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STATES OF JERSEY
r
BUDGET 2005: FOURTH AMENDMENT
Presented to the States on 7th December 2004 by Deputy R.G. Le Hérissier of St. Saviour
STATES GREFFE
BUDGET 2005: FOURTH AMENDMENT ____________
PAGE 37 –
In the estimates of revenue expenditure of the Health and Social Services Committee –
In c r e ase the estimate for Grants and Subsidies' by £79,000 from £7,359,700 to £7,438,700 in order to
increase the amount of grant to Family Nursing and Home Care (Jersey) Inc. by reducing the estimate for Administration Costs from £4,166,400 to £4,087,400.
DEPUTY R.G. LE HERISSIER OF ST. SAVIOUR
REPORT
Introduction
The contribution of Family Nursing and Home Care (FNHC) is well known to all Islanders and it essentially runs the bulk of the community support services which enable Islanders (who might otherwise be in hospital or care) to stay at home, or to leave Health and Social Services Committee facilities, secure in the knowledge that appropriate support services exist.
Rather than go through detailed arguments, key questions are posed and answered, while more detailed data is contained in the Appendices and will be drawn upon in the debate.
What is the proposed cut?
1.6% (£79,000) of next year's proposed grant (£5.6 million) It should also be noted that there are further pressures on the budget. In 1993 £120,000 was granted for a free urinary/colostomy scheme. It currently costs £180,000 (2004). FNHC have subsidised it over 7 years by£270,000.This matter is the subject of separate negotiations between Health and Social Services (HSS) and FNHC.
How was the cut arrived at?
The Health and Social Services Committee proposed a series of cuts at the FSR process, with cuts to voluntary grants being offered up, in the early stages.
Did consultation occur with FNHC, prior to the FSR?
No.
Was a value-added analysis done of the impact of the cuts?
Not evident. FNHC saves massive amounts of money because it means people are not kept in the Hospital and other very expensive care facilities.
Why should FNHC be treated differently to other voluntary agencies? Do they not have to take a similar cut?
It should not be treated differently except in the sense that, while classed as a charity, it operates as by far the biggest charity working with HSS and is its biggest provider of services.
Furthermore, because of the sheer size and complexity of its operations, cuts not only impact on FNHC but also on other statutory, parish and voluntary services with whom it is linked, e.g. the Hospice, Age Concern, Les Amis, Brook Advisory Service.
The bigger question is that of why the agencies' grants were considered for cuts in the first place. For example, the Hospital Car Service has had its grant cut. Given that it represents enormous value for money with free drivers and cars, it seems a strange cut.
It should be asked, given the comparatively small sums involved, why cuts were not sought in high-expense areas or those where more enduring and/or immediate efficiencies could be achieved, relatively easily.
What makes FNHC special?
Aside of its sheer size and role s a virtual, indispensable "arm" of HSS it is dealing with an increasing workload and one which is becoming much more complex.
As the Health and Social Services Committee moves people into the community, be they people with special
needs or the elderly, so FNHC is picking many of their nursing and associated needs.
It is the major contractor for community nursing and support to Health and Social Services. Should FNHC be immune to efficiency drives?
No. The Board are prepared to sit down with Health and Social Services to look at savings. A Working Party exists and has not produced significant areas of savings. However, FNHC remains open to all possibilities. It is continually reviewing its own operations. Furthermore it is stepping up fund-raising activities-in other words, it is using fund-raising to provide a subsidy to the States! (the current aim is to raise £1.5 million).
The management structure is currently under review. Staff visiting homes are increasingly multi-skilled, as are senior staff. Highly skilled staff are used sparingly and only where there is an actual requirement.
Infrastructure costs are kept at a minimum – partly because of some service help from HSS.
The continued growth in service demand and the vital role FNHC plays in helping people move out of very expensive care to the community produces savings and other benefits which totally eclipse "penny-pinching" exercises. FNHC is much more than a provider of physical and/or nursing services. Its staff often deal with people who are isolated, lonely and afraid. Staff perform a role of support well beyond their formal job description.
Conclusion
The early identification of grant-aid as a way of savings costs was mistaken. A massive operation like Health and Social Services requires a major analysis of all areas in order to identify where real savings can be made.
Relatively small (but to the agency, damaging) cuts have an entirely disproportionate effect and take no account of the enormous "value-added" of their work.