed and this was back in December 2010. It says: "Action will be taken in this area." Nothing for 3 years now. The Ministers may say there are certain parts of Deputy Southern projet, which are not workable. That is fine, give us some action. The Minister for Social Security talks about action. Half of it we know already is acceptable and will be implemented anyway. The question is why does it always rely on a Back-Bencher having, in this case, to dig out a Scrutiny Report from 3 years earlier, which was very popular, in terms of submission and in terms of the interest that it generated, and really tapped into a very real issue that people were feeling. Why does it take 3 years for the Minister to take action? Why do we have comments coming on the 18th, which was on Monday, saying why we cannot do this? That is no use to anybody. It is no use to Deputy Southern or a Back-Bencher or any Member who wants to look at this and say: "Well, the Minister is right in that respect. Maybe what is being proposed does not quite do the job that we want it to do, but we will amend it." But, you cannot amend anything 2 days before, you barely have time to read the comments. I think that is the intention. We read them while we are here, probably in question time

and you cannot have any meaningful debate and this is how things come on. So, what is the plan? The comments earlier were quite correct. There are some schemes available. I have been down to the Social Security Department on different issues and have been told: "No, cannot do that." Then I get the handbook out and say: "Well, it does say here you have special payments. You can do that." "No, you can only do that if they qualify for Income Support." "No, that is not what it says here. It says, You can even make special payments for people who are not on the Income Support scheme and who otherwise would not be able to claim'." "Oh, right. Well, we will have a look into that." "Oh, thank you. Thank you for having a look at it now that somebody has contacted the States Member, but what about the individual that has come into the Social Security Department? How much do they have to supplicate themselves? How much do they have to potentially humiliate themselves, get false erroneous information?" It is completely understandable that not everyone would be fully up to scratch, given the complexities of the system. Whereas we could have a fit and proper system where everyone knows what they are entitled to. So action does need to be taken. I am wondering whether the actual proposal from the Social Security Department will be: "Well, what we will do, we will get you in, a one-off payment. We will take all your teeth out and then you will not have to worry about it for the rest of your life. We will give you some dentures when you are 25." Then: "There you go; one-off payment and that will make you a saving for the rest of your life." We joke about that, but that is what they used to do to women in the old days as a wedding present. They used to take their teeth out, so that there was no liability for the husband going forward. Thankfully things have changed when it comes to women. Things have not necessarily changed when it comes to dental provision in Jersey. That would probably seem like a very viable option for many in the Island. So, the current system is ideologically driven. We have the Minister for Social Security coming back in quite an authoritarian way saying: "No, we cannot do that, even though we know that there are aspects that can be done." I think that is it, we do need action. I commend Deputy Southern and the previous work that was done by the Scrutiny Panel. We need to get something which works for everyone in our society. At some point we do need to grasp the nettle. The Minister has said in the past, and he said that he continues to support progressive taxation. As a Minister he is in a position to do something about that. He says that he fulfils his promises. Yet, as soon as we see something where progressive taxation or the principle of progressive taxation could be used, the long-term health care, it is completely absent. There is a carve-out for the most well-off in our society saying: "Oh, we do not expect the most well-off in our society to pay, because that would be wrong that they cannot be sharing their means with the rest of us in a more socially acceptable way." The first evidence we have had is that the Minister has completed reneged on his election promises. So, more generally, I would say to the Minister .. clearly the best of a bad bunch. Would that he were running all the departments. At least we would perhaps have more cohesion there. But, we do need to move to a more progressive system. We all have a limited time in politics and I will ask the Minister: he will have a legacy; will he have a legacy for fulfilling the election promises of a fairer society where those with the most means, who are most able to pay give something back to the community, so that we can all not have these issues about going to see a doctor, going to see a dentist, which we would not expect in other

civilised and developed countries?

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

Just think if this House had not raped the Social Security Fund of all those millions over the last 3 years. You people, you Members here, voted to take £6 million a year out, year-on-year for the last 3 years, of the Social Security Fund. Previous to that we had seen obviously the Chief Minister brought it to the House when he was Minister for Social Security. Before that we saw Senator Routier and he practically told us they had done away with prescription charges. Millions and millions of pounds, probably round about £30 million in total, if not more, probably closer to £40 million. That money could have been building up. It was supposed to be a ring-fenced fund, which belonged to the people who had paid into Social Security, not to the Tax Department. We are now seeing another tax of 1 per cent, which is going to increase to 3 per cent, for our old age when we need nursing care and full-time care, et cetera, which is going to run into many millions of pounds annually. The poor old taxpayer. Right, Social Security, if we have paid it it should still be ring-fenced. For the Minister for Treasury and Resources - who is not in the House unfortunately - to have found a way to convince the majority in here. I am looking around because the majority of you voted to take this money to bail out the General Hospital or was it to bail out higher paid civil servants who were here for a short period of time and disappeared? We do not know how that money is being properly spent. We find ourselves in this position today with Deputy Southern , although there are areas I cannot support him in this, because a lot more work is required by the Minister for Social Security and by the Social Security Department. I have real concerns that a Back-Bencher has to bring this type of proposition to the House to make things happen and to get departments to move forward in certain areas. As the Constable of St. Lawrence

rightly said: "The Scrutiny Report has been out for quite a while now." Like many of our reports we make recommendations and Scrutiny has been around now since 2003. In the early days it was in shadow form and then since 2006 with the advent of Ministerial government. All this work has been done. The amount of Scrutiny Reports that have gone out .. yes, the Ministers all pay lip- service to what we say and they accept our recommendations. In real terms does it make a great deal of difference? I do not believe it does. I wonder sometimes if I am wasting the many thousands of hours that we put into Scrutiny Reports and our officers' time for maybe just one little bit of it to be acted upon. That is a real concern. We have to keep on as Back-Benchers, coming forward and chivvying up the Ministers. Yes, we will hear the Chief Minister and his fellow Ministers paying lip-service to us continually: "We are doing a good job." It is just to placate us. That is all it is about, placating the Back-Benchers. [Approbation] The Minister can have a chuckle to himself at the moment, but as far as I am concerned there is a lot more to it than that. We have to do what is right for our young people, the people of this Island. If we have to ring- fence funds, that is what it should be. The Chief Minister, along with other Ministers have found a way into that. That needs to be locked back to what it was prior to the proposition brought to the House to take this money out legally, for want of a better word. Unfortunately, the majority of you voted for it and it went through. Needless to say I was one of the few, the old dinosaur, as they call me. It is a fossil now, is it? It is probably going that way. At the end of the day, Deputy Southern is absolutely right to have brought this, because it triggers in the mind of the new Minister for Social Security, who I believe is doing an excellent job and is top of his game. I have said it in the House before, there are few Ministers who are as on top of their game as the Minister for Social Security. When he says he will bring this back in the first quarter of next year he will. I have been following him and Deputy Green at the Housing Department. Both those 2 gentlemen are really on top of their game and they are moving in the right direction. I sincerely hope he can convince me to support something that he is bringing later on. But, that said, I cannot say that about all Ministers, because some of them act in different ways and I just wonder if they are the leaders that they are supposed to be, that this House has put in place. I am not going to say a great deal more. But, there are areas within the Deputy 's proposition I cannot support. I know that the Social Security Department will be bringing something forward, but there are one or 2 that I will support.

Thank you.

10. Senator P.F. Routier:

I am pleased to follow on from the Connétable of St. John , because he highlighted the good work that the Minister for Social Security has been doing and is doing. When the Minister spoke earlier I thought he gave a very good overview of the position.

[10:30]

He also explained that the work the department has been doing in bringing forward the Long-Term Care legislation, which has probably diverted their attention away from looking at this more urgently. I believe that we all in this House want to ensure that we have a good dental service for our Island population. I would just like to comment on a couple of speeches, one from the Connétable of St. Lawrence . She made some very valid points about people who are paid and who feel that they are unable to afford to go to the dentist. I think she said that they were Income Support claimants and they did not feel that they had the information to know that they could perhaps approach the Social Services Department for a special payment. That may well be the case, and I think there needs to be more. Perhaps an effort ensuring that people know that they can approach the Income Support Department to get support. I know there has to be an assessment made to see if it is a valid, affordable and appropriate price being paid for the dental support, but I think that there is a mechanism to support those people. This proposition does not relate to the Income Support payments. This is about the other schemes which exist. So although the

Connétable made, as I say, some important points with regard to Income Support it does not relate to this proposition. I think Deputy Young did highlight where the focus of some of the things that really are difficult to support. Paragraph (a) talks about, and I sense it from the speeches that have been had, there is a great deal of unease about supporting paragraph (a) because it would transfer the funding across. I support that. I think there is a lot of work that needs to be done to ensure that using the Health Insurance Fund in a different way .. moving that funding around between those funding mechanisms is a difficult thing to do currently without a bit more investigation. In saying that, I think it should be recognised by all Members that if (a) is not supported, or everything else below that requires .. I believe that everything below that will require some funding. So if (a) is not supported it does make it a bit more difficult to achieve (b) down to (f) certainly. I would just caution Members in thinking about supporting other items below (a). (b) for instance, talks about uprating the monthly payment to dentists. Of course that is all well and good. It gives dentists some more funds, but it does not necessarily give any support to the patient at all. All it does is give more money to the dentist. So I would be wary of doing that because I think there are probably other ways of supporting the patient rather than the actual dentist. I am not sure whether we get more children going to the dentist because the dentist himself is getting more funds. (c) the upper-earnings: I think there has been some good discussion about that. I think a lot more work needs to be done in that. I would be very concerned about supporting that item. When it comes to (d) the publicity campaign, I can understand that there is a wish to perhaps support that, but I would be more inclined to want to support whatever new scheme is brought forward by the Minister for Social Security in the future. I find it difficult to want to spend funds on supporting schemes which may change in the very near future. I think it is an easy one to support, but why promote something which is going to change? The upfront payments, yes; I think it is recognised that the Westfield Scheme is probably not fit for purpose at the present time. It does need to be reviewed and I know we have an assurance from the Minister for Social Security to do that. It does need to be looked at. The remainder I find it difficult to support. I just remind Members that I think Deputy Southern thinks that my comments about paragraph (a) can be challenged. But the way I read it, unless that funding in (a) is supported, the remainder does become rather difficult. I leave my comments there and hope Members will take note.

11. Deputy S. Pitman of St. Helier :

Just a few minor points really. With regard to the Health Insurance Fund, personally I do not see why this cannot be accessed and I think this dental care should be like Deputy Tadier said, part of primary healthcare permission. I know that doctors have been pushing not for dental care but for other primary care provision being increased, because they know this fund is absolutely bursting, increasing and it has been like that for quite a number of years. With regard to the Income Support, I just wanted to clarify - and I hope nobody else has done it - what the provision is for Income Support. I am sorry to say I do not have the same praise for the Minister for Social Security, nor his predecessors. But the actual provision is £500 and then after that you get a loan. Now that has been changed from the original provision and for people on pensions, people who cannot work because they have illnesses, that loan is very difficult to pay and puts them in even more debt. The provision is not sufficient in my view, and that is something else that needs to be looked at. Even with emergency and urgent work, my experience with constituents has been again, like Deputy Tadier says, that people have said that the Social Security Department say you can get provision. When you go down there you get a different message. I can certainly think of one very serious case where a young woman with a child had cancer and her chemotherapy caused all her teeth to fall out. She got her first dentures paid and she was told that she would get her second dentures paid because she needed second dentures because when the teeth fell out her gums shrank. Then when she went to Income Support at the time when she needed these second dentures, they said they would not pay for them. Her gums were sore and had ulcers; she could not speak properly, she

could not eat properly. Because of that she had lost a lot of weight; it caused her lots of stress simply because Income Support had changed their minds. So do not think that Income Support are providing. We hear lots about this in the media and from the Ministers. It is not providing for people who need that support, and that person was entitled. She had cancer. In the end we fought very hard to get that. Just going on, is it not funny how Jersey is one of the top 5 richest jurisdictions in the world. Yet we have this basic health need that people, even in middle income brackets, are finding difficult to pay for. When you look at somewhere like Cuba, which is considered one of the poorest countries in the world, less developed is a term I do not like using - but certainly its health provision is not less developed; all its dental care is free for everyone. A country like that can do that, but we force our people to pay for such basic provision. Also I think we have heard the people who get some support. We have heard the people who can pay for that; that is the very wealthy. We have heard the people who cannot get the support. But the other people we have not mentioned that do get all the support are our prisoners. They get everything. So we have vulnerable people who need this care, need this provision; they are not getting it. Yet we give our prisoners everything they need. So I think I do feel like assaulting somebody and someone in this Chamber in particular, and I might get all my teeth done because I have some work that I need doing.

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

I think what this debate has done, or should I say the comments from the Minister for Social Security have done, has exposed issues from the point of the Council of Ministers. The reason why I say that is because what we appear to be doing is fumbling around the edges as always. What I would say is where in this debate have we said: "Here is the vision. This is what we plan"? There is discussion in the comments about the White Paper by the Health and Social Services Department. Within that it says that it firmly places dentists alongside general medical practitioners, High Street optometrists and pharmacists as frontline providers in the new primary care model. If you do any research just pop into Google "good oral hygiene", and you look at areas where they discuss about dentists and what you have to do for good oral hygiene, and what else the benefits of having good oral hygiene can be. One in particular turns round and says: "Dentists are doctors who specialise in oral health." They have the ability to be able to regularly examine and look at possibilities of diseases, not only within the mouth but they can be caused elsewhere in the body and that all relates to the primary care model. What worries me about what has been said among us, and I am not just going to aim at the Minister for Social Security, I am going to aim this at the whole of the Council of Ministers, because this should be a co-ordinated approach. They should be working together. What I feel like is happening is that there is co-ordination between the Minister for Treasury and Resources and the Minister for Health and Social Services to put more and more funding into the Health and Social Services Department and say that we are going to achieve all these wonderful things in so many years. But then they go running to the Minister for Social Security when they need more money or they need legislation changed, not including him within that discussion from the beginning about what the vision is, how they can help, how they can work together. How can they create a better public service going forward? That is the way I feel that has come out of this debate. That is what it sounds like to me. The reason why I say that again is because then we go on to the last page of the comments and what worries me is that the Minister for Social Security has said in the comments that we cannot support Deputy Southern , in particular on the first page where it says because it is poorly targeted and does not address the areas of greatest need in Jersey. Where is the evidence, Minister? All the Back-Benchers have to provide the evidence. Scrutiny did the report and made recommendations and provided the evidence. If Ministers cannot do the work that has been suggested by Scrutiny, then do not accept it or suggest that this would be possibly placed better within the primary care discussions that are going to happen at this State in the future, rather than accepting to do something piecemeal that does not go

in the overall envelope of things. All these things interact. All these areas will create a better health system for the public of Jersey. On the last page of the comments, and this supports my concerns over piecemeal approaches and the arguments about Deputy Southern bringing something and the Ministers wanting to do this, is that they say that both Ministers are committed to improving existing dental services, which is great. We all support them in that and we hope that something happens very soon. Inevitably, and here we go, the primary care review will have a part to play.

[10:45]

But with that review proving to be a considerably more complex and difficult project than originally anticipated, both Ministers recognise that immediate steps can be taken in advance of the completion of the new model of primary care to improve dental health in key areas. To that end, and as set out above, specific actions will be included in 2014 departmental business plans. Now for me that just opens up a whole can of extra questions and further questions about why has this not been included as part of the business cases of the primary care review right from the beginning? Why were they not seen as doctors of oral hygiene? It really does concern me that this is not joined up, and that is what is coming across to me in this debate. Ministers bring propositions to the Assembly and ask for more and more money to do more and more things. So I would challenge the Ministers to come back with things that are targeted, that are achievable. Pace yourself within a smart framework. Be specific. Be measurable. Be achievable. Do not make promises that you cannot keep, because that raises expectations and only lets people down when you cannot deliver. I am in agreement with areas of the proposition. I do not agree with Senator Routier about the extra money being needed with regards to publicity campaigns for promoting dental health, because I understand there is a budget at the Health and Social Services Department that provides for promoting health in Jersey, and I would have thought that was an area that they would consider, or that that was an area that they already do. Also community dental services. There are dentists that go into schools on an annual check-up. The Education, Sport and Culture Department delivers educational services where they already have a significant budget from the States Assembly who has provided that within the M.T.F.P. (Medium-Term Financial Plan). So I would argue why are they not already doing it? I would support that anyway. I would say that they are already doing it. I do not know if the Minister for Health and Social Services would probably say whether they are or not. What bothers me is, take the personalities out of it, but when Ministers come to this Assembly and ask us to support something, especially when it is asking for millions of pounds, when it is asking for changes in services, when it is asking for helping the public in the future, long- term planning is part of the Strategic Plan, and making the health services of Jersey more sustainable. I would ask them to provide the evidence and to ensure that they are working in a co- ordinated way and not just with particular Ministers, but they are working together and thinking

outside the box to make it a better service in the future.

13. Deputy A.E. Pryke of Trinity :

I am pleased to follow Deputy Vallois and reassure her that what she has just said is happening. There is a joined-up group. It may not seem so, and I am sorry it does not seem like that to her. But with the Ministerial Oversight Group led by the Chief Minister, it does include Ministers for Social Security and for Treasury and Resources. It is joined-up, and the aim there is to give the best possible care for the future health care of all Islanders. But, as we all know, health and social care is a very complicated piece of work and to get it right it will take time. Just to try and answer some of the questions that have been raised: routine dental treatment is provided free of charge by the General Hospital, the Community Dental Department for any child irrespective of their means, up to the age of 11. From age 11 they go into the Jersey Dental Fitness Scheme and, to pick up the point from Deputy Young, what happens if someone joins the scheme and they have not been and are not dentally fit, then the dentist will get them dentally fit and the cost of that is picked up by the Health and Social Services Department, to make sure when they get into that scheme they are dentally fit. The Social Security Department gives dentists £6 a month. The dentists then work out what is needed with that child to keep them dentally fit, because that is the most important. If we can keep them dentally fit it will prevent them needing fillings, et cetera, in the future. Just on the side issue, if some of these children have special needs, all their care is picked up within the Health and Social Services Department's dental services; and also if they need high-level orthodontic treatment, that is picked up in the Health and Social Services Department as well. That is just a brief overview. There is no doubt that a piece of work needs to be done, and it is the 2 departments going to be working together to do that. But the way that Deputy Southern has done it in his proposition is not the way, because if we are going to do this review, and Deputy Vallois talks about strategic vision and we do need that vision. But first of all we have to ask those basic questions. What we have now, is it fit for purpose? It is a bit like the Chief Minister talking yesterday about Lean. In some ways it is similar to Lean. What are we doing? How can we improve the service? Also to look at nursery education: the dental team go into every primary school to do an annual check-up. But no mention has been made about nursery education. Do we need to look at going into nursery schools? I think we need to ask that question. Are we reaching hard-to-reach families? I think we need a review to find out are we doing that? Also, whatever future we plan out needs to make sure that we are fully funded. Deputy Vallois too mentioned about the Primary Health Care Review and all that information will be put into that primary care. It demands that we consider all issues, the options, the cost and the impact on the higher priorities of health care on which we must focus. In an agreement with the Minister for Social Services - because we do work well together and the 2 departments do work and meet regularly - we have given the following assurances that we will commission a survey of dental health to try and include all the primary schools and pre-schools and bring that information up-to-date. We will have a business case considering the dental health education to increase the awareness.  But we need to do that work first and make sure that what we are going to publicise to raise the awareness is what we are going to do. Review of spending on dental health.  Asking the question, are there ways of using that money more effectively; and also importantly more targeted. Also to prepare information implementation plan for the delivery of the publicly-funded dental health scheme for Jersey. But we must make certain that the outcomes of the work ensure that we have targeted the right services and the benefits in the right place. The assumption of this proposition is that money will improve it all. But that might not necessarily be the case. It undermines the importance of making sure we address all real issues from awareness education and culture to dental costs and the ability to pay. We need to do that piece of work, and that is important. Just picking up from the Constable of St. John , it is a shame that he is not in the House, about the Health Insurance Fund. The money has not come to the General Hospital. That money from the Health Insurance Fund has been used in primary care services, and mostly the service agreement we have for funding nursing services, which is a primary care service, as well as the other ones that Health Insurance Fund money went into. I will leave it there, but to finish up, we need to make sure that that piece of work is done, that more research and information need to be gathered and all options, costs and priorities need to be reviewed. We are also looking, as has been said, to work with the Education, Sport and Culture Department. But I really stress that that work needs to be targeted, putting more money into what is already there may not be all the answer. I cannot support the proposition in its current form and I urge Members to allow our department to address and make an informed and appropriate decision

as a way forward.

14. Deputy S. Pinel of St. Clement :

I do not want to go on because everybody has spoken at length. Just to clarify that part (g) of this proposition is a review that the Social Security Department is already undertaking. Parts (b) to (f) will require some funding to some extent and without the agreement of part (a), and also Members have expressed unease at using the Health Insurance Fund, then there is no adequate funding mechanism for these other parts.

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

I am slightly confused because on the one hand we are getting information regarding the issue of our additional funding required, but on the other we are reading comments and we have heard from Ministers: "We are doing a whole lot, and by the way we are going to undertake a whole load of additional actions." Where is that money coming from? We have a Minister for Health and Social Services quite rightly saying: "Well, we need to understand what we are doing" but that is day-to- day management - that is not and should not be because a Back-Bencher has brought a proposition to the States raising an issue that was raised back in 2008 and not acted upon. These are matters that should be part of our everyday culture, whether it is in the Health and Social Services Department, the Social Security Department or other. Absolutely Senator Le Gresley is right. He has had a lot to do, and he still has a lot to do. Indeed, the Council of Ministers have a lot to do, and I am pleased that under the heading "Funding" on page 8 of the comments they highlight and reinforce this States Assembly decision and agreement that the Council of Ministers are required to come back to this Assembly before the end of September 2014 with a primary care funding model. We are going to hold you to that, as much as we are going to hold the Minister for Social Security and the Minister for Health and Social Services to their commitments that they have given today, regardless of what happens to this proposition. Also, the Minister for Health and Social Services said: "Oh, we have to do this review" but no one has explained why we have not had any dental health survey for local 5 year-old children since 2008. Yet when you look at the graph that has been currently provided on page 3 by the Minister for Social Security, it shows that we had one in 2000, we had one again in 2002, again in 2004, 2007, 2008; then nothing. Yet the Minister for Health and Social Services tells us: "We are going into all the primary schools on an annual basis

and we have been doing that for some time." So where is the information? Why are those people not reporting the health of those children's teeth when they are looking at them individually on an annual basis? What is happening? Why do we have to have another review, another group of people to come and look at work that we are undertaking? Then I look at what we are doing, and we have comments about the issue around the publicity campaign. Quite rightly the Minister for Social Security highlights what we are doing now and, in fact, he enhances that in one of the commitments he gives. It is exactly the same point that Deputy Young made earlier, that (d) could be accepted. But the Minister for Social Services said: "No. Reject evidence." I look at (f) and I think: "Well, okay. It seems sensible. Ensure that adequate training is provided by the States to all carers working in public or private residential care." I look at the comments and we are told that earlier this year 3 dental teams, a dentist and a nurse, visited Health and Social Services-run care homes at the Limes, Sandybrook, Overdale and Samarès ward, to undertake inspections on patrons' teeth.

[11:00]

Well, good. Whoa, hang on a minute. These are not the only residential care homes that the States run. So why have these been selected rather than the others? Why not include the care homes that are run by the private sector? Why not? Yet we are told: "Oh, well, do not worry. We are doing it." Well, you are not doing enough. If you are going to do something, do it properly or not at all. I think that is the message that I would like to give and that is why I will be supporting parts of this proposition.

16. Senator P.F.C. Ozouf :