Questions without notice Health and Social Services

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

Are there any further questions for the Minister? Very well, then, we come on to questions to the Minister for Health and Social Services. There are no questions for the Minister?

1. Senator P.F. Routier:

Could the Minister give us any indication of whether she is able to offer bowel screening programmes to men and women in the near future?

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

Yes, I can. I know there was quite a concern about it not being offered this year but it is within our financial plan for next year, and it will be a flexi-scope type of screening and it will be calling everybody under the age of 60 for a one-off screening process. At the moment, we are recruiting staff to be able to do that and I understand that there is a development presentation by our Medical Officer for Health to all G.P.s (General Practitioners) and consultants this Friday regarding it.

2. Deputy S. Pinel of St. Clement :

Respite care was discussed at length in the Health paper, A New Way Forward, and addressed in the M.T.F.P (Medium-Term Financial Plan). Can the Minister please inform the Assembly as to the progress and direction of respite care especially in the area of home carers?

The Deputy of Trinity :

Yes, it is progressing and it is part of one of the work streams in the outline business cases leading up to the full business case. Most Members know that we had some additional one-off funding from the Minister for Treasury and Resources last time regarding respites, I think it was £200,000, especially in the region of providing respite for carers with patients who have dementia. That has worked extremely well and that is progressive, and we will go forward to a full business case in the new year.

3. Deputy R.G. Le Hérissier:

There is continuing public concern about waiting lists. Would the Minister tell the House in which areas the department is desperately or is trying very hard to bring down the waiting list?

The Deputy of Trinity :

Our target for waiting lists, because all waiting lists are a challenge, is 3 months from the date the patient is added to any surgical list and another 3 months waiting for the operation. There are some specialities mostly ophthalmology, orthopaedics, dermatology, diabetes, bariatric and neurology that do unfortunately have long waits. We have a review of the specialities underway and these include additional clinics. One thing that has proved quite effective is text messaging because there is a certain proportion of patients who come for outpatient appointments who do not turn up. These are called D.N.A.s, (Do Not Arrive), and therefore by texting them the day before, that has helped significantly and the number of D.N.A.s that do not turn up I think has fallen by 8 per cent last month. Because there are thousands of people that go through Outpatients Department each month, whether it is physiotherapy or one of the clinics or whatever, therefore every patient that does not turn up becomes a cost and also it could be filled by somebody who actually wants that appointment.

4.3.1 Deputy R.G. Le Hérissier:

Supplementary, can the Minister tell us the areas where the General Hospital is making a strong effort to reduce waiting lists? What are those key areas?

The Deputy of Trinity :

I think I have mentioned that. It is pain, ophthalmology, orthopaedics, dermatology, diabetes, bariatric and neurology. These have long waits and I am sorry about that but we are trying to put additional clinics in place by consultants and senior doctors.

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

Could the Minister tell this Assembly when  will the Action for Children report on respite services commissioned by her department be published and what is the reason for the delay?

The Deputy of Trinity :

As the good Deputy knows, there was a delay because there was a delay with Action for Children themselves I think. One of the officers that did the report was off sick or whatever so the Children's Policy Group had the Action for Children report at its last meeting, which was about 10 days ago. From that, there will be recommendations put in place, which will come very soon and it will be forwarded along with the recommendations and along with the report to Scrutiny.

1. The Deputy of St. Ouen :

Could the Minister confirm to this Assembly that she received the draft report in July this year?

The Deputy of Trinity :

I cannot remember exactly when we received the report. There were some questions that we had to go back to Action for Children so that they could clarify certain points within that report. As I said, that did take time and it went to the Children's Policy Group about 2 weeks ago or something like that.

2. The Deputy of St. Ouen :

The original question was when will the Action for Children report be published and I am not sure we got the answer from the Minister.

The Deputy of Trinity :

I think as soon as Scrutiny has had it and we have the recommendations to go alongside it.

The Deputy of St. Ouen :

Which will be when?

The Deputy Bailiff :

As soon as Scrutiny has got the information, I understood the Minister to say.

5. The Connétable of St. Lawrence :

Will the Minister confirm whether there is an end-of-life strategy and, if there is, will she make it public?

The Deputy of Trinity :

Just for clarification, there is an end-of-life strategy but is the Constable looking at the Liverpool Care Pathway?

The Connétable of St. Lawrence :

I am asking, first of all, whether there is an end-of-life strategy because I recall hearing at one time that one was being progressed.

The Deputy of Trinity :

Yes, one is being progressed and it is part of the outline business case as well, because there are many issues regarding end-of-life and it will be published in due course.

4.5.1 The Connétable of St. Lawrence :

May I follow that question because the Minister referred to the Liverpool Care Pathway so it seems that I should ask a question on that. I gather from her written answer today that the Liverpool Care Pathway was introduced this year during 2012 and I would like the Minister to advise the Assembly what the previous care pathway was and how it differs from the Liverpool Care Pathway?

The Deputy of Trinity :

The Liverpool Care Pathway is a framework. It is all of assessment of patients who are unfortunately getting towards the end of their life. Regarding an end of life pathway, I am not too sure what is in place but I can come back to the Constable with that information.

6. Deputy G.P. Southern :

In relation to written question 24 on patient travel expenses, is the Minister aware that many people on low incomes, especially on income support, cannot afford to lay out the cost of travel off Island to receive treatment and is she prepared in the new policy, which is now in preparation, to advance money to those who have this hardship?

The Deputy of Trinity :

I know it has been an issue which the Deputy has brought up to me and it is one of the points that we are looking at with the travel policy, but regarding his particular issue about giving patients money up front for their accommodation, as it stands, if it is booked through the Travel Department, that should not happen but I am happy to come back to the Deputy to confirm.

7. Deputy R.G. Bryans of St. Helier :

I wonder if the Minister could explain to the Assembly if there is still a differential between the deep cleaning process which happens in the U.K., which consists of steam cleaning, and the one I personally witnessed here in Jersey, which consists of a bucket and a cloth?

The Deputy of Trinity :

If he is thinking of deep cleaning after an infection, because I think it is M.R.S.A. (Methicillin- resistant Staphylococcus aureus), or a similar infection, there are policies in place and I think they have a new machine, for want of a better word that they can close off the ward or the room or whatever and it steam-cleans everything that is inside it, if that makes sense.

8. Deputy M.R. Higgins:

I would like the Minister to follow up on her answer to written question 27 where I was asking questions about the right of children and parents to information. The Minister has gone into some detail talking about guidance and practices of the department. Will she publish this information so that we all have it and we can all read it, and not only to myself but also to the public, because this is an absolute minefield and I do not think it is good enough that the department says: "We have our own policies and guidelines" when nobody knows what they are?

The Deputy of Trinity :

If it is appropriate, yes, I can do that but some of it - I could be corrected - is on the J.C.P.C. (Jersey Child Protection Committee) web link as well, but I will confirm that and come back to the Deputy .

4.8.1 Deputy M.R. Higgins:

Supplementary to that, I just want to take the Minister up on the word "appropriate". What we are talking about are young people and whether parents have a right in being involved in their treatment, whether it be for mental or physical health, and equally the rights of the children. I think it is important that we get these rules clear so everybody understands what they are rather than hiding behind statements made by the department that we are following the law, which obviously it is not in this case because there are no laws.

The Deputy of Trinity :

But also you have to think that everybody aged 16 or over can be presumed to be competent to give consent for themselves, unless the opposite is demonstrated, and the courts state that if a child under 16 has sufficient understanding and intelligence to enable him or her to understand fully what is proposed, then he or she will be competent to give consent because at age 16, as we know, you can vote and you can get married.

Deputy M.R. Higgins:

The question was, I have been told that it is in law. It is not in law. Is it not right that the information is fully published so we all understand exactly what the rules are?

The Deputy of Trinity :

As I have said, if appropriate, I will do it.

9. The Deputy of St. Ouen :

Would the Minister tell this Assembly when will the public know who will be responsible for delivering the improved range of services as described in the White Paper and the proposition as contained in the outline business cases?

The Deputy of Trinity :

As the Deputy knows, we came to Scrutiny the other day. Outline business cases are being worked up into full business cases. There is a task and review group, which includes the voluntary and community sector, G.P.s, other health professionals and they are very busy because I think with the 4 streamlines, between now and the end of the year there are well over 100 meetings to try and put everything into full business cases, and then when it is worked up, it will go to the next stage of what can be achieved with extra money, and then if it is a new service and if it is appropriate, it will go out to tendering and commissioning and with a service level agreement attached to it.

4.9.1 The Deputy of St. Ouen :

I did ask the Minister when will the public know who will be responsible for delivering the new range of services. An approximate answer or a date would be useful.

The Deputy of Trinity :

I would have thought the first quarter of next year if everything goes according to plan.

10. Deputy R.G. Le Hérissier:

A few months ago, there were allegations that an addiction unit was not receiving its normal number of referrals and it was announced that peace talks would take place. Could the Minister confirm that normal service has been resumed and that referrals to this agency are now moving at a normal rate?

[11:45]

The Deputy of Trinity :

Yes, everything is working extremely well. Our officers are sitting down with the officers of that unit. The service level agreement, I think if not signed, is just about to be signed for 3 years and, yes, everything is good.

11. Senator P.F. Routier:

Can the Minister advise on whether any talks have been recently held with Brighter Futures to resolve the issues they had with future funding and future delivery of service?

The Deputy of Trinity :

With the future funding, Brighter Futures have been part of the Full Business Cases alongside other agencies. I know that they have written to various Ministers and departments looking for further funding and that has been co-ordinated with the Children's Policy Group, of which he is a member, and just to confirm that the grant for 2013 for Brighter Futures is still there.

The Deputy Bailiff :

That brings questions without notice to an end.