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4.4 Deputy M.R. Higgins of the Minister for Health and Social Services regarding the legal basis for the Department's patient travel policy:
Will the Minister explain to Members the legal basis for the department's patient travel policy?
The Deputy of Trinity (The Minister for Health and Social Services):
The travel policy is a policy not a legal or a strategy document. It has been in place for well over 10 years and allows the Health and Social Services Department to assist members of the public on low incomes with their travel and accommodation costs when they are accessing health services in Guernsey or U.K. The policy is a voluntary scheme for members of the public who wish to be considered for financial assistance with their travel.
[10:15]
If they take up this option they are required to produce evidence of household income. The information being requested is proportionate in that assistance is directly linked to a relevant band of household income.
- Deputy M.R. Higgins:
The Minister is well aware that there are many elderly people in this Island who have been referred off-Island by consultants to hospitals in the U.K. who, as a matter of principle - and I might add they are not wealthy - will not fill in a means test form because they feel it is demeaning and prying into their private affairs. Will she not confirm that a number of patients have had to forego urgently needed operations in the U.K. quite simply because her department is being inflexible on this issue?
The Deputy of Trinity :
I know of 2 families, which the Deputy brought to my attention and we are trying to find a way round, but we do not know whether they are eligible for free travel until they fill out the form. The assistance is there to help families, and children as well, to be able to access elective care. If they need emergency care, that is covered.
- Deputy G.P. Southern of St. Helier :
Is the Minister aware of 2 problems with her scheme in that (a) normally the scheme only applies to a single person not accompanied and they have to go through hoops to achieve that, which is often necessary, and (b) that monies for travel and accommodation expenses are paid often in arrears and many people cannot afford to fork out whatever, a few hundred pounds, before claiming it back? Should it not be more often paid in advance?
The Deputy of Trinity :
I think the travel has been tightened-up. The Deputy asked 2 or 3 questions in there. Regarding escorts, the department will pay for an escort if it is required and it becomes a clinical decision on a case-by-case purpose. Regarding expenses and whatever, we have now made sure that if someone goes over for the day - and that is what we would encourage - that the appointment time is at the middle of the day so they go there and come back in a day.
The Bailiff :
I think the question, Minister, was whether you could pay in advance rather than in arrears. The Deputy of Trinity :
If they go and come back in a day there is no paying in advance because they are not encouraged to stay overnight.
Deputy G.P. Southern :
I do not know whether that was they are not encouraged or they are encouraged and there is pay or there is not pay. I do not hear the "not" in there. I am not at all clear.
The Deputy of Trinity :
As I said, we have tightened-up with appointments so if a patient needs to go to have an appointment in Southampton or whatever, the appointment now is made at lunchtime, early afternoon, so that they can go and come back in a day, which stops paying for overnight accommodation.
Deputy G.P. Southern :
Is that in advance or otherwise? Is it paid for in advance? The Deputy of Trinity :
If their flight is paid for, there is nothing to advance.
- Deputy G.P. Southern :
A supplementary relating to the answer that we have just received is that is the Minister aware that it is often very difficult to get appointments only in the middle of the day? Specialists in the U.K. say: "You will come to see me when I say" and an overnight stay is often required and, again, this requires people to go through hoops to succeed in getting treatment abroad.
The Deputy of Trinity :
I think that is very important and the work done with U.K. hospitals is one of the conditions to ensure that people have time to get to their appointments at lunchtime or whatever and then can come back in a day. If it is not feasible, there is usually a good reason for it.
- Deputy J.A. Hilton:
I think the time has probably come for the Minister to look at the policy again with regard to people on extremely low incomes being able to finance accommodation prior to them going if that is what they need to do. [Approbation] I will come to my question. The Minister mentioned that it was a voluntary scheme for the public on low income. Can she give Members some indication of the level of income that would qualify an applicant looking for assistance?
The Deputy of Trinity :
The scheme is very generous. For adults with no residential children it is £92,000.
- Deputy M. Tadier :
Does the Minister not acknowledge that there is a fundamental issue to be addressed here that if provision, which would otherwise be provided in Jersey but is provided in the U.K. or overseas for technical or practical reasons, it should also be free and therefore inclusive of travel but for everybody, not simply for those on lowest income, because everybody pays their taxes for health care that would normally be provided at the hospital? If that is not available then everybody has the right to expect free travel for an equivalent service in the U.K. Would the Minister advise if that is what she is working to and, if not, why not?
The Deputy of Trinity :
If you need emergency medical treatment, transferring from hospital to hospital is free. If free travel is wished for, therefore it has to come out of our budget. At the moment it is costing well over £500,000 for travel. There will always be some travel off-Island. We are no different to other hospitals in the U.K. If you live in Cornwall and you need to have treatment in a London hospital, you will pay for that and you will probably go by train, which will probably cost you just under £200 to get there and back. Unfortunately there is no right to have free transport. That is why our travel policy is in place so that we support families who need that assistance.
- Deputy T.A. Vallois of St. Saviour :
The Minister, in the answer to the first question, stated that this was just a policy and was not statutory basis. Could I ask the Minister whether the Health Department have considered whether they would put this policy as a statutory basis? If not, why, and if so, what are the pros and cons?
The Deputy of Trinity :
We have not done that. Under the United Nations, there is no human right to free health care or free subsidised travel for provision of healthcare. If we did do that, I dread to think how much it would cost. Part of our aim of going forward with the new hospital is trying to provide as much as we can here in Jersey to prevent patients going to the U.K.
- Deputy M.R. Higgins:
I think Islanders will be very surprised to hear that there is no such thing as free health care. We have a hospital that cannot cater for all the needs of the Island. We will never be able to have all the specialists we need and all the facilities we need. Does that mean then that the Minister is saying that Islanders are not going to get the health care that they expect and they have been paying their taxes for? To say they do not have a human right and quote the United Nations I think is beyond the pale. We are paying money into the States to provide these services.
The Bailiff :
I think you have asked your question, Deputy . Deputy M.R. Higgins:
I have asked the question, Sir.
The Deputy of Trinity :
We provide free health care at the point of secondary care and tertiary care. That is what we provide in Jersey. I am very proud of the service that we provide, but unfortunately there are some travel arrangements. People who have a household income under £92,000 will not have to contribute towards their travel. We get very good competitive rates for the price of the flight across and that is all done within the Travel Department.