Developing healthcare in the Island

24.02.06.

9.6   Deputy K.M. Wilson of the Minister for Health and Social Services regarding an evidence-based approach to developing healthcare in the Island. (OQ.26/2024)

Will the Minister advise what consideration he is giving, if any, to an evidence-based approach to developing healthcare in the Island and outline the areas where he would consider applying this approach?

[16:00]

Deputy T. Binet of St. Saviour (The Minister for Health and Social Services):

No doubt there are some challenging supplementaries that sit behind that question because it seems a little too obvious in the first instance. I think most right-minded thinking people would seek to use evidence-based approaches to most things, particularly when it comes to healthcare, so yes, going forward, that would be my preferred approach. I have to say that that would probably be my preferred approach in pretty much every area.

1. Deputy K.M. Wilson :

Could the Minister explain what his views are on the quality, reliability, and validity of the evidence provided by the Royal College of Physicians in relation to the rheumatology review?

Deputy T. Binet :

I have to confess only 4 days into office I have not had a chance to read the complete review, but I have had a briefing on it, and I think the outstanding thing that stuck out for me was not just what happened in the Rheumatology Department, but the question that struck me was how did we get to this? That relates to a number of concerns I have over governance procedures.

2. Deputy P.F.C. Ozouf :

I hope the Minister will not mind me reflecting that there have been a number of discussions held by the previous Council on the actions, the serious issues at the hospitals, and I hear him when he says that the report, which I have read, does point towards a bigger culture. Does he signal therefore that the importance of having a system whereby what was known and talked about for a long time but never reported, in terms of rheumatology, I am told, and that the board and the governance structures that were being put in and now seem to be resulting in proper analysis by experts, is really important to get on with and stick with, in order to give patients confidence for what are lifechanging situations? In other words, is he going to stick with the governance model and in fact put it on steroids so that it is even faster to fix the problems that he has identified?

Deputy T. Binet :

I have to say that I am in broad agreement with what has just been said. I do not know if you can put governance procedures on steroids, but if we can I think that is what we would be looking to do.  

3. Deputy M.R. Scott :

Whether the Minister is putting the governance procedures on steroids or not, will he be considering the Comptroller and Auditor General’s recommendations in this area, given that they remain unimplemented even now?

I think that has to be a yes as well.

4. Deputy H.L. Jeune :

Can the Minister outline his initial thoughts as to how these areas will be well governed? Deputy T. Binet :

The comment “these areas” if the Deputy could be a little bit more specific that would be helpful. The Deputy Bailiff :

Yes, Deputy Jeune . Do you want to particularise your question?

Deputy H.L. Jeune :

Well, the areas that he considers applying the evidence-based approach. In the question it says: “… and outline the areas where he would consider applying this approach” and he said all areas he would be considering doing evidence-based approach, and this was related to governance. So my question is to ask the Minister how he will initially outline how these areas or this approach will be well governed. So asking him to answer that question around when he is talking about how it is well governed or the governance around it, what does that mean? Can he explain it further?

Deputy T. Binet :

In the broadest of senses I think that means ensuring that we have a full and comprehensive set of governance procedures from one end of the organisation to the other. It is difficult to be completely specific about that, other than to say that for there to be proper governance it has to be throughout the whole of the organisation. There cannot be any grey areas.

5. Deputy H.L. Jeune :

I think specifically focusing in on the rheumatology report, can the Minister outline the actions he will take to prevent further issues around clinical safety, for example, in this area?

Deputy T. Binet :

These are very early days for me, as I say, but it is not beyond the bounds of possibility that we might consider commissioning a review of the governance procedures, an immediate review, in the same way as we have reviewed the activities of the Rheumatology Department. I think what it has revealed is quite a staggering lack of proper governance and that is something I need to discuss. As I say, it is too early days for me to know the full implications of that and the cost of it, but I think it is something that is going to be coming up for some consideration.

6. The Connétable of St. Mary :

During a public hearing conducted by the Hospital Review Panel during the last Assembly, reference was made to as much as 25 per cent of Jersey residents having the benefit of private health insurance. Does the Minister agree with that assessment? If so, and even if not, is he planning to take further steps with a view to managing private health expectations within the public service and with a view to avoiding unnecessary drainage on the public purse?

The Deputy Bailiff :

That is a long way from the question, the Connétable of St. Mary . It is too far from the question. I do not allow that question.

7. Deputy P.F.C. Ozouf :

I will try. With the benefit of hindsight, which is always a good thing - Captain Hindsight is always right, normally - would the Minister agree that without the governance board being in place it is more likely than not that this longstanding concern in rheumatology would not have been uncovered, investigated and the report that he has now got on his desk done? Secondly, if the link is between the governance board and, as he has rightly said, looking into other areas, will he consider the cost implications, the cost to the health service, of lots of costs of people claiming malpractice, let alone the misery that people have been put through by bad prescribing and put that in the overall picture of cost? Because on the one side we had criticisms of the cost of the governance but it does seem, and he said it himself, that it has worked and we need more of it.

Deputy T. Binet :

I think I am correct in saying that the Deputy is confusing a number of issues and principally the issue of the rheumatology investigation, which I am pretty certain was launched quite a long time before the establishment of the board, so it is my understanding that the 2 things are not necessarily connected.

The Deputy Bailiff :

Yes, but this is a question about an evidence-based approach to developing healthcare. Are there any supplementary questions arising from that question?

8. Deputy A. Curtis of St. Clement :

The Minister has said that all areas will be evidence-based, so will he provide a timetable to publishing any unpublished evidence used in the new healthcare facilities to States Members and what that timetable will be?

Deputy T. Binet :

I do not think I can do an ad hoc timetable for anything at this point in time. I just think that is perhaps not reasonable.

9. Deputy A. Curtis :

In that case, is the Minister happy to commit to publishing as much of any unpublished information on the new healthcare facilities to enable Members to make evidence-based decisions as well as himself?

Deputy T. Binet :

I have to say in all honesty I am not aware that we have withheld any evidence of any merit whatsoever, so I am happy to talk to the team about anything they have kept to themselves, but to the best of my knowledge we have not withheld anything that is of any relevance to the scheme.

10. Deputy K.M. Wilson :

The Minister just mentioned a review of governance. Would he agree to producing those proposals and sharing those with the Assembly in a timely way?

Yes, if that is something that we can do and it is feasible to do, then I would be more than happy to share that with Members of the Assembly.