Letter MHSS to HSS Panel - 5 November 2024

19-21 Broad Street | St Helier Jersey | JE2 4WE

Deputy Louise Doublet

Chair, Health and Social Security Scrutiny Panel

BY EMAIL

05 November 2024 Dear Chair,

Further to your letter of the 21st October 2024, please find below responses to your questions. Due to the unprecedented volume of detailed information requested for the 57 questions, I regret to inform you that we have been unable to provide a timely response to questions 8, 37, 38 and the section entitled Learning Difficulties – Specialist Accommodation'. Responses are being prepared as a matter of urgency and will follow shortly, under separate cover.

Contents

General ............................................................................................................................................... 1 HCS Financial Recovery Plan ............................................................................................................... 5 Health Insurance Fund ........................................................................................................................ 7 I-HCS-GP25-002 – In Vitro Fer lisa on Funding ............................................................................... 10 HCS-GP25-001 – Ongoing Risks and Pressures in HCS2 .................................................................... 15 Digital Systems Improvement ........................................................................................................... 16 General Hospital Wi-Fi ...................................................................................................................... 18 Replacement Assets and Minor Capital (HCS) .................................................................................. 18 Digital Care Strategy – Extension ...................................................................................................... 18 Learning Difficul es - Specialist Accommoda on ............................................................................ 19 Crematorium Resilience ................................................................................................................... 20 Previous Government Plan 2024-2027 ............................................................................................. 20

General

1. Please can you provide details of any an cipated changes in service levels or access to care as a result of the proposed new budget?

Addi onal funding is provided to address a structural deficit in funding. This will increase HCS budgets from £286 million to £322 million in 2025, with the 2025 pay awards on top of this. Whilst the current

Page 1 of 23

service provision is expected to result in an overspend in 2024, closing the funding deficit in 2025 should enable current service provision to be maintained.

In addi on, opera onal work already started should result in improvements to service access. For example,  acute  inpa ent  emergency  care  (General  Medicine)  is  being  priori sed  alongside  the permanent  establishment  of  frailty  Consultants.  This  will  improve  access  to  emergency  care,  ED performance and availability of beds which is expected to have a posi ve impact on Islanders wai ng for elec ve care.

2. Are you an cipa ng any further departmental reviews, GIRFT reviews, or similar to the maternity, rheumatology, and radiology reports, which may entail the need for addi onal funding and resources for specific areas within health?

Regular service audits and peer reviews are part of good governance in health and care services and contribute to the con nuous improvement of services. Best prac ce in healthcare is con nuously evolving through research, new technologies and treatments and clinical knowledge and experience. Whilst standards can be captured in documents, prac cal reviews from clinical peers who can provide feedback based on their wide range of exper  se, is an effec ve way of review and audit. HCS clinicians also benefit from the personal interac on and discussions with experts from the UK.

HCS is commi ed to con nuous learning from peer and specialist reviews, and which will be requested in liaison with clinical care groups and the Medical Director. The Royal College of Physicians is an cipated to undertake a review of Neurology Services in 2025.

3. Can you explain the increase in other opera ng expenses' over the years 2025 to 2028?

This is due to annual increase in the Maintaining Health & Community Care Standards' funding over the years  2025-2028. This  formula-based  increase  is suppor ng  the  maintenance  of  health  and  care standards through providing a con nuous mechanism for funding increased costs in health and care. This is crucial in suppor ng services to maintain standards that constantly evolve and ul mately contribute to Islanders receiving modern clinical services.

4. It is noted that revenue earned through opera ons is projected to remain sta c at £28,973,000 throughout 2025-2028:

1. Do these projec ons account for any future infla onary increases?

Main sources of income include

• Private Pa ent Income

• Long Term Care Benefit

• Catering & Laundry

• Charitable and Medical Educa on Income

There is no income inflationary assumption built into the template at this time. However, inflationary increases will be decided through individual service assessment and agreed in line with the Public Finance Manual.

2. Are any strategies under considera on to increase revenue earned through opera ons?

The private pa ent income strategy is to grow income from £12.2m in 2023 to reach £25m by 2028. This is described in the Private Pa ent Strategy 2025-28 which is published on gov.je.

5. What specific improvement and innova on projects are being funded, and what outcomes are expected from these investments?

The following list of projects for 2025 were outlined in my le er dated 24 September 2024 tled Re: Budget 2025:

Finance Recovery Programme will con nue in 2025 and consists of 6 workstreams:

• Workforce - Medical Staffing, Nursing Staffing, AHP, Non-Clinical

• Clinical Produc vity - Theatres, Pa ent Flow, Off Island Acute Services

• Non-Pay, Procurement, Centralised Purchasing and Commissioned Services

• Medicines Management

• Income Maximisa on - Private Pa ents, Other IMG schemes

• Digital Health

Capital Projects:

• Development of specialist accommoda on for Islanders with learnings difficul es.

• Health Services Improvement Programme. An extension to the exis ng well-established essen al maintenance programme con nuing to address the most urgent Health and Safety requirements, across the health estate. With par cular focus on keeping the Hospital compliant and opera onal un l new facili es are available.

• Digital Care Strategy. Con nua on of exis ng project to ensure con nuous update of digital systems.

• Digital Systems Improvements. Delivery of an electronic pa ent record system for Mental Health and Adult Social Care Services.

• General Hospital Wi-fi. Implementa on of upgrades and extensions to the hospital Wi -fi.

6. Given the net revenue expenditure trends, what steps are being taken to ensure the financial sustainability of Health and Community Services?

The FRP Programme is made-up of six key workstreams with plans in place to achieve £25m of savings over 4 years and to establish long-term benefits through improved processes . These are:

• Workforce Produc vity (Pay)

• Non-pay and Procurement

• Medicines management

• Clinical produc vity (Theatres efficiency, Beds u lisa on/Length of stay, Outpa ents efficiency)

• Income

• IT and Digital

However, a number of risks to future increases in expenditure are outside of the operational control and require a long-term solution to increasing health and care costs.

• Increasing aging popula on and an increase in mul co-morbidi es (contribu ng to increasing costs such as social care services, off-island care and treatment)

• Advancements in health and care treatments (for example, for medicines/drugs, medical equipment)

• Health infla on is higher than underlying infla on

7. Page 91 of the Proposed Budget 2025-2028 states that the ongoing review has provided key insights into current spending and poten al areas for healthcare funding reform. Can you share more details on the most significant findings so far, and how these are shaping the op ons being developed for future funding of Jersey's healthcare system?

The findings and insights which will inform potential options are broadly outlined on Page 92,

The Government Plan 2023 – 2026 noted that the Minister for Health and Social Services would undertake a review to better understand how we are spending money today, and to inform options for the future funding of our health and care system. This work has started and has provided some key insights:

• whilst Jersey's overall spend on health and care services is broadly in line with the OECD average, we spend more on hospital services and less on preven on and primary care services.

• household out-of-pocket spend is higher in Jersey than many other OECD jurisdic ons (this includes payments to see GPs, den sts, and some hospital services)

• our funding system is more complex than other OECD jurisdic ons which tend to favour a predominant source of funding (for example, predominately tax or employer / employee contribu ons), unlike Jersey's mixed funding system of tax, employer / employee contribu ons, out- of-pocket expenses, and private health insurance. Whilst this mixed system for raising funds is not problema c, the ways we govern the funds raised can make it harder for us to maximise effec ve use.

We also know that Islanders broadly support a collective approach to health care costs, as opposed to an individual approach – the majority of people believe we should all contribute to the costs of services provided to Islanders, as opposed to only paying for the services we use as individuals.

These insights will help inform potential options for change which will focus on how we:

• determine the best mix of funding that is needed in future?

• ensure the way we govern and spend the money raised supports best use of that money?

• contract with providers to deliver be er value, safe, effec ve services?

• make decisions about the services needed across the health and care system? These op ons will be brought to the Assembly in 2025.

These options will be brought to the Assembly in 2025. HCS Financial Recovery Plan

Figure 2 – Proposed Budget 2025-2028 (p48)

8. What specific measures are being implemented to ensure that the £8 million in savings projected for 2025 and £9 million for 2026, will be achieved without compromising pa ent care?

A response to Question 8 will follow as soon as possible.

9. How will the FRP ensure long-term sustainability in delivering healthcare services while focusing on efficiency savings?

HCS will work opera onally within their budget from 2025 (see also answer to ques on 1) and has measures  in  place  through  the  FRP  to  deliver  efficiencies  and  focus  on  on-going  good  budget management. However, the long-term sustainability of health and care provision is being separately addressed, please see answer to ques on 7 for more detail on poten al op ons for change.

10. Can you provide more details on how the revised meline for the FRP was decided, and what factors influenced the decision to extend the savings meline to 2026?

The main reason behind the extension of the savings delivery was the delay in having some of the enabling resources in place to deliver the savings whilst ensuring we maintain quality of care. For example, recruitment to substan ve posts to remove agency/locum staff requires an ac ve team of recruiters and HR processes to a ract and on-board candidates which reduces   me-to-hire. This took longer than originally an cipated due to longer se ng up mes and more challenging recruitment market condi ons.

11. Could you elaborate on the strategies being employed to op mise income genera on as part of the FRP, and how these will contribute to the overall financial goals?

HCS income generation is primarily achieved through private patient services. The agreed 5-year strategy sets out the ambition and work plan and can be found on gov.je.

As I said in my foreword to the strategy, the private patient strategy signals a commitment to expand the choice of service provision to Islanders by enhancing the private healthcare offer, attracting skilled professionals to Jersey and increasing income to be used for the benefit of all Islanders.

Enabling choice is a key part of the way healthcare is delivered in Jersey and we must acknowledge that supporting this choice brings benefits to the whole system and is not detrimental to it. Our society is diverse, and encouraging private patients services can support a better balance of healthcare spending and prioritisation towards those who depend most on state funded care.

This strategy recognises and promotes the contribution made by private patients services to our whole Island economy. These services can support growth, not just for healthcare, and are a positive contribution to improving productivity in the workplace and diversifying the economy, continuing to make Jersey an attractive place to live.

Private patients services contributed £12.2 million to Health and Community Services (HCS) in 2023, which is approximately 5% of the overall HCS budget. Without patients using their private medical insurance or choosing to self-fund, Jersey's healthcare system and taxpayers would bear an additional financial burden.

12. What measures are being taken to enhance procurement and contract management to ensure maximum efficiency and savings?

The FRP team and T&E's Commercial Services team continue to focus on priority procurement and contract management initiatives, which span the breadth of HCS. These initiatives are delivering efficiencies, whilst ensuring risks are managed appropriately by ensuring services are thoroughly understood and clinicians are involved when appropriate. Through regular engagement with Commercial Services, HCS staff are growing capability to undertake procurement and contract management activities. Governance, grip and control initiatives are being implemented to better understand contracted services and the associated spends, so that decisions which balance savings and clinical risk can be made effectively. Examples of the initiatives are:

• Reviewing all new supplier requests

• Improved governance with off-island acute care and review of spending profile

• Improving rela onships with NHS Supply Chain

• Strengthened governance for ter ary care spend

We have also formed a Tertiary Care Steering Group to scrutinise and provide oversight over this sharply increasing off-island spend.

The tertiary services/off Island project team is focused on provision of improved grip and control of this growing area of HCS spend. The total cost of off-Island care is over £30m p.a. and rising at above inflation levels which provides significant opportunities to identify service and costs improvements.

HCS currently refers patients to over 40 NHS Trusts and during 2025 will work with consultants and Care Groups to review this range with a view to concentrating spend with fewer providers and consider much more strategic arrangements.

13. What systems are being put in place to ensure effec ve staff management, resource alloca on, and procurement improvements, as part of the FRP's cost-saving ini a ves?

The FRP Programme is made-up of six key workstreams that target all these areas. Please see answers to question 12 above and question 15 below.

14. How will the ongoing FRP be monitored to ensure that the savings targets for 2025 and 2026 are met? What con ngencies are in place if these targets are not achieved?

The FRP is tracked, monitored and reported on a regular basis at:

• Bi-Monthly Finance and Performance Commi ee mee ngs

• Bi-Monthly HCS Advisory Board Mee ngs (in public)

New savings opportunities are identified as part of the FRP which is a rolling programme of continuous improvement. Where a shortfall in savings delivery is identified, recovery actions are taken, and mitigation schemes are developed to compensate as necessary.

15. What specific measures were implemented in 2023 to achieve the £3.2 million in savings, and how will these strategies evolve to meet the £5 million, £8 million, and £9 million targets in subsequent years?

The FRP Programme is made-up of six key workstreams with plans in place to achieve £25m of savings over 4 years. These are:

• Workforce Produc vity (Pay)

• Non-pay and Procurement

• Medicines management

• Clinical produc vity (Theatres efficiency, Beds u lisa on/Length of stay, Outpa ents efficiency)

• Income

• IT and Digital

In line with the above workstreams, the savings delivered in 2023 are as follows.

Health Insurance Fund

16. The Panel discussed the funding proposals for the HIF in its recent public hearing with the Minister for Social Security. As Minister for Health and Social Services, what is your view on how the immediate need for subsidies can be balanced with the long-term viability of the fund? How will GP subsidies be funded if the HIF runs out?

As MHSS, I fully recognise the importance of the primary care system and support the improvements in access to primary care services that have been led by the MSS.

Clearly there are a number of factors contribu ng to pressures in the HIF which include the addi onal subsidies recently agreed (for example, free GPs appointments for full me students), the pressures associated with health and care infla on (for example, rising drug costs) and demographic changes (the ageing popula on). But these are not problems for the HIF alone, we are experiencing these pressures throughout our whole health and care system.

We can contain some costs pressures across the system by:

• iden fying and addressing areas of poor financial control (for example, HCS financial recovery work)

• inves ng in preven on schemes (for example, improvements to breast screening)

• suppor ng Islanders to live healthier (for example, public health awareness campaigns)

• establishing the structures and governance arrangements that support providers to work

be er together to tackle complex issues, such as keeping people safe and well at home (as

per the current consulta on on the Jersey Health and Care system).

Ultimately, however, we are going to have to invest more monies into health and care services, or accept a reduction in publicly funded services.

I intend to recommence the work on health funding reform, initiated by the previous MHSS, early next year with the proposed Health and Care Partnership Board providing advice and recommendations to myself and the Council of Ministers. It is clear that we need to develop long term sustainable solutions for Islanders as a whole.

In the meantime, I will continue to work closely with the MSS and any change to overall funding or HIF funding will take full account of the services funded by the HIF today.

17. What strategies are in place to address the increasing healthcare costs associated with the Island's ageing popula on, par cularly concerning the strain this places on the HIF.

See ques on 16 above.

18. Minister, how do you plan to maintain or enhance access to primary care services for Islanders if the HIF's financial pressures con nue to mount?

See ques on 16 above.

19. To what extent could the planned expansions in healthcare services (e.g., free consulta ons, subsidised dressings) be at risk if the fund's deple on accelerates?

See ques on 16 above.

20. Can you elaborate on how the implementa on of the subsidised dressing scheme is working in prac ce? What feedback has there been from service users so far to date?

The scheme to provide free access to community prescribed dressings comes under the remit of the MSS and the costs are being met from the HIF. The MSS has confirmed that the first phase of the scheme is working well, involving FNHC and local community pharmacies. People with a medical need for dressings are referred on to the service, primarily by FNHC. The trea ng prac oner completes an order form which lists the dressings and products required by the pa ent. The pa ent obtains these from a par cipa ng pharmacy free of charge and the cost of the items is charged back to the HIF. Opera onal feedback from this phase is being gathered now to inform the permanent scheme. Customer feedback

on the first phase of the scheme has been posi ve.

Both Community Pharmacies and FNHC have reported excellent feedback from pa ents. Pharmacies are repor ng an increased demand for products since the scheme went live and have advised that pa ents are delighted they no longer have to pay for these dressings.

21. What metrics or evalua ons are in place to assess the effec veness of the new contracts introduced in 2023 and 2024, such as the reduc on in GP consulta on fees and free services for children and students?

a.  How will you ensure that the addi onal subsidies provided to GPs are directly passed on to pa ents in the form of reduced fees?

The HIF contracts introduced in 2023 and 2024 fall under the responsibility of the MSS. The MSS has confirmed that all GP practices have entered into these contracts, which:

• reduce the adult copayment by a total of £30;

• provide free visits for children up to the age of 18; and

• more recently, provide free consulta ons for full me adults students

Practices are obligated to apply the agreed fee reductions under a contractual agreement. The fees charged by practices are monitored in CLS data systems to ensure compliance. This data shows the modal averages charged and enables the department to engage with the practice in the event that contractual terms were not applied. There have been no instances of non-compliance.

Up to date consultation fees are also published on gov.je

22. If the HIF reaches a cri cal low before reforms are implemented, what con ngency plans are in place to ensure Islanders' access to essen al healthcare services is not disrupted?

See question 16 above.

I-HCS-GP25-002 – In Vitro Fertilisation Funding

23. In the public hearing held on 19th September, the Panel was advised that a modelling system had been used to assess what budget would be sufficient based on known demand for IVF. Can you share the data and methodology used to model the funding alloca on?

All the projections are estimates as sufficient data is not available to accurately determine demand or uptake.

Cost per cycle:

• The costs per IVF cycle varies depending on the clinic providing the IVF. For the purposes of the funding calcula ons an average figure of £6,169 was used as the cost of an IVF cycle including the necessary medica ons but not including the costs associated with frozen cycles.

• The costs associated with embryo freezing and transfer of frozen embryos varies. For the purpose of these calcula ons the average of freezing embryos is £818, with the average cost of a frozen cycle transfer being £2,723.

Calculating the number of cycles per year:

• As set out in the amendment to P20/2024, IVF is funded by the NHS in accordance with NICE guidelines in Scotland. In 2021 there were 2,924 NHS funded IVF cycles in Scotland. 2,924 equates to 58% of the total IVF cycles in Scotland that year, with a further 42% of IVF cycles being privately funded. Whilst a propor on of the cycles will be privately funded because the couple do not meet with NICE criteria, it is reported that a propor on of cycles are privately funded because of the wai ng mes associated with NHS funded IVF (target wai ng me is 90% of pa ents have ini al screening within 52 weeks) ie. the total number of IVF cycles that meet NICE criteria per year in Scotland is likely to be higher than 2,942 but, as more detailed data is not available, the figure of 2,924 is used for the basis of these calcula ons (equa ng to 87 cycles in Jersey).

• 2,942 cycles as propor on of popula on in Scotland equates to 87 cycles in Jersey mee ng NICE criteria (albeit no ng the numbers of mee  ng NICE criteria is likely to be higher).

• The  proposed  income  thresholds were  then applied  to the 87 cycles  to try to  calculate the dampening' effect of the income criteria.

• Apply to proposed income criteria dampens demand from 87 cycles to 76 cycles that meet NICE criteria.

• 33% of IVF cycles will provide 2 addi on viable embryos for freezing which based on 76 cycles equates to freezing costs for 25 IVF cycles.

• Of 25 cycles where embryos are frozen, 40% will have resulted in pregnancy from the ini al fresh embryo transfer, leaving 60% (15 of the 25 frozen cycles) requiring frozen transfer at a later date. Sta s cally that equates to the 15 ini al frozen transfer and 9 second frozen transfers ie. 24 frozen egg transfers in total.

Total costs based on 76 cycles per year

*NICE guidelines set out that counselling support should be provided to couples before they embark with IVF to supporting their decision making. during the process and after the process.

**Enhance IT platform required to support service improvements and monitoring

• It is recognised that, in addi on to the income criteria, the funded IVF criteria as published are more restric ve in other areas that the criteria used in Scotland, for example:  

o In Jersey the criteria provide that neither partner can have children from a previous rela onship, in Scotland one of the partners may have children from a previous rela onship

o In Jersey, the maximum number of IVF cycles includes any that the couple may already have had, even where the couple self-funded that IVF. In Scotland, the maximum number only includes previous cycles that were NHS funded.

• These addi onal restric ons are likely to result in less than 76 funded cycles per year but:

o there is insufficient data on which to calculate the impact of these addi onal restric ons on demand / reduced demand

o as set out above the 76 cycle figure was based on Sco sh data which it is known does not include all couple who are likely to be eligible for IVF

o whilst  calcula ons  were  based  on  76  cycles,  the  £620k  funding  provided  for  in  the Government plan is only sufficient for 73 cycles

o no allowance has been made for a poten al ini al surge in 2025 and 2026 as couples previously excluded from funded IVF become eligible for the first me in Jersey.

NOTE:

The Minister for Health and Social Services is taking an appropriately cautious approach to IVF funding given the significant difficulties associated with understanding the impact of the proposed criteria, but

a detailed monitoring system will be in place by 1 January 2025.

In the event that demand is below the anticipated 73 to 76 annual cycles, or the per unit cost of IVF can be reduced (there are ongoing negotiations with UK providers about the potential to secure a reduced cost in light of the overall increase in public monies being invested in IVF) the Minister will review and amend the criteria at end of Q1 2025.

24. How was the figure of £620,000 determined, and what assump ons were made in this process?  See above.
25. Did you adopt the Na onal Ins tute of Care and Excellence (NICE) guidance for IVF funding and if not, why not?

NICE guidance is non-binding advice intended to assist the NHS to exercise its duty to deliver services. NHS Trusts are not compelled to deliver services against the guidelines, and in England and Wales most NHS Trusts' IVF provision does not accord with the guidance on the grounds of affordability.

P.20/2024, as lodged, proposed a new funding model for IVF which accorded with NICE guidance. The proposition was amended by a majority decision of the Assembly, removing the central proposition that IVF should be funded in accordance with NICE, and instead requiring the development of access criteria that accords with good clinical standards.

MHSS did not adopt the NICE guidance on the basis that:

• it is non-binding guidance

• funding in accordance with NICE guidance would create a significant addi onal investment requirement

• the Assembly did not direct that IVF services should be funded in accordance with NICE guidance.

26. Given current infer lity trends and the increasing average age of first- me IVF pa ents, how many Islanders do you realis cally expect to benefit from this funding each year? Do you have data from your IVF travel bursary scheme which could help inform this calcula on?

As set out above, based on the available public data is it estimated there up to 76 funded cycles of IVF may be provided per year. Increased infertility would result in more people receiving funded IVF as the service is not capped to a total of 76 couples.

The average age of first time mother in Jersey is 33 which is within the age criteria of 26 to 39 (or 40 to 42 which tests showing ovaries are likely to respond to treatment).

HCS does not have an IVF travel bursary scheme.

27. What steps will be taken to ensure that the funding criteria are fair and inclusive? How will you address concerns that some individuals may be excluded from receiving funding?

It is recognised that criteria exclude some groups of people for example:

• single people of all genders

• same-sex male couples

• couples where one or both partners are already a parent

• couples who have already privately funded their own IVF treatment

• couples with higher household incomes.

As set out in the response to Question 31 below that are a numerous changes to the criteria that could be made to provide more equity of access and, in the event that of reduced costs and / or lower than anticipated uptake the criteria will be reviewed with a view to providing more greater equity of access.

28. What steps will be taken to prevent financial incen ves from driving pa ents towards IVF over other poten ally suitable treatments

Couples will only be provided funded IVF where it is a clinically appropriate treatment for them. As set out in the criteria You must have exhausted all other preliminary treatments that have been clinically recommended before you can access funded IVF.

29. What measures will be taken to ensure that couples op ng for other infer lity treatments, such as Intrauterine Insemina on (IUI), are adequately supported and not financially disadvantaged?

HCS's assisted reproduction unit does not charge for the IUI procedure but the pathology lab does charge for preparation of the sperm (£350) where the sperm is donor sperm. Donor sperm is not required by many couples. IUI is provided on-island by the assisted reproduction unit, so there are no associated travel or accommodation costs for the couple.

30. How will the effec veness of the funding be monitored? Will there be a review process to assess the impact on those seeking IVF treatment?

The primary purpose of the funding is to support couples who are experiencing fertility difficulties to become parents. Pregnancy and live birth rates will be monitored to assess outcomes.

As set out above, a detailed monitoring system will be in place by 1 January 2025 to monitor update against the criteria. The criteria will be amended if they are found to be too restrictive.

31. In our public quarterly hearing held on 19th September 2024 you advised that expanding the criteria to include same-sex female couples who currently face higher costs because they are required to have I.U.I. (intrauterine insemina on) before they can access I.V.F, was something that you could not make an absolute commitment to but would be something you would be happy to discuss. When will you be in a posi on to make a firmer commitment on this and to share further details of what this would look like?

As set out above there are ongoing negotiations with UK providers about the potential to secure a reduced per unit cost for IVF in light of the overall increase in public monies being invested in IVF. In the event that costs are reduced (and / or the going monitoring of the access criteria indicate they are too restrictive), the Minister will review and amend the criteria at end of Q1 2025. Amendments to the criteria could include any of the following:

• removing restric ons on access by couples where one partner has children from a previous rela onship

• not including previously IVF cycles in the maximum number of cycles where number of cycles, where those cycles were privately funded

• providing for IVF for single women

• further lowering the income thresholds

• removing the requirement for same-sex female couples (and opposite sex couples who do not have sex) to self-fund IUI before proceeding to funded IVF

a.  What consulta on is taking place, if any, with the LGBTQ+ community on this ma er?

There has been no consultation with regard to the proposed new criteria.

HCS-GP25-001 – Ongoing Risks and Pressures in HCS2

32. Please can you provide a detailed breakdown of iden fied risks and pressures and further details of the priori sa on process and how the proposed £29.9 million will be spent?

The addi onal funding has been allocated to fund the underlying structural deficit funding. Pressures occurred in a range of services linked to increasing costs such as off-island placements, ter ary care contracts, increase in high-cost specialist treatments including high-cost drugs, and increasing demand for in-pa ent hospital medical care. See also answer to ques on 1.

33. How was the figure of £29.9 million determined? The breakdown of the growth funding is as follows:

P-260024 – HCS Health Services Improvements (Backlog Maintenance)

34. Please can a list be provided to the Panel of what the most urgent Health and Safety requirements across the health estate are and detail of the required meframes needed?

Please see a ached Appendix A

35. Out of the known infrastructure failings, what work has been done to rec fy major issues to date Please see a ached Appendix B

36. What is the cause for the number of delays over the last 6 years with addressing red risk' items, which in turn, have now resulted in the amber risks' turning red?

Maintenance programmes and funding streams were aligned to the comple on dates for delivery of the previous new hospital schemes (Future Hospital; Our Hospital). As these were not completed, the exis ng facili es con nue to age and require intensive maintenance work. Whilst the work has been con nuously risk assessed and priori sed it has also resulted in some risks that have previously been rated as amber' now being rated as red due to further deteriora on of the facili es.

A limita on to addressing red risks are not only resources but also the availability of decant facili es. For example, to undertake work on wards in the hospital, beds and clinical areas need to be decanted to a different space.

37. The Panel notes that £5 million is included in the Proposed Budget however it is your view that con nued funding would need to be found on an annual basis from 2026 onwards un l the new Health Facility is in opera on. How much funding annually do you envision will be required and where do you foresee the budget coming from?

The Council of Ministers are aware of the on-going requirements for the exis ng hospital estate and infrastructure un l the New Hospital Facili es Programme has been delivered. The HCS Estate team will con nue to undertake their risk-based assessment aligned to the progress of the New Hospital Facili es Programme on an annual basis and iden fy required resources for inclusion in the proposed Budget 2026.

Digital Systems Improvement

38. The Panel understands that the objec ves and benefits were con ngent on the commencement date

of 1st October 2024 however the constraints of the allocated funding did not align with the recommended route of delivery. Did the ECR System project commence on 1st October 2024 and therefore receive the funding decision to implement Op on 3? If not, what are the next steps?

A response to Question 37 will follow as soon as possible.

The Electronic Care Record (ECR) System project has received approval to enter discussions with Commercial to progress with the procurement process. The team is currently working with Commercial to secure approval for issuing a request for quote (RFQ) to the supplier, followed by demonstrations. The analysis of the responses will align with the decision on the outline business case. Subject to States Assembly approval of the funding and recommended delivery timeline, as outlined in the business case, the project will move into contract negotiations with the supplier. There has been no significant change in the project's timeline at this stage.

39. What discussions have taken place to date to explore funding op ons from other departments such as CYPES?

A response to Question 38 will follow as soon as possible.

Initial discussions took place to explore potential funding options from CYPES. However, these conversations were impacted by the recent departure of the Chief Officer of CYPES, who has stepped down from their role. Further discussions are anticipated with the interim Chief Officer to allow for continuity in exploring collaborative funding opportunities.

40. How do you intend to mi gate the poten al risk that Procured systems may not meet the specified requirement standards leading to service failures, addi onal costs and resources for development or replacement'?

To mi gate these risks the following strategies have been or will be employed:

• Comprehensive Requirements Gathering: A thorough requirements analysis has been conducted, involving all key stakeholders, including end-users, service users, carers, and subject ma er experts, to clearly define and document system specifica ons. This engagement ensures that both current and future service needs are met, with a focus on future-proofing the system to adapt to evolving care demands.

• Rigorous Supplier Evalua on: A robust supplier evalua on process was carried out, allowing suppliers to demonstrate their capabili es. A comprehensive report on these evalua ons has been submi ed to the Commercial Team. Moving forward, an RFQ and demonstra on process with the preferred supplier, incorpora ng an enhanced list of requirements, will be ini ated. The supplier's responses will be integrated into the contract and will include tes ng against both func onal and non-func onal requirements to ensure the system fully aligns with our needs.

• Contractual Safeguards: Clear contractual terms will be established, including performance and requirements guarantees, SLAs, and penal es for non-compliance (subject to commercial review). This ensures that the supplier is accountable for delivering the agreed standards and requirements.

• Lessons Learnt: Previous experiences and lessons learnt from similar projects have been reviewed and incorporated into the process to avoid repea ng past mistakes and ensure con nuous improvement in procurement and implementa on prac ces.

• Change Control Process: A formal change control process will be implemented to manage any system adjustments or enhancements during and a er implementa on. This process will ensure that changes are carefully evaluated and approved to prevent service disrup ons or unplanned costs.

• Ongoing Monitoring and Feedback: During and a er implementa on, con nuous monitoring of the supplier's performance and the system's effec veness will take place. Regular feedback loops, such as end-user workshops and steering group mee ngs, will be established to ensure the system remains fit for purpose. Any risks that emerge will be addressed promptly.

By employing these strategies, we aim to minimise the risk of service failures and manage costs effectively, ensuring the system meets the required standards and facilitates seamless service delivery.

General Hospital Wi-Fi

41. Please can you provide further informa on on what this new project entails and why these works are required in 2025?

The existing Wi-Fi in the hospital is variable in terms of capacity and coverage, which currently is a barrier to using digital health systems at the bedside and mobile across wards. The new Hospital EPR System investment will deploy further functionalities, and these new ways of working are largely mobile, digital at the patient bedside. New devices such as fluid monitors, e-observations, rely on reliable Wi-Fi to provide a safe level of care. The project will also address weak core network points at the same time as addressing the access points (the Wi-Fi kit in rooms), end to end, which are otherwise at risk of becoming bottlenecks in the network. This project addresses these issues and requirements and enables the strategic objectives of enhanced patient care and health outcomes and operational efficiencies. Further detail can be found in the Business Case which has already been shared with the Panel.

Replacement Assets and Minor Capital (HCS)

42. What is the reason for the change in the proposed alloca on from £2,500,000 to £2,250,000 in 2025 for this programme of works?

£2.5m was the original 2025 proposed allocation, however £0.25m from 2025 to 2024 to purchase equipment for HCS was brought forward to 2024 to support the procurement of critical equipment in 2024. As a result, the 2024 budget changed from £2m to £2.25m whilst the 2025 allocation has been reduced by £0.25m from £2.5m to £2.25m.

43. Please can you provide further informa on on how the proposed £2,250,000 will be spent?

Items for the annual replacement plan of medical assets are currently being identified with clinical and operational teams. Equipment requested is usually used in theatres, radiology, clinical investigations, and clinical specialties.

Digital Care Strategy – Extension

44. The Panel understands that in order to con nue the implementa on of the Digital Care programme, funding is needed to implement a number of areas. What is the risk should one area not receive the required funding?

a.  How would the lack of funding impact work already underway?

Should funding be curtailed to deliver the Digital Care Programme, this will have a direct result on productivity of the workforce, patient outcomes, capacity, patient safety and financial recovery. By underfunding projects, the delivery of intangible and cashable benefits will be hampered. For example, dual running of paper and digital systems, and reducing and optimising manual processes with digitised ones. Improving flow through enhanced and actionable business analytics, reducing administrative burden through a single digital system as opposed to part manual and part digital. Benefits realisation will be reliant on the funding, and the faster the funding is provided the faster the benefits are realised.

45. Should funding be approved, what other Government ini a ves do you foresee being reduced in scope or phased due to the comple on of this project?

The funding and resource requirements have been planned and agreed with colleagues from Digital Services based on prioritisation of needs and impact. Prioritisation across the Government for digital projects is being undertaken regularly to ensure resources are being focused on projects with the highest impact and benefit.

Learning Difficulties - Specialist Accommodation

46. Please can you provide a progress update on this project as well as the spend to date? A response to Question 45 will follow as soon as possible.
47. What are the key milestones for this ongoing project? A response to Question 46 will follow as soon as possible.
48. How do the projected amounts for £3,200,000 for 2026 and £1,624,000 for 2027 correlate to the project's original agreed alloca on of £4,037,000 for 2024? Do they make up part of this amount or are they addi onal?

A response to Question 47 will follow as soon as possible.

49. What is the reason for the proposed reduc on in the project total from £9,350,000 to £8,850,000? A response to Question 48 will follow as soon as possible.
50. What is the ra onale for no funding being required in 2025? Has the project been delayed? If so, why?

A response to Question 49 will follow as soon as possible. Crematorium Resilience

51. As Lead Minister for the Crematorium project, please can you provide further details on how you intend to modernise the crematorium'?

It is my intention to respectfully update the Crematorium in partnership with our key stakeholders. This will include updating the facility and also reviewing the furniture and equipment.

52. Please can you detail what energy sources are being considered to power the hybrid cremator and how the op ons appraisal for this is being undertaken?

At this stage of the project initial scoping work is underway to consider all potential options for the hybrid cremator and once the preferred option has been agreed I will have further details about cost and timeframes which I am happy to share with the Panel.

53. Can you provide the cost implica ons and meframes for each op on being considered? See below.
54. What are the meframes and cost implica ons for ensuring all staff are fully trained to operate the new plant?

This will be dependent on the plant that is installed and commissioned. However, full training will be provided for all relevant staff.

Previous Government Plan 2024-2027

55. The previous Health and Social Security Panel presented a comments paper to the previous Government Plan 2024-2025 highligh ng its concern for the level of funding that had been determined for a new vaccina on scheme, aiming to create an adult vaccina on programme. Can you provide any informa on to the Panel regarding the extrac on of money from the Health Insurance Fund to deliver the scheme in this year's Budget?

Adult vaccina ons are delivered by either Primary Care, Public Health, sexual health teams, through Occupa onal Health services (such as HCS and Government of Jersey Immunisa on team) and privately. The vaccines, and payment for delivering the services, are funded through a combina on of the HIF, HIF Medical Benefit, contracts which access HIF funding, Public Health budgets, Occupa onal Health budgets and pa ent payments.

There is no extrac on of funding from HIF to Public Health – the Minister for Social Security enters into agreements with community pharmacy and general prac ce for the delivery of some vaccina ons (currently Covid and Flu), purchases vaccine for use in primary care se ngs (currently Flu, RSV and Shingles) and subsidises vaccina ons undertaken in General Prac ce via Statutory Medical Benefit and Contracted Medical Benefit.

A number of vaccines are delivered by the Public Health team, including urgent responses to major disease outbreaks or other infec ous disease threats e.g. MPox, measles. These are funded by Public Health.

In addi on to delivering some vaccina ons, the Public Health Vaccina ons Team fulfils other func ons, including:

• Providing specialist immunisa on knowledge to primary care providers and the public

• Assessing children eligible for BCG vaccina on and offering vaccina on clinics

• Scheduling of baby immunisa ons (necessary to maintain high uptake)

• Scheduling of baby six-week baby checks

• Inpu ng data from the GP records into the child health system ensuring there is a comprehensive vaccina on history

• Developing Pa ent Group Direc ves (PGDs)

• Conduc ng annual cold chain audits of GP prac ces and an annual stock check of vaccines in Primary Care

• Leading communica ons for vaccina on campaigns e.g. COVID, flu, shingles, RSV.

Through the 2024–27 Government Plan process, £400k was allocated to Public Health, to continue funding the adult vaccination programme. This was intended to fund:

• 1 Health Protec on Nurse

• 1 Vaccina on Manager

• 1 Opera onal Lead

• 1 Analyst

• A small amount of non-pay cost

Funding was reduced by the 20% Government Plan growth reduction, resulting in a cost pressure. The shortfall has been met by reshaping other Public Health funding.

A vaccinations plan has been developed, the principles of which have been shared with the Minister for Health & Social Services. It includes the aim of streamlining and simplifying funding arrangements and ensuring resilience in delivery.

56. Last year, the previous Panel expressed concern regarding the lack of detail about the increase in staffing levels over the last three years within Public Health. Can you provide further informa on into the ra onale for this?

The picture of public health staffing in 2023 was complex because:

• the directorate was rela vely new, had a range of new responsibili es and built from teams spread across the organisa on. Baseline staffing numbers were difficult to calculate and staff transfers were not fully understood or taken into account,

• staffing numbers included those who were not part of the public health team, e.g. those delivering Major Incident health and wellbeing services (employed by HCS, but with the budget overseen by Public Health),

• the numbers included staff involved in offering a centralised adult vaccina  on service, which has since transferred to primary care,

• there were a range of budgets financing public health which added complexity and this complexity was difficult to communicate and understand.

The aim of the business case to maintain public health activities in 2023 was to secure recurrent funding for essential services, whilst offering a substantial budget reduction, bring together a plethora of budgets, reducing complexity and offer greater transparency about public health spending.

As part of the Government Plan debate, Public Health were required to secure approval from the States Employment Board prior to recruiting to the posts in the 2024 business case. This approval was achieved in February 2024 and the new structure implemented from 01 April. 18 posts were disestablished and 11 substantive posts established. A number of individuals were placed at risk of redundancy; some secured new roles and some left the organisation.

The Public Health establishment is robustly managed. Any vacancies are considered for re-structure to further improve capacity, skill-mix and value for money. Contracts for a number of fixed term, agency and contractor staff have not been renewed during 2024, and workloads have been reprioritised and/or reallocated to substantive staff.

57. The previous Panel recommended that "Ahead of the debate of the Government Plan 2024-2027, the Minister for Health and Social Services must provide details of how many exis ng public health staff the requested monies under the revenue expenditure growth "maintaining the public health and health protec on funding" will fund". It was noted that the figures of the es mated staffing levels for this year (2024) may be subject to change due to informa on based on assump ons. Please could you provide the Panel with an up-to-date FTE figure of the staffing levels for this year and for 2025, and whether there is any underlying growth for next year?

Currently the Public Health establishment is 51.3 FTE (the includes filled and current vacancies). 37.1 FTE staff are currently in posts, and an additional 10.6 FTE are held by temporary staff (i.e. in fixed term posts, employed as specialist advisors or cover for maternity leave). As at October 2024, a further 4 posts for the Major Incidents health and wellbeing support are employed in HCS or CLS.

The public health budget will reduce in 2025-6. The budget will reduce by approximately 14% in 2025 compared to the 2023 baseline. In 2025, a further two vacant posts will be disestablished, in addition to the 11 Public Health and 4 Major Incidents posts disestablished in 2024. A further budget reduction is planned in 2026 which will bring the total budget reduction to 18%.

58. During the previous Government Plan, the previous Panel recommended that "the Minister for Health and Social Services must ensure that funding is iden fied in 2024 to improve and enhance the breast cancer screening service." What funding was iden fied, if any, and how has any addi onal funding improved the service?

An enhanced breast screening service will start by end of 2024. This will enhance the service and enable the roll out of a opt out' breast screening service. The opt out' service will ensure that all eligible women are automatically being contacted for a breast screen rather than relying on women contacting the service to opt in' for the screen. The additional equipment for this service has been funded through the John Clive Le Seelleur Fund, and additional staffing is funded through charitable funding for the next three years. The existing mammography unit is currently being replaced and is funded by the HCS departmental capital equipment budget.

Yours sincerely,

Deputy Tom Binet

Minister for Health and Social Services D +44 (0)1534 440540

E t.binet@gov.je

Total: £28,105,000

* Identified Capital Funded Projects Outside Of Backlog - Total: £2,900,000 but no business case to support improvement works

HCS Estates

Health Service Improvements Programme (Backlog Maintenance) Completed projects 2019 - 2024

Healthcare Services Improvements (Backlog) 2019 - £2.8m

• JGH Emergency Supply Generation - (General Hospital)

• JGH BMS replacement, Central Monitor and Controller plus site network (General Hospital)

• JGH Fire Risk Assessments (General Hospital - overall site)

• JGH Lift Replacement, 1 x Dirty Lift + 2 x Bed Lifts (General Hospital - 006 Block A, Parade Block)

• JGH Replace Chilled Water Plant 4 No Chiller ITU, ED, Theatres

• JGH Chilled Water Plant. 2No 200kW Chillers for Maternity Unit.

• JGH Chilled Water Plant.4No Chillers for Radiology MRI CT.

• JGH Emergency Lighting. All patient areas require emergency lighting, to back-up essential lighting circuits

• Testing & Inspection, Production of electrical, schedules, drawing and testing programme for all electrical systems and outlets

• JGH Ventilation ductwork identification and testing of fire dampers to BS EN 1366-2 and HTM Firecode 05-02.

• JGH Replacement of 4 No bed pan washer/disinfectors within inpatient locations.

• JGH Low surface temperature radiators installation. Hospital - Parade Block

• JGH Endoscopy Ward Refurbishment

• JGH Medical Gas Pipeline Systems. Medical Vacuum Plant.

• JGH Medicine Room Refurbishment x5 Ward s

Healthcare Services Improvements (Backlog) 2020 – (£5.0m)

• JGH Sorel Ward Refurbishment

• JGH Portlet Ward Refurbishment

• La Chasse Refurbishment.

• JGH Pathology Refurbishment.

• Overdale, Sameras Basement Water Ingress resolved.

• Crematorium plant refurb (burners)

• JGH Peter Crill 4th Floor Refurbishment

• JGH Satellite Kitchen and Servery Refurbishment inclusive of Restaurant area and Mental Health Liaison Offices.

• JGH Minor Fire compliance works

• JGH Resus AHU – Ventilation replacement

• JGH Ventilation System record drawings

• JGH Kitchen cold Store & Deep Freeze (Feasibility)

• JGH Day Surgery Unit Theatre 1 - Replacement Ventilation (Feasibility)

• JGH Replacement Fire Alarm System (Phase 2) (Feasibility)

• JGH Block F (Phase 1B) Emergency Escape Lighting (Feasibility)

• JGH External works - Block E (Gwyneth Huelin) replaced manhole covers

• Closure of Gloucester Lodge – Relocation of Alcohol & Drug Service to Maison Le Pap

Healthcare Services Improvements (Backlog) 2021 – (£5.0m)

• JGH Refurbishment, compliance and remodelling. Maternity Unit – Started Sept 21

• JGH Site wide Medium Temp Hot Water (MTHW). New Circulating Pumps and valves.

• JGH Replace Air handling units - Block E – Day Surgery – due to complete May 2022

• JGH Replace Air handling units - Block F – Pathology – due to complete Sept 2022

• Five Oaks - Central Stores fire alarm upgrades

• All Sites - Fire Compliance – ongoing improvements

• JGH Renal CWP Replacement & Water condition unit replacement

• JGH Granite Block repointing

• JGH Granite Block Roof Repairs

• HCS site wide DDA Regulations Audit complete

• JGH Cold storerooms replacement – design complete, require funding in 2022.

• JGH Fire Damper remedial works – Audit

• JGH Maternity re-roofing works

• All Sites - Replace Non-compliant Clinical Wash hand Basin, Taps & TMV's – Audit complete

• JGH Minor bed head lighting improvement works on 50% of wards

• JGH Renal Nurse call replacement

• JGH Granite Block window restoration

• JGH Electrical Testing & Inspection - Year 4 complete

• JGH Medical Air Plant Replacement – Gwyneth Huelin Block

• JGH 3rd Floor Exec Suite Refurbishment

• JGH Day Surgery Chiller Replacement (due to complete May 2022)

• JGH Replacement Renal Dept DX Condensing Unit

• JGH Main Theatre Load Bank/Harmonic Filtration Unit installed.

• JGH Temporary PCR Testing Facilities (Permanent location due May 2022)

• JGH Nurse Call Replacement 90% site upgraded.

• Relocation of Willows Day Centre to Sandybrook Day Centre

• JGH Retinal Screening Clinic

• Decant of Samaras Ward

• JGH Relocation of AAU / EAU

• Relocated Jersey Talking Therapies to Don Road

• Jersey Care Commission –Upgrades @ Sandybrook & Le Geyt

2021 Capital Projects & Equipment Replacement

• Aviemore Fire improvements

• Five Oaks boiler replacement & site wide back-up generators,

• Purchase of Klondyke (Learning disabilities)

• Jersey Hospital Nightingale Wing

• New MRI Scanner

• New CT Scanner

• CSSD new disinfectors

• Laundry new Ironliner install & infrastructure improvements.

• St Peter's Catering Unit

• Le Squez Accommodation Block (10 units for LD Service) Andium

• Orchard House Improvements

Healthcare Services Improvements (Backlog) 2022 – (£5.0m)

• JGH Refurbishment, compliance and remodelling. Maternity Unit – Started Sept 21

• JGH Site wide Medium Temp Hot Water (MTHW). New Circulating Pumps and valves.

• JGH Replace Air handling units - Block E – Day Surgery – due to complete May 2022

• JGH Replace Air handling units - Block F – Pathology – due to complete Sept 2022

• JGH Fire Compliance

• JGH Fire Damper remedial works

• JGH Replacement of the water tanks – Block E

• JGH Renal Nurse call replacement

• JGH Granite Block window replacement

• JGH Day Surgery Chiller Replacement

• JGH - Nurse Call Replacement – site wide - ongoing

• JGH - LED Replacement – site wide - ongoing

• JGH Rayner Wet Room refurbishment

• Ad hoc Emergency works

• JGH - Conventional Fire Alarm Replacement

• All site water Management

• JGH Critical Care Vent Block F

• JGH - External Roofing Works – ongoing

• Sandybrook JCC works (decs & lighting to common areas).

2022 Capital Projects & Equipment Replacement

• Klondyke – supported living accommodation

• Aviemore Relocation – supported living accommodation feasibility

• Plemont/Samares Rehab – relocation from JGH to Overdale

Healthcare Services Improvements (Backlog) 2023 (£5m)

• JGH - Ward Refurbs

• Robin – Medicine Room

• Beauport – full refurb.

• JGH – Maternity Refurb - Phase 5, 7, 8 & 9

• JGH - Catering walk-in freezers replacement project.

• JGH - Pathology AHU replacement (CAT3 Labs)

• JGH - Fire Compliance (Fire alarm, fire doors & fire stopping)

• JGH - Fire Dampers – full site audit & part replacements.

• Sandybrook JCC upgrades - wet rooms windows and fire stopping.

• Sandybrook bedrooms 1-5

• JGH – site wide LED lighting upgrades

• Five Oaks Infrastructure upgrades (Fire Alarms, BMS, Lighting, Smoke vents)

• Five Oaks – walk in cold rooms for Pharmacy.

• JGH - Asbestos removal

• Ad hoc emergency works

• Minor works packages (<£10k)

• JGH - Bartlett wet room - conversion to store

• JGH - Granite roof repairs

• JGH – Day Surgery Chiller (Ventilation) replacement.

• JGH Bartlett – Dragar Networking

• JGH Bartlett - Kitchen vent & lighting.

• JGH Renal Nurse call

2023 Capital Projects & Equipment Replacement

• Enid Quenault Centre

• Rosewood House

• New Hospital Facilities Programme

Healthcare Services Improvements (Backlog) 2024 (£5m)

• JGH Pathology - RAAC Mitigations Works

• JGH Ward Refurbishment Programme: Bartlett Ward

• JGH Refurbishment, compliance & remodel Maternity – Phase 11 and PC

• JGH MTHW. Circulating Pumps and control gear – (Med Temp Hot Water Systems)

• All sites - Minor Works Projects: under £10k

• All sites - Emergency works

• JGH Fire Compliance

• JGH Water Compliance

• JGH Fire Damper remedial works (Blocks E & F)

• JGH Window replacement - Sorel

• LED Lighting Replacement – site wide rolling programme

• JGH Conventual Fire Alarm Replacement – OPD, Pathology, Ante Natal Dermatology

• JGH External Roofing Works - Entire Site

• JGH Peter Crill Lift Replacement

• JGH EBME installation

2024 Capital Projects & Equipment Replacement

• Clinique Pinel

• Orchard House closure

• St Ewolds

• Overdale demo

• New Hospital Facilities Programme

• EQ new mammography scanner

• RAAC Safety improvements

• League of Friends conversation into Ops Hub.

• Progressing Interventional Radiology Suite.