9653 The impact of changes to service level agreements between the department and Family Nursing and Home Care

5.4   Deputy G.P. Southern of the Minister for Health and Social Services regarding the impact of changes to service level agreements between the department and Family Nursing and Home Care:

What measures have been, or are being, taken to ensure that any changes to service level agreements between the department and Family Nursing and Home Care will not see an increase in costs or the reduction or removal of services for people requiring home care services and will the Minister explain when any such changes were communicated to clients and if not why not?

Senator A.K.F. Green (The Minister for Health and Social Services):

Answering the Deputy 's question, not in necessarily the order in which he asked the different points, and I apologise in advance because it is a slightly longer than normal answer but there are several questions there. The subsidy reduction has been subject to discussion since 2014. Implementation has been phased in to help the Family Nursing and Home Care manage transition. The Family Nursing and Home Care manages and communicates its change with its own service users. It is the responsibility of that organisation to communicate changes, not my department. Health and Social Services provides, and will continue to provide, funding of over £7 million a year. Over 80 per cent of the overall funding, a relatively small proportion of this related to the Home Care Service. Family Nursing and Home Care are not the only provider on the Island but they are the only provider that is subsidised by my department. In my view, it is not fair to customers in general that Family Nursing are able to charge £11 an hour because of a subsidy from Health and Social Services. We have always been mindful of the effect the increase in rates might have on low income households and support for anyone needing financial assistance with the costs of such care, whichever approved provider is supplied, is already available through the long-term care scheme or on the personal care component of income support. The intention is to target financial support where it is most needed, not to provide an unfair subsidy which means that all clients, whatever their means, can access subsidised rates.

1. Deputy G.P. Southern :

Is the Minister content that his long-term care scheme has the reach to ensure that no one in need of home care will be deprived of the finances with which to pay for it? The Minister appears to say that the new scheme, Income Support Personal Care Level 4, was already in place. Is it not the case that that is not in place until January at the earliest?

Senator A.K.F. Green:

Funding changes are not taking place until January and the Deputy is right, we are bringing in a new scheme to support people that fall between the lower levels of the long-term care scheme and the income support scheme and that will support people in their own homes better than they are currently. There is a gap there and it will support people better than they currently are and we hope to have that in place by January. In fact 2 extra staff have been put in place to ensure that the assessments are carried out as quickly as possible to support people.

2. Deputy K.C. Lewis of St. Saviour :

I think we all appreciate that savings need to be made however Family Nursing and Home Care does provide an absolutely essential service to this Island with regard to care in the community and savings should not be made in this regard. Does the Minister not agree?

Senator A.K.F. Green:

Family Nursing and Home Care is a much loved organisation. It delivers good care in the community. [Approbation] Traditional home care will continue to be funded but at the correct level. District nursing will be fully funded. Sustained home visiting, part of P.82, fully funded. Enablement, P.82, fully funded. Rapid response, P.82, fully funded. Children's Services, including the new palliative care service starting very shortly, fully funded. That is investment in the community.

3. Senator S.C. Ferguson:

Given that 80 per cent of the funding is provided by the States does the Minister not think that cutting the funding is undermining the whole of his care in the home policy? Does he not realise that the home care service is extremely valuable and does he not realise that putting the cost of it up from £11 an hour to £19 an hour is going to hit the least able to protest and make a protest about this, the elderly, the pensioners?

[10:15]

Would the Minister not reconsider and look at this again because this is going to hit the pensioners ...

The Deputy Bailiff :

Senator, if you could finish your question please. Senator A.K.F. Green:

I will do my best with this but I thought we had a long-term care scheme in place and we are bringing also a level 4. This is not aimed at cutting, as the Senator says. What we are is paying the market rate for a job. The market rate is around £19 an hour. Currently the department subsidises it to the tune of about £40 an hour. The service users are paying £11 an hour. Now, if they need support that is what they will get through the long-term care scheme or if they do not need support then they will pay the market rate. There are 20 other providers, by the way, in the market.

4. Senator S.C. Ferguson:

Can the Minister be certain, a supplementary, that the other providers are providing the same quality of service as Family Nursing?

Senator A.K.F. Green:

Well, they are registered, licensed and regulated, so yes.

5. The Deputy of St. Ouen :

Would the Minister accept that it may not be possible to conclude all the long-term care assessments by the end of this year and neither, it may not be possible, to introduce the additional benefit the Minister has spoken about above the current income support components? Therefore, in those circumstances will the Minister commit to continue funding the home care services provided by the charity at 2016 levels until all those provisions are in place?

Senator A.K.F. Green:

I have put extra resources and approved extra resources again on Friday to ensure that we meet our target. If we do not meet our target then the Family Nursing and Home Care have sufficient reserves in order to be able to tide them over that very short period but I am confident that we will meet the requirement to carry out those assessments by January.

6. The Deputy of St. Ouen :

I do not think this relates to the reserves held by the charity, which are often donations or legacies. This relates to the charges that will be imposed upon the clientele of the Family Nursing so why cannot the Minister commit to maintaining funding at existing levels if the measures to help clients are not in place by the beginning of next year?

Senator A.K.F. Green:

As I said, I am hoping that they will be in place by the beginning of next year but it is a matter for Family Nursing how they decide to deliver their service. We are giving them a budget on what we are prepared to pay, which equals the market rate, and they have sufficient reserves if they wish to subsidise it themselves.

7. Deputy M. Tadier :

In previous debates we talk about stability. Now, does the Minister accept that this is a completely unacceptable short lead-in period for Family Nursing and Home Care, their staff and their users? Even if it is the right thing to do, which is still a moot point, does the Minister think that it is absolutely discourteous the way that he has dealt with this and he needs to be communicating better and also giving a long and decent enough lead-in period for any of these changes which will affect, necessarily, some of the most vulnerable but also some of our great care staff that work very hard in the community?

Senator A.K.F. Green:

We have been negotiating with Family Nursing for 2 years. How they negotiate with the staff is a matter for them. They employ the staff. They direct the staff. That is a matter for them.

8. Deputy M. Tadier :

That may be the case if the Minister says that but when it comes to the users of the service, is that not something that falls under the Minister's remit and a care of duty which he has and, by implication, all of us have on the users of that service?

Senator A.K.F. Green:

Which is exactly why we brought in this other policy, which we hope to have in place by January; that will pick up those people that fall just below it. But the matter of communicating with the staff and their customers is a matter for Family Nursing.

9. Deputy T.A. Vallois of St. John :

Could the Minister explain what responsibility, if any, Family Nursing and Home Care have under the service level agreement to Health and Social Services and also their clients?

Senator A.K.F. Green:

Sorry, I did not catch the beginning of the question. The Deputy of St. John :

Could the Minister explain what responsibility, if any, Family Nursing and Home Care have under the service level agreement with regards to use of the money provided by Health and Social Services and for the client?

Senator A.K.F. Green:

They have a responsibility to use the £7.2 million that we give them appropriately and that is why I said that the district nursing is fully funded. They are using the money for home visiting, fully funded. Reablement, fully funded. Rapid response and new children's services. The only thing we have in dispute is the cost of the home care service which we are going to fund at the correct level.

10. Deputy G.P. Southern :

Since, sadly, there has been a lack of communication with recipients of home care and that it is likely that many recipients will be listening to this broadcast as it goes out over the airwaves, will he give the assurance that no one in receipt, who should be in receipt, of home care allowances will be left high and dry come January?

Senator A.K.F. Green:

What the listeners will be listening to is the fear put about by Deputy Southern and co, we are a Government ... what other governments around the world have a long-term care scheme in place? What other governments recognise that there is a gap between that and the personal care component and do something about it? So we are there to support people and making them feel that they are going to be left high and dry is nothing short of worrying people but it is not true. The plan is to support people in the community at the right time but at the right price.