Flu Pandemic funding

STATES OF JERSEY

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FLU PANDEMIC FUNDING

Lodged au Greffe on 20th November 2007 by the Minister for Treasury and Resources

STATES GREFFE

2007   Price code: B  P.176

PROPOSITION

THE STATES are asked to decide whether they are of opinion

in accordance with Article 11(8) of the Public Finances (Jersey) Law 2005 to amend the expenditure approval for 2007 approved by the States on 13th September 2006 in respect of the Health and Social Services Department head of expenditure, to permit the withdrawal of an additional £517,000 from the consolidated fund for its net revenue expenditure in order to fund expenditure already incurred on preparations for pandemic flu.

MINISTER FOR TREASURY AND RESOURCES

REPORT

Background

Under the Public Finances (Jersey) Law 2005, heads of expenditure for departments are, in the normal course of events, approved as part of the Annual Business Plan approval  process  by  the  States.  The  sum  of  such  approvals  is  known  as  the "expenditure  approval".  The  Public  Finances  Law,  does,  however,  state  in Article 11(8) –

"...  the  States  may,  at  any  time,  amend  an  expenditure  approval  on  a proposition lodged by the Minister on the grounds that –

1. there is an urgent need for expenditure; and
2. no expenditure approval is available.".

Two  such  spending  pressures  have  emerged  in  2007,  meaning  that  the  existing expenditure approval is no longer adequate. The States have already approved an amendment  to  the  2007  expenditure  approval  in  respect  of  the  Social  Security Department's  head  of  expenditure.  This  report  seeks  an  additional  expenditure approval  in  respect  of  the  Health  and  Social  Services  Department's  head  of expenditure for 2007. This would result in the department being permitted to withdraw additional amounts from the consolidated fund for its net revenue expenditure in 2007. This will, in itself, not increase the base cash limit of the department in subsequent years.

Funding for Pandemic Flu preparations

Details of the need for the request for additional funding are set out in the attached report from the Health and Social Services Department (see Appendix).

The States are requested to approve the additional allocation of £517,000 in respect of expenditure already incurred on preparations for a pandemic flu epidemic. This would increase  the  2007  net  revenue  expenditure  of  the  Health  and  Social  Services Department from £137,095,000 to £137,612,000.

Financial and manpower implications

There  are  no  additional  manpower  implications  arising  from  this  proposal.  The financial implications are as set out in this report and its Appendix.

APPENDIX

Health & Social Services Department Preparation for Pandemic Flu Outbreak Phase Two (Reduced Scope)

(Supplementary Paper for States Members to support proposition from Senator Shenton)

0. Executive Summary

• In the annual review of our flu pandemic plans we have adjusted our predictions to assume that the pandemic (expected to be a strain of H5N1) will run its course in Jersey in only four weeks.
• Due to the adjusted predictions on the pandemic a larger stockpile of antivirals (Tamiflu) was identified as necessary along with various other preparations identified in the Phase Two plan to Council of Ministers.
• Council  of  Ministers  originally  endorsed  the  Phase  Two  plan  but subsequently  the  plan  has  been  referred  to  scrutiny  for  further consideration and assessment.
• Health  &  Social  Services  had  already  taken  the  opportunity  to purchase the additional stocks of Antivirals at a cost of £517,000.
• Due to the existing pressure on Health & Social Services expenditure the department is unable to absorb this additional cost within existing resources.

1. Recommendation

• In order to achieve a balanced budget for 2007 Health and Social Services  request  an  additional  £517,000  to  be  allocated  to  the Department budget.

2.0  Introduction

In January 2006 the Council of Ministers endorsed an approach to preparing the Island for pandemic flu. In April 2006 the Emergency Planning Board endorsed the health plan  which  set  out  this  approach  in  more  detail,  the  key  components  being  an escalation plan for the hospital and a plan for treating pandemic flu in the community to cope with a surge of extra patients. In May 2007 the Council of Ministers endorsed the  Phase  Two  preparations  but  subsequently  the  paper  was  withdrawn  to  give scrutiny an opportunity to review the proposal.

3.0  Case for Purchase of Antivirals (Tamiflu)

Based on UK predictions, it was previously estimated that Jersey would experience 25,000 cases of pandemic flu over a 16 week period. We have translated from French the Inspecteur Medical's (Medical Officer of Health) report from 1918 (a major flu pandemic year) which demonstrated that for a community of our size and area, a short sharp outbreak affecting some 25,000 people over a four week period is more likely than over a longer period. We have also reviewed the Guernsey data from 1918 which shows the same pattern.

Dr. Muscat has discussed our revised hypothesis with the National Health Protection Agency and they have also confirmed that they feel that this pattern is more likely for small communities in the next pandemic.

Our plan to date has been to deliver antiviral drugs to patients as they are diagnosed with pandemic flu. In our opinion, this approach, based on prior medical/paramedical confirmation of influenza-like illness would not be fully effective given the more intense anticipated nature of the outbreak.

"The epidemic of influenza of 1918 hardly lasted about thirty days, from October 16 to November 16, but its contagiousness was such that in a few days there were accounts of hundreds of patients, and the deaths were so abrupt that many times the doctors, who were completely flooded, could not arrive in time to see the patient"1

Dr. Paul Chappuis, Inspecteur Médical 1889-1922

To minimise the risk highlighted above we would recommend patients start taking antiviral  drugs,  ideally,  within  two  hours  of  onset  of  a  fever  to  get  optimal effectiveness.

We therefore propose the pre-distribution of antiviral drugs to the whole population at the time of declaration of the pandemic by WHO with very clear patient guidelines for use ONLY after onset of flu like symptoms including a fever.

4.0  Current Situation

Due to the endorsement of the Phase Two preparation plan Health & Social Services Department took the opportunity to procure the additional Antivirals (Tamiflu) for £517,000. Unfortunately due to the time lapse the manufacture will no longer accept the return of the goods.

Even  though  the  Phase  Two  plans  have  been  referred  to  Scrutiny  for  further consideration, it is requested that these funds are still allocated to Health & Social Services to fund the purchase.

Dr. Rosemary Geller – Medical Officer of Health

Russell Pearson – Director of Finance Health & Social Services Department 12 November 2007

1 Rapports de L'Inspecteur Médical et de L'Inspecteur Sanitaire pour l'année 1918.