Questions to Minister without notice Health and Social Services

3.  Questions to Ministers without notice - The Minister for Health and Social Services The Bailiff :

Very well. That concludes question time on notice and we come then to Questions to Ministers Without Notice and the first period is to the Minister for Health and Social Services.

1. Deputy G.P. Southern :

This refers to page 30 of the White Paper circulated by the Minister yesterday. On page 30, it suggests that recruitment of nurses and retention of nurses is vital to delivering the aims of this White Paper. Is she content that the £5 million for the nursing establishment will attract sufficient numbers, especially in the light of the £3.2 million which she has allocated over this first period of phase 1 to nursing terms and conditions?

Deputy A.E. Pryke of Trinity (The Minister for Health and Social Services):

I am very pleased that the Deputy has got the White Paper with him. The nursing establishment we  have,  asked  them  for  some  funding  which  was  in  the  2012  Business  Plan  for  nursing establishment and nursing terms and conditions. It is always a challenge and will continue to be a challenge to recruit and retain nurses especially. But at the moment, this is the money that we have identified for the next 3 years and we are working hard to make sure that we recruit those nurses and especially the hard to reach ones

3.1.1 Deputy G.P. Southern :

The question was is she satisfied that the £3.2 million allocated over the first 3 years, phase 1, is sufficient to attract, recruit and retain sufficient quality of nurses?

The Deputy of Trinity :

As I said, the amount of money that we have identified we can use within the first 3 years, whether we go on needing more remains to be seen when we get to phase 2. But it is not only recruiting but it is also making sure that we retain them and making sure that we have got a plan to train our own nurses locally, which is going to be an important part.

The Bailiff :

The question, Minister, was whether you thought that what had been offered was sufficient to attract them?

The Deputy of Trinity :

I thought I said yes, Sir, for the first 3 years.

2. Deputy S. Power:

I refer to her department's excellent White Paper on Caring for each other and Caring for ourselves. In the briefing yesterday, the Minister and her senior management referred to what I would call the frivolous use of the Accident and Emergency Department. How does she propose to deal with the Friday night/Saturday night invasion of people who are nauseous because of inebriation or people looking for such things as a pregnancy test on a Saturday night? How does she propose to deal with things like that?

The Deputy of Trinity :

I am very pleased again that the Deputy has got the White Paper with him. A. and E. (Accident and Emergency) Department is a challenge and, as you said, on Friday and Saturday nights, it is a different world down there. The hospital management are working hard to try and find different ways of using the A. and E. Department properly. One of them, as he probably knows, is having some sort of G.P. liaison officer working in A. and E. so that those people who come to A. and E. who should go to their G.P. can be directed there. That is one issue. We know that quite a few parents bring their children down to A. and E. because it is expensive to go to the doctor. One of the business cases is early intervention and working with the G.P.s to try and see whether we would commission G.P.s to give so many free visits to the G.P. during a year. That is one of our thoughts. But also most of those issues on a Friday and Saturday night are alcohol-related, and the biggest thing that we need to look at is to change our society. It is a societal issue that we are more responsible with the amount of drinking that we all do.

3. Deputy M.R. Higgins:

Drawing the Minister's - and the Members as well - attention to written question number 14. In Table A, it shows that the cost of medical insurance for inpatients has risen by over £430,000 per annum from 2008 and that theatres and anaesthetics has also gone up by £32,000. Can the Minister confirm if this is the impact of the failures in the Health Department - and certainly the death of the nurse - and other consequences that have happened for the hospital to be paying much higher insurance premiums, because the medical insurers consider the risks are so high?

The Deputy of Trinity :

If the Deputy turns the page, he will see an explanation of the variance and one of the main things was that before medical staff were coded to hospital management and administration but from 2010, the department had coded this insurance to each division. But saying that, increases in medical insurance premiums are part of a global trend. As you know, more people will seek litigation and that does put the price up. Jersey is not immune to these trends. We provide services on Island and that poses risk and increases the insurance. We could just simply fly everybody off the Island but medical insurance is a fact of life.

3.3.1 Deputy M.R. Higgins:

Is the Minister stating therefore that there has been no increase in premiums as a result of the recent sort of tragic deaths of people at the General Hospital?

The Deputy of Trinity :

It is a very difficult thing to say categorically one way or the other. We procure our medical insurance and we try and do that very well, but at the end of the day, as I said, it is a fact of life that obstetrics and orthopaedics - which are essential to any functioning hospital - have their risks and a high cost of insurance.

4. Deputy S. Pinel of St. Clement :

While the White Paper deals extensively with the long neglected situation with the Children's Service, the requirement to wraparound care for children and the importance of early intervention; would the Minister reassure Members that young people leaving care will not fall through the net and will receive the support they require, hopefully in collaboration with the third and voluntary sectors?

The Deputy of Trinity :

For the first 3 years with the White Paper, we put early intervention as one of our main spheres but that does not stop business as usual continuing, and I must stress that. One of them is making sure that for all our children - and I class them as they are all our children because they are of the States of Jersey - we have a corporate responsibility that we give due care and attention to that. That will be continuing because I am always keen that our looked after children have a very good chance and that we continue to look after them up to 21-25 if necessary.

The Bailiff :

I am sorry. According to my calculations, we are one short of a quorum. Usher, could you go and summon back Members please?

[11:30]

The Deputy of Trinity :

Sir, has the clock stopped or is it still ticking away quite nicely?

The Bailiff :

I am afraid it has stopped. Now we are quorate, again.

The Deputy of Trinity :

It is a shame, Sir.

The Bailiff :

Deputy Pinel, did you want a supplementary question?

The Deputy of Trinity :

I still had a bit to say about the third sector, charitable organisations. Shall I carry on? The Bailiff :

Briefly.

The Deputy of Trinity :

We are continuing to and will continue to work with the charitable sector, Parishes and private sector too, because in this White Paper they have an important part to play and very importantly there will be, if the States agree, financial resources as well.

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

I, too, am going to refer to the White Paper and we know that there is a transition plan leading up to 2021 spread in phases of 3 years. My question to the Minister is we know that Jersey has a very high proportion of cancer-related illnesses and yet cancer prevention has been itemised for attention during 2019 to 2021. Why has it been left until then and how has the Minister and her department prioritised what will be done during the transition period?

The Deputy of Trinity :

There are quite a few questions in there. Cancer screening, cancer prevention is business as usual and I know my Assistant Minister mentioned this in questions a couple of weeks ago, by example the bowel screening that is starting in 2013. So those things are beginning. But we chose those 5 outline business cases for the first 3 years because they were the highest pressure within Health and Social Services.

6. Deputy J.M. Maçon:

Will the Minister go and meet with her Social Services frontline staff who have recently been moved and discuss the facilities they now have to use, such as the severely reduced family meeting room?

The Deputy of Trinity :

I am always ready to go and meet my frontline staff, whether they are in mental health, out in the community or within the hospital. There has been some movement of officers to try  and streamline so that, for example, all children's services are operating out of one building and that is now at Les Bas, as they work very closely with the health visitors from the Family Nursing Services. So it looks more joined up work. Older services of social workers are now working up from Overdale. But I am always happy to meet any of my staff and I do that very often.

7. Senator L.J. Farnham :

When the police headquarters are finally relocated, an opportunity will arise at Rouge Bouillon for the Fire Rescue and Health to combine control rooms; is this something the Minister would support?

The Deputy of Trinity :

I know there have been plenty of discussions; I think that is one of the C.S.R. with Home Affairs. We run a very efficient Ambulance Service and a very good one but when we relocate within the Fire Service that could be an opportunity to see if we can work closer together. But we will wait until we get there because I am sure it is quite a few years into the future. I hope to have a new hospital by then.

8. The Deputy of St. Ouen :

Does the Minister plan to publish a summary of the White Paper responses and if so, when will this happen?

The Deputy of Trinity :

Yes, the White Paper is out for an 8-week consultation, which will bring us to the end of July and I am sure we will publish, like we did with the Green Paper, the responses before we lodge.

9. Deputy M.R. Higgins:

Just following on again on insurance premiums; can the Minister explain what is encompassed under ambulatory care and also explain why it has gone up by over £80,000-odd?

The Deputy of Trinity :

Ambulatory care, as I understand it, is the Outpatients Department. I cannot tell you exactly what is made up in that figure but I can surely get him the information.

Deputy M.R. Higgins:

Can the Minister be a bit clearer on what goes on in that division of the hospital? The Deputy of Trinity :

It is the Outpatients Department.

10. Senator S.C. Ferguson:

Under the White Paper it is obviously going to be an expensive procedure that we are indulging in. Would the Minister like to confirm how many further years of extraction from the Health Insurance Fund will be made?

The Deputy of Trinity :

This Assembly, when the Chief Minister brought this proposition when he was Minister for Social Security, it was for a 2-year look at getting the £6 million, and that is what we have done. We have done this as the second one.

3.10.1  Senator S.C. Ferguson:

Yes, but how many more years does the Minister estimate will be needed with the amount of expenditure that is listed under the White Paper?

The Deputy of Trinity :

The States Assembly agreed for 2, and that is what we have done; 2. The problem is not going away. The £6 million will come from somewhere and it will probably come from the request for the finances that we have put in the medium-term financial planning. The £6 million was used for primary care, Family Nursing Services and the other charitable organisations that deliver primary care into the community.

Senator S.C. Ferguson:

That does not answer my question. More money will be required; if it is not coming from the Health Insurance Fund where does the Minister think it is coming from?

The Deputy of Trinity :

It will be put in the medium-term financial planning. The Bailiff :

I am told that brings questions to the Minister to an end so we move on to the second period for questions for the Minister for Planning and Environment.