States Meeting Transcript - 3rd July 2014

STATES OF JERSEY OFFICIAL REPORT THURSDAY, 3rd JULY 2014

PUBLIC BUSINESS – resumption ...............................................................6 COMMUNICATIONS BY THE PRESIDING OFFICER ......................................6

1. Temporary absence of the Bailiff ........................................................6
2. Draft Sea Fisheries (Vessel Monitoring Systems) (Jersey) Regulations 201-

(P.85/2014) – apology from the Connétable of St. John ..................................6 Connétable P.J. Rondel of St. John : ............................................................6 Deputy C.F. Labey of Grouville :...............................................................6

2. Draft Regulation of Care (Jersey) Law 201- (P.95/2014) - resumption..................6

1. Deputy J.A. Hilton of St. Helier:.........................................................6

1. Senator A. Breckon:......................................................................8
2. Deputy G.C.L. Baudains of St. Clement : ................................................9
3. Deputy S. Power of St. Brelade : .........................................................9
4. Deputy M. Tadier of St. Brelade:.......................................................10
5. Deputy S.G. Luce of St. Martin : ........................................................11
6. Deputy R.C. Duhamel of St. Saviour:..................................................12
7. Senator P.F. Routier: ...................................................................13
8. Senator L.J. Farnham :..................................................................14

9. Deputy R.G. Le Hérissier of St. Saviour:...............................................14
10. Deputy M.R. Higgins of St. Helier:..................................................15 Mr. H. Sharp Q.C., H.M. Solicitor General:..................................................17 Deputy J.A.N. Le Fondré of St. Lawrence : ...................................................17
11. Deputy J.H. Young of St. Brelade : ..................................................17
12. Deputy J.A.N. Le Fondré: ...........................................................19
13. Deputy J.G. Reed of St. Ouen : ......................................................20
14. Senator S.C. Ferguson:..............................................................21
15. Senator F. du H. Le Gresley:........................................................21
16. Deputy J.A. Martin of St. Helier:....................................................22
17. The Very Reverend R.F. Key, B.A., The Dean of Jersey: ............................23
18. Connétable J.M. Refault of St. Peter:................................................23
19. Deputy T.A. Vallois of St. Saviour:..................................................23
20. Deputy A.E. Pryke of Trinity : .......................................................24

2. The Deputy of Trinity :..................................................................28

1. Deputy R.C. Duhamel: .................................................................29
2. The Deputy of Grouville :...............................................................30
3. Deputy T.A. Vallois: ...................................................................30 The Solicitor General:........................................................................31
4. Deputy J.A.N. Le Fondré:..............................................................32
5. Senator I.J. Gorst :......................................................................33

6. Deputy G.C.L. Baudains:...............................................................34
7. Connétable S.W. Pallett of St. Brelade:.................................................34
8. Deputy S.Power:.......................................................................34
9. The Deputy of Trinity :..................................................................35

3. The Deputy of Trinity :..................................................................44

1. Deputy J.A. Hilton:.....................................................................44
2. Deputy T.A. Vallois: ...................................................................45
3. Senator I.J. Gorst :......................................................................45
4. The Deputy of Trinity :..................................................................45

3. Draft Explosives (Jersey) Law 201- (P.96/2014)........................................46

1. Senator B.I. Le Marquand (The Minister for Home Affairs): ...........................47

1. Deputy G.C.L. Baudains:...............................................................47
2. The Deputy of St. Martin:..............................................................48
3. The Connétable of St. Brelade:.........................................................48
4. Deputy J.A.N. Le Fondré:..............................................................49
5. The Connétable of St. John:............................................................49
6. Senator B.I. Le Marquand:..............................................................49

2. Senator B.I. Le Marquand:..............................................................51

3. Draft Explosives (Jersey) Law 201- (P.96/2014): amendment (P.96/2014 Amd.) ......51

3.3.1 The Connétable of St. Brelade:.........................................................52

4. Draft Explosives (Jersey) Law 201- (P.96/2014) - resumption - as amended..........52

3.4.1 Senator B.I. Le Marquand:..............................................................52

5. Senator B.I. Le Marquand:..............................................................52

3.5.1 Senator L.J. Farnham :..................................................................53

LUNCHEON ADJOURNMENT PROPOSED..................................................54 LUNCHEON ADJOURNMENT................................................................54 COMMUNICATIONS BY THE PRESIDING OFFICER:....................................54

4.1 Welcome to His Excellency The Lieutenant Governor..................................54

5. Draft Comptroller and Auditor General (Jersey) Law 201- (P.98/2014)..............54

1. Senator P.F.C. Ozouf (The Minister for Treasury and Resources - rapporteur):.........54
2. Senator P.F.C. Ozouf :..................................................................56

1. Deputy R.G. Le Hérissier: ..............................................................57
2. Senator P.F.C. Ozouf :..................................................................57
   3. Senator P.F.C. Ozouf :..................................................................58

4. Draft Comptroller and Auditor General (Jersey) Law 201- (P.98/2014): amendment (P.98/2014 Amd.) - Article 7.............................................................58

1. Deputy T.A. Vallois (Chairman, Public Accounts Committee): ........................58
2. Senator P.F.C. Ozouf :..................................................................58
3. Deputy R.G. Le Hérissier: ..............................................................58

4. Senator P.M. Bailhache : ................................................................59
5. Deputy J.H. Young:....................................................................60
6. Senator S.C. Ferguson:.................................................................60
   7. Senator I.J. Gorst :......................................................................60
   8. Deputy M. Tadier :......................................................................61
7. Deputy T.A. Vallois: ...................................................................62

5. Draft Comptroller and Auditor General (Jersey) Law 201- (P.98/2014) - resumption - as amended..............................................................................65

1. Senator P.F.C. Ozouf :..................................................................65
2. Deputy J.A.N. Le Fondré:..............................................................65
3. Senator P.F.C. Ozouf :..................................................................65

6. Senator P.F.C. Ozouf :..................................................................65

7. Draft Comptroller and Auditor General (Jersey) Law 201- (P.98/2014): amendment (P.98/2014) - Article 15..................................................................65

1. Deputy T.A. Vallois (Chairman, Public Accounts Committee): ........................66
2. Deputy G.P. Southern :..................................................................66
3. Senator P.F.C. Ozouf :..................................................................66
4. Deputy J.H. Young:....................................................................67
5. Deputy T.A. Vallois: ...................................................................67

8. Draft Comptroller and Auditor General (Jersey) Law 201- (P.98/2014) - resumption - as amended..............................................................................68

5.8.1 Senator P.F.C. Ozouf :..................................................................69

9. Senator P.F.C. Ozouf :..................................................................70

10. Draft Comptroller and Auditor General (Jersey) Law 201- (P.98/2014): amendment (P.98.2014) - Articles 1 and 18..........................................................70

5.10.1 Deputy T.A. Vallois (Chairman, Public Accounts Committee):......................70

11. Draft Comptroller and Auditor General (Jersey) Law 201- (P.98/2014) - resumption - as amended..............................................................................70

5.11.1 Senator P.F.C. Ozouf : ...............................................................70

12. Draft Comptroller and Auditor General (Jersey) Law 201- (P.98/2014): amendment (P.98.2014) - Article 19..................................................................71

1. Deputy T.A. Vallois (Chairman, Public Accounts Committee):......................71
2. Senator P.F.C. Ozouf : ...............................................................71

13. Draft Comptroller and Auditor General (Jersey) Law 201- (P.98/2014) - resumption - as amended..............................................................................71

5.13.1 Senator P.F.C. Ozouf : ...............................................................72

14. Draft Comptroller and Auditor General (Jersey) Law 201- (P.98/2014): amendment (P.98.2014) - Article 20..................................................................72

1. Deputy T.A. Vallois (Chairman Public Accounts Committee):......................72
2. Deputy J.H. Young: .................................................................72
3. Deputy T.A. Vallois:................................................................73

15. Draft Comptroller and Auditor General (Jersey) Law 201- (P.98/2014) - resumption - as amended................................................Error! Bookmark not defined.75

5.15.1 Senator P.F.C. Ozouf : ...............................................................74

16. Senator P.F.C. Ozouf :..................................................................75

1. Deputy J.A.N. Le Fondré: ...........................................................75
2. Senator I.J. Gorst : ...................................................................75
3. Deputy J.H. Young: .................................................................76
4. Deputy T.A. Vallois:................................................................76

5. Senator P.F.C. Ozouf : ...............................................................77

6. Comptroller and Auditor General: reappointment (P.99/2014)........................78 [Debate proceeded in camera] ................................................................80

7. Income Support: free G.P. access (P.101/2014).........................................81

1. Deputy G.P. Southern :..................................................................81

2. Income Support: free G.P. access (P.101/2014): amendment (P.101/2014 Amd.)......84

1. Deputy R.G. Le Hérissier: ..............................................................84
2. Senator F. du H. Le Gresley:............................................................85
3. Deputy G.P. Southern :..................................................................88
4. Deputy M. Tadier :......................................................................89
5. The Deputy of St. Ouen:................................................................90
6. The Deputy of Trinity :..................................................................91
7. Deputy J.A. Hilton:.....................................................................91
8. Senator P.F. Routier: ...................................................................91
9. Deputy J.H. Young:....................................................................92
10. Deputy S. Pinel of St. Clement:......................................................93
11. Deputy M.R.Higgins:...............................................................93
12. Deputy R.G. Le Hérissier:...........................................................93

3. Income Support: free G.P. access (P.101/2014) - resumption - as amended...........94

1. Deputy M. Tadier :......................................................................94
2. Senator F. du H. Le Gresley:............................................................95
3. Deputy S.Y. Mézec of St. Helier:.......................................................96
4. Deputy G.P. Southern :..................................................................97

8. Draft Community Provisions (Food Supplements) (Jersey) Regulations 201- (P.74/2014)...............................................................................99

1. The Deputy of Trinity (The Minister for Health and Social Services):..................99

1. Deputy G.C.L. Baudains:..............................................................100
2. The Deputy of Trinity :................................................................101

2. The Deputy of Trinity :................................................................101
3. The Deputy of Trinity :................................................................102

9. Draft Community Provisions (Nutrition and Health Claims on Foods) (Jersey) Regulations 201- (P.75/2014)...........................................................102

1. The Deputy of Trinity (The Minister for Health and Social Services):.................102

1. Deputy M. Tadier :....................................................................103
2. Connétable J.E. Le Maistre of Grouville :..............................................103
3. Deputy J.M. Maçon:..................................................................103
4. Deputy J.H. Young:...................................................................104

5. The Deputy of Trinity :................................................................104

2. The Deputy of Trinity :................................................................106

1. Senator S.C. Ferguson:................................................................106
2. The Deputy of Trinity :................................................................106 Deputy J.M. Maçon:........................................................................106 Deputy M. Tadier : ..........................................................................108 Deputy J.M. Maçon:........................................................................108 Deputy J.H. Young:.........................................................................108

ADJOURNMENT..............................................................................110

The Roll was called and the Dean led the Assembly in Prayer. PUBLIC BUSINESS – resumption

COMMUNICATIONS BY THE PRESIDING OFFICER

1. Temporary absence of the Bailiff

The Greffier of the States (in the Chair):

Firstly I inform Members that the Bailiff has asked me to notify Members that he has been overseas on States business and was due to be in the Chair this morning but unfortunately his flight back was cancelled. He has had to reroute and he hopes to be in Jersey by lunchtime and to be in the Assembly this afternoon.

2. Draft Sea Fisheries (Vessel Monitoring Systems) (Jersey) Regulations 201- (P.85/2014) – apology from the Connétable of St. John

Connétable P.J. Rondel of St. John :

After the debate on the Fisheries proposition several days ago I said a few strong words about the Assistant Minister. As I said them in public I should like in public to apologise to the Minister if I hurt her feelings in any way. [Approbation] Thank you.

Deputy C.F. Labey of Grouville :

May I respond to that please? I appreciate the Constable's apology and doing so in public and while I accept I might not have explained the projets or Regulations as clearly as I might have I felt that his remarks were quite unjust. I think it is one thing ..

The Greffier of the States (in the Chair):

The Connétable has apologised and we do not want to reopen the wound. The Deputy of Grouville :

No, but I would like to say a few words because I think a few people - especially the response I have had from the public - were quite shocked. While most of us try to do our best in here I feel some of the questions that were allowed to be put were totally off the subject and so it was unfair, but I would like to say there was a vote during those projets that asked Scrutiny to be called into look at the projets. I did feel that Members are confusing the role of Scrutiny. Scrutiny is not there to enhance their own understanding or to let them off the hook if they have not read the projets before them and to gain so many votes from Scrutiny Members too to try and put these projets to Scrutiny I was quite surprised. I would like to thank the Constable for his apology which is accepted.

2. Draft Regulation of Care (Jersey) Law 201- (P.95/2014) - resumption The Greffier of the States (in the Chair):

Very well. The debate therefore that the Minister for Health and Social Services had proposed yesterday afternoon, the principles of the Draft Regulation of Care Law. Deputy Hilton.

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

This proposition was lodged on 20th May 2014 with a set debate date of 1st July 2014 allowing the Health, Social Security and Housing Scrutiny Panel less than 6 weeks to conduct a review. Members are probably aware the panel has been fully engaged in 2 other reviews, one being the Child and Adolescent Mental Health Service, and a full review into the proposed dual site hospital and full business plans on White Paper health spending, both of which have taken up an enormous

amount of our time in recent months. Combined with this we also had the Minister for Social Security lodge his Family Friendly proposition which again was due for debate on 14th July putting our officers under even more pressure to complete the work. We regret the panel was not in a position to conduct a full review for what is an important piece of legislation but even if there had been States Members prepared to come forward and assist with this review our officers on Scrutiny were working flat out on other reviews and there simply was not the capacity within Scrutiny to achieve more than we did, which was a desktop review on the draft law. We sincerely hope these matters will be addressed by the relevant parties in the next States Assembly to avoid the logjam currently being experienced. In brief it should be noted the Draft Regulation of Care (Jersey) Law is the primary law which is the foundation for the regulatory framework. Without this no Regulations can be brought in. This matter has been dragging on for a very long time. I have my own personal views why this has happened but what is important today is we are being presented with a draft law to approve which our expert adviser in her report confirms the draft law provides a sound framework for regulating health and social care services which reflects the key aspects of the requirements particularly identified in the England regulatory standards at present. What is clear to the panel is that there are fundamental areas to be explored in great detail once the Regulations come forward and indeed this will be an important piece of work for the next Health, Social Security and Housing Scrutiny Panel to undertake. My only hope is that when this happens Scrutiny is given the time necessary to carry out a full review on what will be an extremely important piece of work. The situation in the U.K. (United Kingdom) at the moment is each country has its own law governing the provision and delivery of care services, and currently the care law of England and Wales has been updated and is going through major changes. Due to the major changes taking place in the U.K. our adviser has recommended that the Draft Regulation of Care Law be suspended until the Care Act 2014 in the U.K. has completed its consultation on market oversight allowing time for the draft law to reflect the most up-to-date information and best practice but my fellow panel member, the Deputy of St. Ouen, and I considered this recommendation and agreed that there should not be a delay in the adoption of this draft law and it should proceed as normal. Due to the very tight timescale as explained previously the panel has been unable to review the exact details of the Care Act 2014 and therefore suggest that this information when available is used to shape the future draft Regulations. Our adviser has identified 6 key areas covered within the draft law and has made a number of observations which Members can read on page 4 of our report. Also the recommendations are shown on pages 6, 7 and 8 and the panel hope serious consideration will be given to these recommendations by the Minister and her department when she brings forward the Regulations which will underpin the law. One area I would like to touch on is that of safeguarding. It is of utmost importance the safety and wellbeing of our most vulnerable Islanders is placed at the very top of any Regulations which are brought forward. Members may be aware of previous incidents which have taken place in elderly residents' homes where individuals have suffered at the hands of unscrupulous carers. It cannot be stressed

strongly enough that checks and balances are put in place to ensure as far as is humanly possible only those people who have a genuine interest in caring for the vulnerable are the ones employed to carry out the service. One thing I would like to mention there is my concern, which I have stated previously in the Assembly, of criminal record checks. I believe very strongly if countries and other jurisdictions within the European Union do not have systems in place that are sophisticated enough to inform us whether an individual has a criminal record they should not be employed in the care industry. In conclusion the panel is aware that the finer detail will come with each set of Regulations. The panel asks that the consultation takes place with all stakeholders to enable them to be part of the development of the Regulations. We recommend a thorough detailed consultation period is held for each of the Regulations allowing for adequate time to be allowed to address any concerns arising out of the consultation. Finally the panel believes it is of utmost importance that

future Regulations should be fit for purpose and able to meet the needs of the Island. [Approbation]

1. Senator A. Breckon:

First of all I would like to declare a non-pecuniary interest. I am a member of the management board of Maison St. Brelade which as I say is non-pecuniary. Having said that, and I think the Minister mentioned this morning, it is an excellent place for people to live and the residents are at the centre of attention of everything that goes on there. It is well run to a high standard and - get the advert in - reasonable rates as well. There is indeed a waiting list. Although I welcome it it is a bit disappointing because in the Scrutiny Report on page 7 it says that in May 2006 the Council of Ministers acknowledged that legislation regulating the provision of health and social care in Jersey was no longer fit for purpose and approved drafting time for a new law.

[9:45]

That is 8 years ago and perhaps we owe an apology for some people Deputy Hilton has just mentioned and the Minister mentioned. We have left some vulnerable people to the vagaries of the market. I can give an example of that in a minute but we do have a duty of care to those people. Somebody came to me a number of years ago because they had been charged over £20,000 for a month for care for a lady at home. When I made inquiries the only safeguard was the person registered with the business. The staff were not regulated at all and I found that surprising because when I did see the proper framework for looking after people at home it was very comprehensive, the proper way to do it, and this particular agency, let us call them, were not doing any of that at all. The difficulty for older people in this situation is where do they go and who do they trust. The person they have met with from the agency, the owner, the approved person if you like, was very plausible in their presentation about what was provided but it was actually a money-making machine. There were all sorts of charges there and it was heading towards the Royal Court for a discussion on the charges, and it settled a few days before out of court but of course this was very traumatic for an elderly couple in these circumstances. At the time I thought: "This is absolutely nonsense if we are allowing this to go on." Although it is to be congratulated that it is here today the question is who has really been progressing this for 8 years? That is really sometimes where I think we have a failure in the system where somebody says: "Yes, it is a good idea to do this but who chases the progress?" Things are left to lie and if it was just about knocking a wall down then it is not a problem but when it affects vulnerable people's daily lives then more should be done and quicker. Sometimes we have legislation before us that comes out of the ether and then there are things like this which just have not appeared at all, so although it is not necessarily all on this Minister's watch really there are questions to be answered about where has it been and who has been loitering with it because it is a real issue for people. That is why it is welcome because it is not just a law, it is the Regulations that follow and it is about individuals at home or the vulnerable having a proper care plan which will sit under this. I can also appreciate what Deputy Hilton is saying because when it is dropped in the lap of Scrutiny like this then it is something that questions like that need to be answered, but also if Scrutiny were to delay it then they will be frustrating the situation even more. They are between a rock and a hard place and they are to be commended in doing what they have done in such a short period of time. Again I hope other Ministers will learn from this and perhaps take Scrutiny on board at an earlier stage. I know it is a policy in development and it is considered taboo but it is not a secret. It was 2006 with the Council of Ministers and somebody should have done something sooner because I feel although this is welcome we have let people down in the meantime and that is not appropriate. We should have done more and we should have done more sooner and parked some of the other stuff that has occupied our minds in the meantime, and for those reasons I fully support this, but it is with those

frustrations if you like that it has taken so long.

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

I appreciate what the Minister is trying to do. I have no problem with the Regulations that are being proposed but there is something which does trouble me about this proposition and I hope the Minister will be able to help me understand it better in her summing up. When I read a report, for example, on page 5 which transfers responsibility for regulating health and social care from the Minister for Health and Social Services to the Commission I am concerned that we might be falling into the same situation as we have seen with some of the incorporated utilities. When there are problems that are brought to a States Member from a constituent or whatever we then find that we have nobody that we can hold to account. At present we ask the Minister and we can hold the

Minister to account. If this is being passed over to a regulator, to a Commission, our ability to hold that entity, especially as it is shared with Guernsey, to account is virtually non-existent. It does concern me and I hope the Minister can assist me when she sums up.

3. Deputy S. Power of St. Brelade :

The first thing I would like to say is that in the last year the Health, Social Security and Housing Scrutiny Panel have been asked to do an extraordinary amount of work. If one looks at the Housing Transformation Programme, if one looks at the Child and Adolescent Mental Health, yesterday's debate on children with special needs and this one this morning and it gives me particular pleasure to thank them for the absolute dedication that this panel has had in the last 6 or 7 months in generating this amount of work and quality reporting from the panel. From my own personal point of view, I am very grateful for the Deputy of St. Ouen and Deputy Hilton for carrying on as they have had to do without the Chairman. It is to their eternal credit the quality of work that they have done. The next thing I would like to say is that I welcome most parts of this Draft Regulation of Care Law and Members may or may not know that I am also a member of the committee of Maison St. Brelade. In my naivety, in my absolute naivety 3½ years ago I started a charity with the Rector of St. Brelade and a Scotsman so there was an Irishman, an Englishman and a Scotsman and we started a charity with a great deal of naivety, and I have to say to everyone in the Assembly that in spite of the mistakes we made we survived the first 3 years. I will openly say to everyone in this Assembly that starting a charity which has an element of care is extraordinarily difficult. I will say also that for those of us that have done this I cannot say that I was qualified in any area to carry out this work except for, I suppose, a commitment or a desire to help which was based on my own personal experiences. I do not want to talk about that but what I do want to say is this and it refers to the draft law itself. I was recently with the trustees of Caring Hands. We decided that we would seek registration and go through this registration process because we were not registered and we need to be registered and we need to be regulated. For those of us that have never been through the process before I have to say that the Health Department and the person responsible for regulation in the Health Department has guided us through the process almost as if we were completely unable to understand the process. She explained it to us, we understand the process, we understand the responsibilities and I think that the process that the Health Department is engaging in at the moment is to be praised. It is not perfect in every way but it is getting there. Indeed the Health, Social Security and Housing Panel have pointed out some of the issues that are there which brings me to my point. The Scrutiny Panel on page 8 talk about staffing, training and funding. Three and

a half years ago we had no staff, no training and no funding but we managed to do what we did. My colleague to my right has just said it is still the same now. We have improved slightly and the charity itself has stabilised. I make this point for colleagues and for the Minister for Health and Social Services and for the professionals of the health service who are going to have to steer this through in its various stages after today, and that is that when a charity presents itself or when a group of people presents themselves to carry out some form of care, sometimes the charity starts without consulting the process and that is what we did. I found out through 3½ years that I have learned through this process. I have learned through the process of running a charity what I did not

know and now I know a lot more. The point is this: I hope that the persons in the regulation of care within the health services continue to adopt this light touch for those of us that are a bit naïve, get ourselves sometimes into deep water and end up in a care situation where we are caring for people sometimes with complex issues that we were not aware of at the outset. That is an area in itself on which I could write a book. Indeed those adults in society today who find themselves in trouble through financial problems, marital problems, relationship issues, drug and alcohol related issues and all sorts of other issues that come knocking on the door of Shelter Trust or any of the other places including Caring Hands, we do not know when they bang on the door what their complex needs are. We have learned a lot and for a charity, and somebody like myself who had no training, to be regulated that provides any kind of care is absolutely necessary. I speak from personal experience that we have learned so much from going through this process. To sum up, I am grateful for the Health Department to have brought it to this late stage and that we are addressing it today and I am extremely grateful to the Scrutiny Panel for the work that they have done both in this area and in other areas. For myself, having to fill in a police background records check this week for my own role was a bit of a surprise but I was happy to do it. For me I have to say that being in the care business or being in the care charity or being in the care provision has been an enormously steep learning curve.

4. Deputy M. Tadier of St. Brelade :

Clearly this regulatory framework is very necessary. We know that the current situation is not satisfactory but I have 3 considerations which I think are germane more broadly to this area. The first one is that although this will be absolutely necessary it should not be seen as the panacea for solving all the problems in the care sector. One area that needs urgent attention is the working conditions. Essentially what I am saying is that if people are having to work - as we know is the case - often under duress, if there are not sufficient safeguards in place for workers to make sure that the number of hours they are doing a week for example is not limited in an effective way either in theory or in practice, if we know that they are expected to carry out certain duties perhaps which they are not ideally trained for which are not in their job description which we know does go on, all these factors add to duress. It is these things that often with the best will in the world from the individuals, who I think the vast majority of them go into it as a vocation although there will of course be others who just go into it as a job, these really are the issues that lead to safeguarding issues. I do not think in most cases when there are issues it is due to any malevolent intent although there are a very small minority, as we know, who seek out these positions but it is by and large due to duress.

[10:00]

It is important that we have a hand-in-hand approach that when these Regulations come in we also make sure that we are having sufficiently trained people coming forward. We know Social Security is running the critical skills and that we are training-up nurses and that is to be commended but we need to make sure that these jobs are jobs that people want to go into and that they are sufficiently well paid. It is not something that we can necessarily directly influence ourselves but we can perhaps help to propagate that kind of culture. It is always interesting to note that the most essential jobs and the most difficult jobs in our society, indeed in wider society, are not those which are valued in the most in monetary terms and hopefully that is something that can change in the future as we become more and more reliant on the care sector. The second area that I have grave concerns about, and from having seen various issues over the last 6 years that have been brought to my attention, is that I am concerned about the trend for outsourcing. When we have companies essentially who are there to make a profit the emphasis is different from what it might have been in the past where the care of individuals, vulnerable individuals who may be young, or may be old, the prime motivation was to care for those individuals and now there is a risk that that has become an ancillary consideration and the prime consideration is profit. I do not think I am saying anything

controversial there or radical. That is simply a statement of fact. I have spoken to people in the department about future care plans perhaps around respite and so on where there is talk about trying to engender competition in the sector which will grow the market and provide better choice but ultimately we know it is a finite market and we know that it is not a typical market either which the free market can necessarily solve all the problems. It cannot solve problems elsewhere and it certainly will not be able to do that in this area. My concern is that whether it is light touch, whether it is very rigorously applied legislation and regulation is that what happens if we have a provider who is very specific and is the only one in Jersey that provides a certain service, and we find that over a period of time concerns are raised. The Commission is then put in a position where they have to perhaps the nuclear option, cancel this registration and we are left with a lacuna. What happens in the meantime? We are faced with that, we pull a licence and we have 50 or 100 people dependent on that service and are we as a States able to step in and provide it? It seems like the risk is in pragmatic terms that we do not apply the legislation because there is an impasse. They know that they have us if you like because we rely on that service which we have now outsourced. We do not provide it centrally. These are my concerns, the practical concerns that will arise from it. The third point is slightly different. Safeguarding is absolutely imperative. We know that in the past it has been very difficult to compel essentially private or outsourced companies to comply with background checks. We have asked them to do it but I have seen in the past where you have had these providers who just ask the workers: "Tell them you have to get a C.R.B. (Criminal Records Bureau)", and expect the workers to do it themselves, and for whatever reason, probably due to time constraints, they have not done it. You have had people working there for a period of time who have not even had a background check. The flip side of the coin, which is often forgotten - and I have had a case myself - is that there are people out there, and it is to do with the rehabilitation of offenders. We know that in Jersey, and in fact it was interesting that it was on a French news programme the other day commending the Probation Service in Jersey as a model saying that recidivism in Jersey because of the effectiveness of the Probation Service and perhaps other factors to do with living in a small island, was very effective. That is to be commended but there are people who would like to work in the care service who have perhaps transgressed in some way at a very young age, who have recognised that issue, have turned their lives around

completely, and I have had to deal with a case for a young lady who has been in that very situation. The irony was she told the employer of her previous conviction some 10 years ago. It cannot be spent and that is something we need to look at. We need to look at spent convictions more generally. They were quite happy to take this individual on: first of all, her conviction had nothing directly to do with the area of work she was working in. The second point is they said she was the best worker that they had but yet they were compelled one way or the other to let her go even though she had been completely upfront, completely honest and that she was a prime example of somebody who was working in the care industry for the right reasons because pressure was put on. Now hopefully, this is a case which can at some point be resolved. It has been going on for quite a while but this individual is now, as you would imagine, completely distraught that the area in which she has trained, put so much training in and relied on to rehabilitate herself has now been pulled from under her feet and she is in a place where there is no clarity as to whether this individual can work in that industry. What kind of message does that send out to somebody who has tried to do the right thing, tried to get themselves back on their feet and is ultimately doing a job which is beneficial for the Island? So these wider considerations - I hope I have not strayed too much - I think will need at some point to be considered. How do all these factors fit into the regulatory work? They cannot all be necessarily resolved but they will be considerations that come up and I will be watching very interestingly how the practice fits in with the theory.

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

I do not know in this day and age what the digital equivalent of a stuck record is but I look around the Chamber and think that most people here will know what a round piece of black vinyl looks like when it is put on a record player. Yet again we have the same story, time and time and time again. Legislation, years waiting for it, years and years waiting for it, prepared by offices full of senior civil servants with expensive legal professional advice bought in and then 6 weeks for 2 members of a Scrutiny Panel with one officer to review. It is completely unacceptable and as we have got to the end of this session, it has become more and more and more regular. It has happened to the Health Panel, time and time again. It has happened to my panel. It is happening across Scrutiny. You have to ask yourself the question why it is done. It is almost like a reverse procedure; the longer it takes, the more important it is, the shorter the amount of time allowed for Scrutiny. It needs to be addressed. Once again, and again the record is stuck: "Do not worry about the enabling legislation. When the Regulations come back it will be fine." How many times have I heard that? "Do not worry. We will sort it out in the Regs." Despite the Minister's assurances, I cannot help but believe that there is U.K. influence in this paper that we have before us today. A U.K. system, which is now known to be flawed and under enormous and serious review. So I understand completely the dilemma that the Scrutiny Panel find themselves in today. Do they stop this moving forward in the knowledge that we have a summer break coming up, an election, a new panel, and the serious and real possibility that a full review of this would not be completed well into the spring of next year, almost a 12-month delay? What a dilemma to be put in. Their report says much about what they should be doing but at least they have stood up this morning and Deputy Hilton has said how difficult it is for them to stop this moving forward because like them, I, my panel, and other  members of Scrutiny  feel the responsibility of keeping Government  moving forward. I came in here today ready to vote against this but after speaking to the Scrutiny Panel, I will go with them. It is not that we do not desperately need this new law, because we do, but we

need the best law. We should expect the best law and the people of this Island deserve the best law. I will be looking for guarantees from the Minister when she responds at the end and if I am still here when she comes back with the Regulations, she can expect me to give it the closest scrutiny.

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

We are discussing the principles of the law at the moment and quite often when we do have legislation brought forward we do not really kind of do the subject justice. So it is with that in mind that I want to make a few remarks and hopefully the Minister for Health and Social Services will be able to reply. Having seen various programmes on television recently, and particularly in the U.K. of the shocking occurrences of poor care in care homes where monies have been paid either by individuals or through government programmes to look after people, there is no doubt in my mind that a Draft Regulation of Care Law should be introduced to Jersey. But that is only part of it because, as we all know, like the policing function with the Honorary Police and other areas where help and assistance is given to the Government to facilitate those services, we all know in our heart of hearts that if the Government had to pay or the individuals had to pay for the amount of care that is put into the system by individuals, loving caring individuals and family members, then we would not be able to afford the whole programme. It is with this in mind that I am particularly concerned, and we will come on to it when we discuss the details of the law. Within the interpretations of the definition of the terms and the regulated activities and the attention that must be, as other Members have mentioned, to the filling in of the Schedule 1 regulated activities. There are a whole host of things that need to be sorted out before I am assured that by bringing in this care law we are not going to be discouraging many of the caring family members from delivering services except through being able to be registered because under Part 2(3) the regulated activities are those that must require them to put their names forward and be vetted as a provider of that service. Somebody might say: "Well, okay. You are taking things to an extreme point" and perhaps by giving an example I can indicate that that may well be the case. So say, for example, I wanted to provide care facilities, to pop into my parents who are both still alive and make them a cup of tea in the morning or breakfast, go shopping for them or whatever. The way I read it, at the moment - and there will be more debate when we come to these Regulations - it suggests that there will be regulated activities and the point I am making is that if we extend regulated activities, and they are not defined at the moment at all, to such actions, then I think we will automatically squeeze-out the very people who are providing sound care to their loved individuals in a way that they should continue to operate.

Senator P.F. Routier:

Sir, would the Deputy just give way just for a moment? Just to clarify whether the .. talking about going into deal with your own family's circumstances. My understanding of the legislation is that it only relates to people who are receiving remuneration for their work. It does not apply to people, a family member going into help.

Deputy R.C. Duhamel:

No, well, that shows how the Assistant Minister has not read the details properly because under the interpretation, Article 1 Part 1 - I have not got the number, but it is on page 39 - it does define a worker not only to be an employee or person under contract for services, but it does mention under (d) a volunteer. So it does extend to all those persons, as I am indicating, who are offering their services for nothing because they want to behave in the best way that they can for their loved ones. So this is the point I am making.

[10:15]

I am absolutely happy that if people are doing these things for money they have to come up to scratch and up to standard but, in principle, if this is the thin end of the wedge and we are wanting to move in a direction to regulate all activities under these very wide definitions then I think we run the risk of coming forward with an impractical form of legislation which will be the death knell, if you like, for all of the social care that is provided for nothing by family members. I hope I can receive assurances that that will not be the case from the Minister for Health and Social Services, but in not coming forward with the schedule of regulated activities at the moment to flesh-out which things are in and which things are out, I think we leave it open at this point. Thank you.

Deputy J.M. Maçon of St. Saviour :

Sir, on that point should we not put that perhaps to the Solicitor General just to clarify whether a volunteer or a family member are the same thing or are not the same thing under this law?

The Greffier of the States (in the Chair):

We could ask the Solicitor General to return, yes, but at the moment I will call Senator Routier.

7. Senator P.F. Routier:

I should just declare that I am a trustee of Les Amis, which is currently an organisation which is registered and regulated under the current system. I am also a parent of a son who uses those services and obviously am very keen that if, I am sure, anybody has a member of family going into care they would want to ensure that they are being cared for in an appropriate manner. The structure of this law I believe is sound. There is certainly .. and it should be supported. The Scrutiny comments regarding the new developments that are coming about in the U.K.'s changes, I think obviously have taken the right position about letting this go forward because even with our Regulations, which will come forward at a later stage, they will be able to reflect what is current thinking in what is not necessarily just in the U.K. but across the whole of Europe, and I think whatever is best practice wherever that is, we should be following that. I would just like to pick up on the point which Deputy Baudains made about his concerns about separating out the regulation away from the States. From my point of view, because the Health Service themselves are providing services, I do feel that it is right to have a separated-out regulatory service because the current situation is Health Services are not regulated so we do need to ensure that Health Services are regulated and you cannot regulate yourself. I do not believe that it is right that the regulator should be looking at their own services, if the regulator was still in with Health. So I think it is vitally important that it is separated out and independent. This can only be the right way forward as far as I am concerned. I know there is criticism that it has taken quite some time and I understand.. well, I know it has been a very, very time consuming piece of work to pull together but we should support it and as a Government we need to be sure that the services that are being provided by ourselves and also out in the community are being carried out correctly. Not only as a Government but I am sure if any of our family members were to be going into services we want to ensure that they are being cared for in an appropriate manner. I can only give this my wholehearted support.

8. Senator L.J. Farnham :

Just a brief observation, if I may, and listening and watching the headlines about this debate I could not help but wondering how I would feel if I was a care worker because .. and let me just quote from the comments. It says here: "Some of these people, particularly those being cared for at home, are at the highest risk of abuse, ill treatment and exploitation, yet our existing laws, designed to protect them, are over 30 years out of date." Now, while I recognise that people are at risk, in fact, we are all at risk in our society but fortunately the vast majority of us are honest people with good intentions and I believe that to be the case in general for care workers. Fortunately, a care worker is not motivated by money and I heard what Deputy Tadier said and there is this dilemma, this odd sort of situation where arguably the most valuable people in our society are undervalued when it comes to remuneration but perhaps it is a good thing in a way that these people, the majority of them are not motivated by money. But during this important debate I would just like to pay tribute to all of the care workers in the Island. Many of them are extremely hard working and are caring people. I have had first-hand experience with my late father, who received exemplary care from such people and I just wanted Members just to remember that while we are discussing this. Thank you.

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

I would just like to echo some other comments. I am not sure .. The Greffier of the States (in the Chair):

You mean repeat them, Deputy ?

Deputy R.G. Le Hérissier:

In the sense, Sir, that I would like to critique them. I am not sure that Senator Routier fully grasped what Deputy Baudains was trying to say. I think what Deputy Baudains was trying to say, it is all well and good to give power to a new Commission or a utility board but if things from an outsider's perspective start to go wrong or if the balance starts to go wrong and I know this is very alarmist and people will say with these enormous number of checks and balances how could you conceive of such a situation, but say that was to happen and I will cite a case .. if they were to go wrong, how can we intervene without being seen to be micromanagers? That is what we are struggling with with our utility boards at the moment, where there are serious doubts in one area and serious questions which, quite frankly, have not been confronted at a strategic level, let alone at a detailed level. I think that is the point Deputy Baudains was trying to make. I mean, we work together on these propositions that are coming up later in this sitting and those are the sorts of points. I would like to know how will the Minister, even though she or he may be in charge of running their own services, as Senator Routier said, how will the Minister deal with situations where Members have a concern and they wish to express it in this Assembly? How will she deal with the questions? Will

she just say: "Sorry, I cannot be involved; I have given all my powers away to a Commission"? The reason I mention that is I do not know if Members have analysed what happened with Mid- Staffs. It is mentioned in the reports but basically a whole culture developed in a hospital despite a whole plethora of checks and balances which, of course, the inevitable response is to put in even more checks and balances and more regulation; that is the way we work. But a whole culture developed of uncaringness, of insensitivity to patients where unconsciously or otherwise, senior management and workers they were all complicit in what was happening. How did it ever get to this stage? Why did nobody in a whole plethora of regulation, and I know I will be so told: "Oh, it was not regulated enough. Let us have more regulation." But I am not sure that is an adequate analysis of the situation, quite frankly, and I am not sure had there been whistle-blowers around, had there been politicians who were taking an interest in the issue, whether it could be picked up. I know the N.H.S. (National Health Service) is not politically regulated in the way we are; there is only the Minister for Health and Social Services and a few junior Ministers who have to do the whole thing at that level. But that is why I think the ultimate political accountability without pedantic political interference is important. The other issue where I would echo Deputy Tadier is the role of the public sector. The English, and indeed, a lot of the U.K. sector got into deep trouble because it was based on a business model based on heavy mortgages brought out on properties which could only be financed by a steady flow of local authority fees. These fees started to slow up because of government cutbacks and we have companies operating in Jersey who have felt the brunt of that kind of system, quite frankly. We know that there have been real issues, there have been continuous changes in ownership of some of these big operators, Middle-East interest, German interests, and to what extent would the Minister regard it as her role, because I see there is a comment in the documentation, which I have not quite sorted out about regulation versus being involved in policy. To what extent would market oversight be part of the role of the Minister or of the Commission? In other words, to say the very thing that I think it was Deputy Tadier said: "Look, we are entering a monopoly situation." They may have one of these financial models that I have mentioned where they are mortgaged to the hilt and basically they rely on a steady flow of essentially public sector fees to keep them going. How will the Minister deal with that if that situation arises? We maybe regulating to our heart's content but if the ship is sinking because of defective financial modelling how will we deal with it? The other issue, and it sounds a strange one, but I remember when I was on the old Health Committee, we had to go to a care home to inspect a carpet because the care home operator would not replace it because there were a lot of cigarette ends that had been ground into the carpet and although the Minister will say: "We are not allowed to smoke" .. anyway we had to inspect this carpet because there was a lot of debate about whether it was unfair to require the operator to replace the carpet because the smokers, and indeed, food was being ground in, were doing it. So I wonder if the Minister feels there is sometimes a case of over-rigorous standards? I know in a way it is very hard to argue that but I have heard that before and, again, I would like her views on that, on how the Commission will handle that. Thank

you.

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

First of all, I was not going to mention this but I would fully endorse what Deputy Le Hérissier has just said, and Deputy Baudains said before. I want to start off by giving a warning tale and it is something that has troubled me for some time. A lady who lived next to me a number of years ago and became a very good friend of my wife went into a nursing home and she was reasonably well- off, had sufficient money. She went into one of the more upmarket care homes in the Island where they used to have a glass of wine on a Friday when visitors came and so on. It was all very, very pleasant. Over time she started worrying about her finances and how the money was going, and it was going rather rapidly. She was also very concerned, too, about jewellery, and other things that she had had in the care of the home. It eventually transpired that my wife went to go and see her one day and it was found that she was not there. She had been taken to hospital. She suddenly got violent and that she was suffering from signs of dementia, which was rather amazing considering the dementia came within 2 to 3 weeks. We were very, very puzzled by this. My wife visited her in hospital and again, the hospital staff were saying she was suffering from what appeared to be dementia. She never did return to that care home, which, by the way, they said to her: "Do not worry about it. When your money runs out we are going to look after you. Do not worry about it at all." When she went out of hospital she went to one of the, I think, worse care homes in the Island, and I think she died about 3 months later. Now, I am really, really .. I hate to say this but I do wonder. I do not believe that she got dementia in 3 weeks or whatever and I do wonder about her removal to the hospital and subsequently. Now we know that hospitals see patients when they come in and I can give an example in the U.K. of my own mother and mother-in-law. They went into hospital with various sort of infections and at times, coming out with some odd statements. We said to them .. they thought, I think, in my mother's case, she had dementia, or my mother-in- law had dementia. No way. It was the medication that they were on. When it was pointed out to them, they were both compos mentis and there was obviously something not quite right and they changed their medication, it was amazing the transformation in both of them. Now what I am trying to say is that there are, I believe, unscrupulous people involved in care homes and Deputy Tadier has mentioned about those where the profit motive is the main thing and they are mortgaged to the hilt and so on, and we need to be exceptionally worried. So what I am trying to say is here, I do support law coming in and regulation. I think it is absolutely essential that we do but it is a warning. The reason I am mentioning these stories is for relatives and friends of those who are in care homes, if they suddenly get dementia within a few weeks, start asking questions about the medication they are on, and so on. Anyway, I have got it out because it is something I have felt very strongly about for some time. Now I also have some reservations with the law but again, I am going to take the view that Members will have the opportunity to amend the law at a later date when the Regulations are published. It may not be ideal but we have got to start bringing in some regulation of this sector. Now, I also fully endorse .. so I fully endorse a lot of Deputy Hilton's comments and Deputy Tadier 's regarding criminal record checks on carers although I do suspect that if we bring them in we are going to lose many of them because there are an awful lot who have

not got criminal record checks. [10:30]

But, as I have stated in this House many times, I think it is scandalous that the criminal record checks are preventing many Jersey people with minor criminal records from getting employment in this sector and other sectors when people from countries outside the Island, whose records cannot be checked, are employed and these people may have serious convictions whether it be for murder or rape or something else. We have no way of knowing what they have done in the past. We have a strange form of discrimination in this Island against our own people who we can check and they may have a minor thing and they will not get a job, and people from outside the Island, who we cannot check, could be sound, probably are, but on the other hand, there could be some serious offenders there. I think that it is something that is unacceptable and needs to be addressed by Ministers who have ducked this issue to date. So what I am trying to say is I broadly support the idea of the Regulations coming in. I do not think it is perfect and the Scrutiny Panel have done the best they can and I am inclined to support them in their reasoning and supporting it. But again, I would just also state that I also support Deputy Baudains and Deputy Le Hérissier about how do we hold these people accountable? One thing this House has been exceptionally good at over the last 3 years or 6 years is devolving power to bodies outside this House where they are no longer accountable to the House. We may have one Minister in charge who is supposed to be acting as our representative but what happens when push comes to shove and we start questioning them: "Oh, it is not our issue" and he is not going to intervene or whatever. So I have to say it is probably the best we can do at the present time, but it is not good enough. Thank you.

The Greffier of the States (in the Chair):

There was a question raised earlier that the Solicitor General was asked to address. I understand he may be in a position to address that.

Mr. H. Sharp Q.C., H.M. Solicitor General:

The question was what did the definition of volunteer mean in the interpretation section of the law and whether it might cover family members. If one looks at page 39 of the proposition one can see that the definition of worker includes not just employees but also people on work experience placements, or a volunteer. In principle, a volunteer could literally be anyone providing care on a voluntary basis so it could include a family member, but one has to read on to Article 2 and there is the effect of Article 2 subsections (1) and (2) is that the States Assembly can, by Regulations, define what sort of activities will fall within the ambit of the law and what activities will not fall within the ambit of the law. So obviously it is a matter for the Minister and States Members. I had rather understood the thrust of the proposition to be that family care was not going to be included within the ambit of the law and that the Regulations would, in due course reflect that. But that, as I say, is a matter for the Minister and, of course, States Members in due course.

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

Sir, could I ask a further question although I am not sure whether it is a matter for the Solicitor General or a matter for the Minister? On page 8 of the report, reference is made to the phasing of what the Regulations will be applied to and it makes reference to personal and in this case, nursing domiciliary care. What would be the Solicitor General's interpretation of what personal domiciliary care is? Because I was wondering whether it might include, for the sake of argument, housekeepers or, as we have also heard, carers.

The Solicitor General:

Well, primarily that is a matter for the Minister but reading that, it appears to mean that it may well be intended that carers who go and .. either volunteers or paid people go and live in someone's home and provide care and sleep in their house, for example, so they are on call as just a random example, they would be covered by this law. But as I say, I think really that .. who you choose to.. what type of care you choose to categorise as falling within the law is really a matter for regulation and States Members rather than me.

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

I have no doubt at all that it is a major step forward that the Islander has a completely new primary law regulating the quality of care and safeguarding those providing that care for vulnerable people. Absolutely no doubt about that. But I think it is important in this debate to ensure that we have got the scope of the law right because I want to raise an issue that has not been raised yet so far, which is, if you like, the financial regulation aspect which I think was touched upon by Deputy Tadier and Deputy Le Hérissier. In the Scrutiny Report, which is very, very helpful - extraordinarily helpful and I thank the panel for it - it says on page 4, that it is the intention that this law should be extended and cover a whole range of personal health services which, including such things as dental practitioners, medical consultations, paramedical activities, cosmetic procedures, social care, as well as what we might regard as obviously the core purpose now, which is residential care, long- term residential care. So it is clear that this framework of this law has to work for a whole range of broad services in the long term and given the amount of time and effort .. I do not know how many years; somebody said 8 years, I think. I think it is important that the scope of these laws, we think strategically very early to ensure that we get a broad scope. We do not find halfway down the track

we are too narrow, we did not include enough scope and we are.. we will need to regulate things and we cannot do it. So clues that I have to where the scope of this law might need to be in that I notice on the expert adviser's report on page 19 and 20 of the Scrutiny comments, which is pages 9 and 10 of the expert adviser's report, they tell us about the similar moves in the United Kingdom and they tell us about how they have got different laws now in Scotland, England and Wales, and Northern Ireland and how here in England we have the Care Act 2014. Now that sets down the scope of that law and the scope obviously is vital because as part of registration and licensing one can only put conditions on licences if the scope is set out in the law. There, I see that the draft Regulations in the U.K. in the Care Act will include funding reform, market oversight and provide a failure, as Deputy Le Hérissier spoke of, but the key, charging. Charging. Of course, when one goes back through this list of services that ultimately may be provided under this law, the vast majority of them are going to be private sector providers and in many cases they are going to be monopoly providers. As Deputy Tadier says, well, what real choices do people have when you are in the hands of a monopoly provider on this Island needing a service? I was reminded of the debate we had.. excellent debate on the Long-Term Care Law. The Island has set the outstanding example, I think, of best practice here. We have introduced a really progressive scheme to provide public funding mechanisms, a really substantial significant one and we have introduced a tax to pay for it, to provide for long-term care for a certain type of primary care. It was right that we did so but I remember the issue in the debate coming up, well where is the regulation going to be on this? Because Government are going to set out a set of rates. I think I remember the Minister for Social Security telling us: "Do not worry" when Members raised how would we know that people are getting value for money in those services and we are not having profiteering and exploitation of people? I think I remember the Minister for Health and Social Security telling us: "Do not worry. We have got the new Care Law coming along." So I asked a question, when I start.. when I look at.. so plainly their Scrutiny Report is telling us that in the U.K. is defining a wider scope for their regulation Law and they do say, for example, they are not going to be implementing in their law the charging and funding arrangements until, in their case, April 2016 because their.. there it is. You see your work here. It says here they refer to a thing called a cap on care costs. That suggests to me that other jurisdictions are thinking about putting limits. Now, of course, you would not want to do that straight away but I wonder does the law that we are about to pass.. is the scope broad enough to ensure that we do not find out at a later date that when we have got this Commission, excellent people there, yes, they will have the powers no doubt about it to deal with all the issues about the persons that provide the care, where the premises on which they are made, the numbers, qualification and training staff and so on. So when we talk about the Articles, I think I am going to.. I would like.. later on Articles 12 and 14 are the relevant ones here because they seem to quite limit the scope of the conditions of what can be included in the registration. The only reference I could find in there to a condition on costs and charges it says: "Impose requirements as to the publication of information as to charges made for the provisions of any service for the carrying on of regulatory activity." So in other words, the law at the moment, the draft we have got here, seems to limit it to just making people aware, telling people what they are going to have to pay. So following that in with what Deputy Tadier and I think Deputy Le Hérissier said, where we have monopoly providers, massive States funding coming through the Long-Term Care thing, what.. if we have got this regulatory law, is its scope broad enough in the longer term to deal with that? But having said that, I have just put that issue out there for the Minister for Social Security to think about and it may be that it is another phase and it takes a number of years until we get that right. But I think at this stage when we are putting in place the basic framework, I think it is great that we have got the quality of care, the safeguarding. We seem to have obviously focused on that but as Deputy Duhamel says, when it has got scope of the regulated activities we have got a blank page and so we do not yet know and the Solicitor General told us we are going to have to set out that blank page and we are going to have to say what is in, what is out. Are family members who

provide support in or out? What about how do you define a family? What about long-term friends? Close friends and associates of people that have known each other for a long time that might want to provide that. So I think there is work to be done there. So I am very much supportive of this. I just wanted to put those issues out there because I think every time that we do these laws, we should think broad, think strategically and get it right. I think the Deputy of St. Martin was right. Had there been time what with the excellent Scrutiny Report we have got, would have been followed up and fleshed-out and we would .. some of the questions I pose we would have been able to answer. So I am obviously going to support the law.

12. Deputy J.A.N. Le Fondré:

Yes, I broadly welcome the legislation today. What I just wanted to comment on, make a couple of observations on, was certainly perceptions in terms of inquiries that I have had in the past. I emphasise perceptions because I am sure there will be another side to the story. But basically that as far as the private sector were concerned or private sector providers that they were being applied under the existing Regulations were required to have almost a higher standard of provision of service compared to similar services being provided by the States themselves. That is why I do welcome that as it is my understanding that these Regulations will be applicable across everybody including ourselves. But I suppose what I wanted to just cover is in the report, obviously on page 6 it obviously identifies that I presume that this will be applicable, for example, to the general hospital. It also makes reference to the whole regulatory side of things being phased-in. So I suppose question one for the Minister, and the phasing timetable is on page 8 of the proposition, is what is the overall timetable to get everything in? Because obviously it talks about certain parts being 2015 but what about all the other parts? Number 2, and I am talking about the hospital in particular, is when will.. I do not think that is included in that timescale. When will that be covered under the Regulation?

[10:45]

Just from, I suppose, a wider perspective - I know we have had it in other areas, I think the airport may have been one - is when that Regulation comes in, I am going to assume that will be before we have the new hospital in place, is what will be the position if, and I say if, there are any parts of.. I use the hospital as an example, that are found to be deficient and what is the potential impact of that? The other issue I suppose, which goes back to my first point about perception as to a sort of inequality of how standards are applied. Will there be any areas that .. let us assume the timescale is going to be 3 or 4 years. I do not know. Will there be any areas that perhaps that the States provide care which will not be caught by the new Regulations immediately? Where there may be discrepancies in how those standards are applied compared to the private sector and will that just be allowed to continue or will there be an expectation that, for example, if there are any deficiencies those deficiencies will be remedied sooner rather than later and are those best practices applied rather than just relying on the letter of the law? I am obviously saying it is a hypothetical situation so I do not know if that is the case but I am just asking what would be the position. I do have to echo the comments made by Deputy St. Martin in relation to the time on Scrutiny. It is always unfortunate we are all seeing this squeeze towards the end of the year. But we do have to recognise that Scrutiny at the very beginning made a huge effort to change how they were perceived to be operating, were very positive in how they approached things and I think the counter-side, as it were, as the response has sometimes been a bit patchy, as to how Scrutiny has been dealt with and obviously that is going to have to be a matter for the new Chief Minister, as and when, to ensure that matters are improved even further. What I would like just to go back to specifically to the Minister again, and it was really following on from the question I raised with the Solicitor General. What is the Minister's intention that, under the timetable of phased implementation, the reference to personal domiciliary care would mean? I am assuming on the basis this is the care regulation that we are talking, as it is envisaged it is to assist people who are infirm in some shape or form.

But could it be captured? Could it capture somebody who literally comes in to help do a bit of cleaning once a week for somebody who is elderly? I am assuming that is not the case but could you just confirm that for the record? Thank you.

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

I do not think anyone here would argue that all the health and social care activities should be regulated. However, I do - as one of the panel members - stand by our adviser's report that has been undertaken, and would just like to remind States Members that although the U.K. has had a wide range of regulation in place to support and cover the delivery of care, there have been some significant issues that have been raised, highlighted in recent times in 2 large and major reports: the Francis Report and the Cavendish Review and as a result, as the adviser quite rightly points out, the law is currently being updated and major changes could be taking place. So we need to view our law and what is being proposed in light of that and certainly I, like the Deputy of St. Martin, will definitely be looking at the Minister for Health and Social Services to absolutely confirm and guarantee that whatever the outcome is within the U.K. and the review of their legislation that if we need to amend our primary legislation that that is done as a matter of priority. I think there are a couple of other small points that I would like to raise. It is to do with the regulated activities. We are told that a number and quite a wide range of activities will be regulated; however, it will take time. Some of these areas include medical consultation and treatment in the field of general and specialised medicine, dental practice activities of a general and specialised nature, activities not performed by hospitals or practising medical doctors but by paramedical practitioners, cosmetic procedures or techniques undertaken by medical and non-medical staff, and so on. I just would like the Minister to explain how and what priorities she is going to place on introducing regulations for some of these matters? Because it is my view, and then I think the Minister highlighted it in her opening speech, that we need to protect the vulnerable people in high risk areas. I would suggest that our hospital and other areas are quite high risk areas. I am not sure if I heard the Minister correctly in her opening speech but the suggestion that we are going to wait until 2020 before we have the hospital appropriately regulated, I think is too long to wait. [Approbation] I apologise because it is a question that perhaps I should have raised given sufficient time but we have already

had the Minister confirm that the first regulated activities will be to do with care homes and children's homes. Yet as many.. and then a couple of Members have already pointed out Schedule 1 within this P.95 proposition - which is the draft Regulation of Care (Jersey) Law - is totally blank. I am confused. If it has already been decided that those activities are the first ones to be regulated, why are they not included on this particular schedule? Again, perhaps the Minister can answer that question. Finally I would like to just draw Members' attention to our comments that we issued, and if you have it in front of you I would like to ask you to turn to page 10. It speaks about the financial and manpower implications. We are told that a business plan for funding implementation, the first phase of introducing the new regulatory regime has been undertaken and it then speaks about what some of that includes. The point that we would like to make and draw Members' attention to is that it is not clear if the business plan for the implementation will cover all of the other areas that require funding especially within the areas recommended from the adviser regarding premises and resources. We do say it is imperative - and I stress the word "imperative" - that alongside any draft Regulations a detailed cost analysis is provided showing all financial implications that will be incurred within that specific set of Regulations. The reason why we say that is quite simply that before Regulation is introduced, let us all have our eyes wide open to all of the matters that surround the introduction of those Regulations. Let the consultation be thorough. Let it be fully inclusive and, as I say, let us make sure above all else - as my fellow panel member said - that the primary Law and the Regulations that will follow it, really do meet the needs of this Island. Thank you.

The Greffier of the States (in the Chair):

Can I just remind Members we have been debating this matter since 9.30 a.m. and I do hope that those Members who are still to speak will have something additional to add. Senator Ferguson.

14. Senator S.C. Ferguson:

But of course, Sir. I must say that I do agree with the Deputy of St. Ouen. The range of activities to be regulated is extremely wide. Surely G.P.s (general practitioners), for example, are regulated already and so are the other professional bodies so why are they included in the setup? The volunteers: I must speak up for the families involved. In my own case, I hired a lady to granny-sit during weekly daytime and I did evenings and weekends. Now, if the Regulations envisaged by the Minister will include me as the carer, is this aim to put more people into care homes? Is this yet another cost to the family? Will there be inspectors tramping through my lounge to make sure that it is old lady-friendly and so on? No. I am sorry. This is not good enough. We need a proper definition. I have also had calls from family members whose relatives are being cared for the States in a quasi-living independently basis. The family members want to help but they are being excluded by the carers employed by the States. Now presumably these are being checked by the Social Services Department. I do not know. But certainly from the volunteer point of view, would I, as my mother's carer, have required inspection and registration? As a corollary to Deputy Higgins, when my mother was in hospital, we found she was not being fed and, in fact, Members know that I do not do early mornings but I used to do breakfast and dinner and my granny-sitter did lunch. Lack of food can also cause confusion. I can confirm that there is now a red tray policy but this was after I raised this in this Assembly, but all too often as per North Staffs it still happens. To pick up Deputy Young's point, I found that hiring a granny-sitter and doing a fair bit myself meant it was about half the cost of a care home. It wreaks havoc with your social life but you can cope. If we put a cap on costs, as he was talking about, what happens to the quality of care? You put a limit on costs then the services offered under that will gradually fall away. Yes, we do need regulation of rogue agencies and certainly, as I understand it, it is probably the first time that the States-end of the organisation has been inspected. We have started with the care homes and now we are doing

the carers. Yes, we do need it but please, do not overregulate it where the families are concerned. They are providing a service out of devotion. Do not ruin it for them because most oldies prefer to be, if we are talking about the vulnerable old in society they prefer to be in their own homes, not institutionalised so a light touch, please, Minister.

15. Senator F. du H. Le Gresley:

Firstly, I would like to congratulate the Minister for Health and Social Services for bringing this very important piece of legislation to the Assembly. Moving from that, Deputy Young raised the issue of the new long-term care benefit which, of course, started to be paid on 1st July in some cases - in many cases. We were particularly concerned to ensure that there was a framework in place with care homes to deal with the payment of this new benefit and my officers have been working tirelessly, I have to say, over the last 6 months with the Jersey Care Federation to come up with a framework agreement which, I am pleased to say, the homes that are currently registered under the Nursing and Residential Homes (Jersey) Law have signed the agreements and I countersigned the agreements on 1st July and they are now all in place with the agreement of, as I say, the individual owners of these homes. I have not got one in front of me so I cannot go into the detail but they have been negotiated very carefully with these homes. The essential thing is with regard to charging is that what we have agreed with these homes is that when it comes to care charges, the personal care charges that the long-term care benefit is designed to help with, they will charge the rates that are equivalent to long term care benefit. So we have 4 levels.

[11:00]

So if, in the case of a home that is charging at level 2, shall we say, that will be equivalent to the benefit that we are paying because the average case, we will be paying the benefit direct to that home for the care of the person there who has been assessed by social workers. So we have that agreement. Now the only bit that is not completely tight, if you like, is the co-payment which is relating to accommodation and food costs and I think we have made the point during the debate on long-term care that homes have different levels of services they provide for their residents and we are not in a position to restrict a home from charging for, as I used to say, a room with a view or extra services that somebody may wish to pay for. There is a co-payment which, I think is fixed at about £312 a week and many homes will be charging that co-payment but some will be charging

extra on top of that for the extras they provide and that will be for the decision of the resident if they wish to pay that and accept that as the cost. Now when it comes to the area that really that we have all been concerned about, domiciliary care and bearing mind that our long-term care benefit, unlike Guernsey, is going to be available to people who are receiving care in their own homes, have been assessed as needing a certain level of care which would be equivalent to going into a residential home. This is work that has been done by the Minister's Department, Health and Social Services; the Commissioning Section have been working on an approved provider's framework for home care services and this has been in conjunction with the various organisations, obviously the one that we all know, the biggest one, Family Nursing Home Care but, of course, there are other organisations who deliver care in the home. The important thing there has to be to come up.. they have had to demonstrate that they have the appropriate skills and experience to enable them to provide quality, safe and effective home care support so they have been assessed on that basis and I am not sure of the exact number. I think it is about 10 or 11 community providers which will be for domiciliary care, have been approved and that list now appears on the Jersey Online Directory. So we have been doing a lot of work both in Social Security and in Health to ensure that the benefit that we are now paying from 1st July is in an environment where there is a safe system in place to ensure the care of the person who needs that care. Of course, it does not go far enough and that is why the Minister is bringing the Regulation of Care Law. In the case of homes that all registered as I said, under the Nursing and Residential Homes Law, we do have inspections and there are standards that we can accept but when it comes to domiciliary care, we do not have that sort of protection and that is why it is so important that the Regulation of Care Law, the framework law is put into place as soon as possible and that the Minister comes forward with Regulations in support of that law and I hope Members will give it wholehearted support today.