Questions without notice Health and Social Services

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

Very well, that brings Questions without notice to the Minister to a close and we move now to the second period which is questions to the Minister for Health and Social Services. Deputy Southern .

1. Deputy G.P. Southern :

In answer to written question 6560 the Minister stated that in addition to the current recruitment and retention problems they have with staff it is complicated by the need to recruit approximately 145 additional F.T.E. (Full-Time Equivalent) posts in 2013. Will the Minister inform Members how many vacancies she expects to have in 2013 and how many vacancies she has now? What is the size of the problem?

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

I do not have the exact details of a per cent but I think it is in the region of approximately 45 vacancies but I will check that and come back. Nursing recruitment and retention, as we go forward, is going to be a challenge. We have done some quite, as he knows, good initiatives here. We grow our own nurses and as well as having a Back to Nursing course, which has brought in another 15 nurses and they will be trained within the next couple of months, as well as local nurse training too. But, yes, it is a challenge and will continue to be a challenge.

6.1.1 Deputy G.P. Southern :

Point of clarification, Sir. The answer said nurse retention and recruitment, the 145 surely apply to all positions, rather than just nurses.

The Deputy of Trinity :

Yes and if it is in the part of the White Paper there will be change that we have with the redesign of Health and Social Services, not only within Health and Social Services but also to include those we are going to need within the third sector.

2. The Connétable of St. Martin :

Will the Minister advise the Assembly whether there has been a notable rise in the diagnosis of cancer cases in recent years and, if so, what investigation is being carried out by the department and the Medical Officer of Health as to possible causes, as to what appears to be a dramatic increase on the Island?

The Deputy of Trinity :

The Medical Officer of Health does keep very good statistics and there is a somewhat rise but the actual percentages, I do not have that detail at hand but I can send it to him, so it is no problem at all.

3. The Connétable of St. John :

Can the Minister, please, inform Members, why she is asking the Island what they think about the proposals in the H. and S.S. (Health and Social Services) White Paper when she has already reached the conclusion that a new hospital is to be built, as identified in the advert for Managing Director of the General Hospital, published by GatenbySanderson? Will the Minister inform Members what the cost of engaging this consultancy for this position is and, plus, give details of what the competitive 6-figure salary is, please?

The Deputy of Trinity :

At this stage, regarding the 6-figure salary, it is inappropriate for me to give a figure because it is going through the due process to advance to recruitment and they are in the process of short listing and, I think, interviews will be next month. The Hospital Director role is an important role, as identified, especially, by Verita and also backed up by the Aitkenhead Report. It did stress that it needs somebody with good experience of working in a general hospital, so that is important and was one of the features in the advert that went out. Regarding a new hospital, it has been well recognised that we do need a new hospital and feasibility study has got under way in the last couple of weeks and a report will come out towards the end of August/September time. It is either going to report, I hope, that we either need a new hospital on a different site or whether we need a new build or whatever on the present site. No decisions have been made; we need to wait for that feasibility report.

6.3.1 The Connétable of St. John :

Supplementary, Sir. Does the Minister not consider it essential that the level of community care provided to Islanders is clearly identified and documented and, of course, before the need of a new hospital can be identified?

The Deputy of Trinity :

Yes, the cost of a new hospital is in a ball-park figure. We mentioned about £252 million to £300 million based on our figures, so that is why it is important that a feasibility study is done on exactly what size of hospital we need and whether we want to do everything here on Island or send some people away for treatment. That is why it is important that this report is done and it will come out towards the end of the year.

4. Deputy R.G. Le Hérissier:

Would the Minister comment on the fact that while she is not in direct control of G.P.s (General Practitioners) there are various levers pulled by her and the Minister for Social Security?

[12:15]

Could she comment on the increasing disparities that are being exhibited in the way repeat prescriptions are being administered by G.P.s? G.P. and dental costs are fast reaching a tipping point in the Island and this is a further fact exacerbating that situation.

The Deputy of Trinity :

Yes, as we know, the G.P.s come under, at the moment, Social Security but over the last couple of years we have been working with G.P.s to try and ... especially with the White Paper because they are an important part of how we redesign Health and Social Services and they need to be part of that. As regarding repeat prescriptions, as the Deputy knows quite well they are a private business and we have no control over how much they charge for any of the services that they provide.

6.4.1 Deputy R.G. Le Hérissier:

Supplementary, Sir. Would the Minister be prepared to look into whether the rationales put forward to patients for repeat prescriptions are medical rationales or, at heart, are financial rationales?

The Deputy of Trinity :

I hope the rationale is for medical reasons but there is a great deal of work to be done with G.P.s and that we are working extremely well with the primary care body and this is probably one of the questions in the great mix of things that we will be looking forward, as we begin the redesign of Health and Social Services.

5. Deputy S. Pinel of St. Clement :

Can the Minister advise what her department is doing to improve the access to occupational therapists for Island schools; this is with reference to children with conditions such as autism?

The Deputy of Trinity :

I was not particularly aware that there was an issue, so if Deputy Pinel has a specific issue I will certainly look into it. I know a lot of work is being done with Autism Jersey and there has been a heartfelt report done to try and improve services, especially at Les Chenes. I know it is in part of the White Paper going forward too. But if there is a particular issue then I would welcome her talking to me about it.

6. Deputy J.H. Young:

Before making her decision to restructure her Environmental Health Unit jointly with Guernsey, did the Minister consider the potential benefits of co-locating that unit with the environmental team and the potential for efficient and enhanced services? Could she, please, also confirm that within the joint Guernsey unit that she is satisfied that, despite the differences in legislation on such things as noise, there will be no diminution of service locally?

The Deputy of Trinity :

As we are working with Guernsey is high priority too because there is quite a lot of areas that we can work with Guernsey and obviously it would save money for Guernsey as well as us. Environmental health is one of them and it has an environmental officer who spends, I think, either 3 days in Guernsey or 2 days here or vice versa and it works very well. That officer who is in Guernsey used to work in Jersey here, so she understands fully our laws and works with us. Regarding location, with part of the environmental health that is here working at Howard Davis Farm with the Environment Department, yes, I know we have had some discussions but I am open to any suggestion of working closer together with Guernsey or any other department must be a good thing.

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

On Tuesday, 6th December 2011 the Minister answered with a question tabled by Deputy Southern which raised the issue of user-pays charges contained in the 2012 Business Plan. At that time the Minister responded that certain projects were being scoped or under review and that she would report back to Members once the project details were available and more information was provided. I would like the Minister for Health and Social Services to inform us what progress has been made, if any, on the Patient Transport Review, the introduction of A. and E. (Accident and Emergency) charging mechanism and income generation initiatives within community and social services.

The Deputy of Trinity :

As the Deputy and this Assembly must be aware any user pays is going to be very sensitive and it needs a lot of working up. My officers have been working with the patient transport group to look at how we can improve the service, as well as reducing user pays and our main aim here, especially with patient transport services, is to improve the services. We are looking at moving the suitable clients from, shall we say, a very expensive mini bus into a cheaper and more user- friendly car service for those who can do that. We will be looking at making some charge for certain pay groups. However, there are restrictions with that Motor Traffic Law and so we have to go very carefully with that. As regarding the charging for A. and E., again, this is a very complex area, we know that A. and E. is used at times inappropriately for many different reasons because of the cost of going to G.P.s, et cetera and this continues to be scoped. Our aim is to perhaps have a G.P. out of hours perhaps in A. and E., so those who come to A. and E. with specific triage first can either go to A. and E. or go to see the G.P. This is still going to be worked up and it is part of a lean project that is being undertaken at present.

6.7.1 The Deputy of St. Ouen :

I would like to ask the Minister for Health and Social Services, first of all, when does she plan on completing these particular projects because these were proposals for savings to be delivered in 2012? Will she ensure that all the new user-pays charges will come to this Assembly for proper consideration at the appropriate time?

The Deputy of Trinity :

It is being worked up and I am very aware how difficult it can be but also very importantly to protect those people like vulnerable adults and families, that is going to be my high priority. But there are times, especially with patient transport, where at times it can be used kind of perhaps, shall we say, inappropriately and so it does need to be worked up. Yes, it will be debated soon.

8. Deputy S. Power:

The Minister will remember in 2006 when she chaired the closure of the Overdale Review. Can she outline briefly to the Assembly as to what those existing wards at Overdale are being used for now, for what sort of treatment?

The Deputy of Trinity :

I can indeed and I have to say it was a very good report. I am sure Deputy Power would agree with me too. Those existing wards at Overdale have been revamped and are used at the moment as facilities for patients with mental health problems because, as you will be aware. Rosewood House has been redecorated and done up but the patients there could not stay while all that work was being done, therefore, the ones that are appropriate to be moved went to McKinstry Oak. But now, with Clinique Pinel, with the funds coming into Clinique Pinel and the work there due to be started within the next couple of months or so, they have all moved out of Clinique Pinel and we are still using the McKinstry Oak Ward . It has been done up since significant money was put in it to make it a good standard.