Health services

2025.01.21

Deputy L.M.C. Doublet of St. Saviour of the Minister for Health and Social Services

regarding the Government Annual Plan for 2025 (U0Q.1/2025):

Given that the report has not been formally presented to this Assembly but instead appears on the gov.je website, will the Minister please provide further details on the plans to separate health services from government as outlined in his Annual Plan for 2025, including how the new devolved funding of healthcare would operate?

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

If I understand correctly, the question relates to the Health Department's recently-released Annual Plan and the implication in the opening sentence is that the plan should have been presented to the Assembly formally. If my enquiries of yesterday evening are correct, Annual Plans - or as they were called in the past, Departmental Operational Business Plans, Delivery Plans, and last year, Ministerial Plans - are plans that get published annually as a matter of course. At this point I think I should inform Members that the plan was put on to the government website without first being sent to States Members entirely without my knowledge or agreement. Anyway, I have revisited the Health and Community Services Annual Plan for 2025 and, while I stand to be corrected, I cannot find anything of a substantive nature that I have not explained to the Deputy on more than one occasion and to the Assembly as part of the States Members' briefing held on 5th December last year. While I have already made several attempts to explain my intentions for the coming year, I thought it might be helpful to provide Members with another copy of the layout plan that I have presented previously. This was going to be distributed to Members but that failed to happen over the lunch hour, so I do apologise. Anyway, I am happy to talk through my explanation using the very words that I am sure fuelled this latest urgent crisis. I was going to say if Members would be kind enough to look at the paper provided - but I had provided the paper - and in my view the layout is self-explanatory. Both at the briefing sessions and in written material I have been at pains to explain that in my view, and the view of many health professionals, the health service has been overcentralised in the Parker era and this had had an adverse effect on efficiency and the delivery of services. As a  consequence,  I  have  stressed  repeatedly  the  importance  of  securing  a  high  degree  of autonomy for health so that it is able to have a more direct control of its essential functions. Bearing in mind that the service employs about 30 per cent of States staff and accounts for £300 million of our expenditure, and in 2023 under the centralised system it required a financial review by a major accountancy firm that cost £500,000, I do not think my actions are unreasonable. In the foreword to the Annual Plan I chose to suggest that it should be separated from but connected to government encompassing all health functions, including strategy, policy legislation, public health, digital health, commissioning, procurement and population data.

The Bailiff :

I must ask you to bring your answer to a close, Minister.

Deputy T.J.A. Binet :

There are 2 paragraphs and then I can stop. In addition, while it appears The Bailiff :

They might be very long paragraphs. [Laughter]

Deputy T.J.A. Binet :

I think I can just get through the essential bits in 2 paragraphs. I think it is important to The Bailiff :

Well, a few seconds more. A few seconds more. Yes, carry on.

Deputy T.J.A. Binet :

I have gone as quickly as I can but it is quite a long and complicated question; just bear in mind, I wanted to answer it comprehensively. I can wait for supplementaries and

The Bailiff :

Well I think the time has come to wait for supplementaries. The normal rule, as you know, is one minute 30 seconds for a Ministerial answer. There is some flexibility and that has been honoured more in the breach than the observance, frankly, during the course of the day, as has indeed the necessity for discipline and succinctness in asking questions but there we are. A supplemental question, Deputy Doublet .

1. Deputy L.M.C. Doublet :

I thank the Minister for his initial answer, and I understand mistakes do happen and that the Minister has shared much of this information. I was alerted to this report by the chair of the Public Accounts Committee who drew my attention to an announcement on the radio. Upon analysing the report that was referenced, the phrases "a new standalone Health Department separated from but connected to government" and also references to a "devolved funding mechanism", these are the specific issues that I would like the Minister to explain in more detail to the Assembly today. Could he first of all explain what exactly is meant by "separated from but connected to government"? Would the Health Department still be a government body? What status would the Health Department have?

Deputy T.J.A. Binet :

I thank the Deputy for giving me an opportunity to revisit my statement at an appropriate point because in the foreword - and I think that is what has drawn people's attention - I go on to say that it is devolving, and this is the key point, which I quote: "Essentially to build the autonomous internal framework for H.R. (human resources), finance and procurement within the broader government system, along with digital I.T. which received particular attention." There it is, that is the important point: an internal framework separated from government but built within the broader government framework. It is just simply what I had explained at all of the consultations in that we need Health to work as a cohesive whole, collaboratively, separated as we can from government with everything running through the central system.

[14:45]

We have done 12 or 14 consultation processes, we have done Scrutiny, and the Assembly and I have been at pains to be accurate about that throughout.

2. Deputy J. Renouf of St. Brelade :

I think the issue here is caused by possibly this phrase "separated from but connected to government" carries far more meaning than the Minister seems to be prepared to acknowledge, at least for many of us. If something is going to be separated from government it raises questions such as are the people working in the health service going to be government employees? Can he clarify that?

Deputy T.J.A. Binet :

Very happy to clarify, and I am really surprised that the Deputy has not been able to get his head round it. It says quite clearly "within the broader government system". Perhaps the Deputy could suggest some wording that would be more appropriate than that, but I think that is fairly clear.

The Bailiff :

Well, are they going to be employees of the Government or not, Minister? Deputy T.J.A. Binet :

On the assumption that it is within the broader government system then the answer has to be a firm yes. I will just make the point that I have never made any suggestions to the contrary.

3. Deputy J. Renouf :

I would respectfully suggest that the words "separated from but connected" does indeed seem to imply something that is not part of government. What I would ask is: has the Minister in considering this reorganisation of the relationship between government and health service looked for inspiration anywhere? Where has he seen models of this working elsewhere and has he considered any risks that might arise?

Deputy T.J.A. Binet :

No, I have to say that with problems of this sort I do not go looking over the fence particularly. I have approached this from an objective point of view as to what I would do if it were a business that were given to me to manage, and I make no apology for the fact. I am not sure if these have been distributed but I would invite people to take a look and perhaps the Deputy would tell me what he thinks is wrong with creating a partnership board where you have got all the component parts sitting round the table, making decisions together, and drawing from a central health fund. It cuts out a whole lot of administrative inefficiencies and I think it will serve us very well. It is fully integrated and, as I say, I make no apology for any of it.

4. Deputy I. Gardiner of St. Helier North :

I completely support that we need to have a joint health approach, and I have seen this graph, so I would not be asking this question and talking about this crisis if BBC Jersey at 7.00 a.m. and 8.00 a.m. on Monday announced to the public of Jersey: "Health Minister Tom Binet wants to separate the service from government and let a new board run it with a new central fund." This is what Jersey residents received on Monday morning as a statement. Now, would the Minister consider how he can communicate to the public of Jersey to make sure that this announcement does not hold a ground?

Deputy T.J.A. Binet :

Well, after I had spoken to the Assembly about this at the presentation on the 5th, I had spoken to the media; they have had all of this information. As I said earlier, I was not aware that this had been sent through and put on to the government website. The media went and issued a statement. They obviously had not, with respect, read the article in context and they had not read the part that says "within the broader government system". It is very clear. Had they contacted me before they went out and put the story out, I would have drawn their attention to that. I am afraid I cannot be responsible for what the media have to say. I have done an embargoed interview with them at lunchtime because I know that I cannot be seen to be saying anything until I have addressed the Assembly, but I put the situation clear and that will be reported to the public once this Assembly meeting is over.

5. Deputy I. Gardiner :

I am looking at the report that was published. A draft was approved on 28th November 2024 and on 4th December edition a foreword which said about separation was approved on 4th December. The Minister has approved this foreword asking about separate from the government service on 4th December but can the Minister explain what has happened between 4th December and now that we are saying that it is no separation?

Deputy T.J.A. Binet :

Nothing has happened at all and I did not approve the foreword; I wrote it. It is my department, I care deeply about what I am doing. I think I am doing a good job; I think I have made it very, very clear. I will say that in all the consultation processes that we have had, not one person has failed to understand the intentions here at all. I rest my case.

The Bailiff :

That, I am afraid, runs us out of time. I allowed slightly more than the 8 minutes I said I was going to allow to make up for injury time and interjections. There is no further time for this question. We now come to questions without notice. The first period of questions without notice is for the Minister for Infrastructure and, to keep everyone in suspense, the first to ask a question is Deputy Coles .

THE STATES noted that, in accordance with Standing Order 63(9), a written response would be provided to the following oral questions that had not been asked during the time allowed at the meeting: