Education and Home Affairs - Approved Panel Minutes - 3 April 2006

Social Affairs Scrutiny Panel

Date: 3rd April 2006

Location: Le Capelain Room, States Building

Present Deputy F.J. Hill, B.E.M., Chairman

Deputy J.A. Martin, Vice Chairman Deputy D.W. Mezbourian

Deputy A.E. Pryke

Deputy S. Pitman

Apologies

Absent

In attendance Mrs. K. Tremellen-Frost, Scrutiny Manager [Item 6]

Mr. C. Ahier , Scrutiny Officer

Mr. W. Millow , Scrutiny Officer

was  to  have  been  implemented  in  conjunction  with  the  new Income Support system.

The  Panel  asked  whether  Age  Concern  and  the  Association would  monitor  the  new  out-of-hours  service  and  consider informing the Panel of its findings.

2. Matters Raised

During the course of its meeting with Mrs Minihane and Mr Le Brocq, the Panel considered the following matters in relation to the co-operative out-of-hours service:

The impact of the service on those who currently received HIE.

The possibility that the new service would make Jersey a more attractive place to work for GPs.

The impact of the new system on short-term residents of the Island.

The access visiting GPs would have to patient information.

The use of Public funds establishing and maintaining the out-of-hours service.

The potential impact of the service on Accident and Emergency (A&E).

The arrangements for receiving and transferring calls in the new system.

3. Consultation

The Panel was advised that no formal request had been made by the Department of Health and Social Services for the views of Age Concern or the Senior Citizens Association. It was further advised  that  no  request  had  been  made  by  the  Jersey Competition  Regulatory  Authority  (JCRA)  for  its  own investigation.

The  Panel  was  advised  that  Mrs  Minihane  had  consulted informally with members of Age Concern and the Association at meetings held on Tuesday mornings. The Panel was informed that these meetings were generally attended by approximately ninety people, approximately half of whom benefited from Health Insurance Exception (HIE).

The Panel was informed that Mrs Minihane had not received many  adverse  comments  relating  to  the  new  out-of-hours service. The  Panel  was  further  informed  that  no  adverse comments had been received relating specifically to the use of the Gwyneth Huelin Wing at the General Hospital for the Co- Operative's surgery.

The  Panel  was  advised  that  the  Senior  Citizens  Association would hold a meeting in April 2006 regarding the new out-of- hours service. Mrs Minihane advised the Panel that an invitation to the meeting would be extended to a representative of the GP Co-Operative.

5. Family Nursing and Home Care (FNHC)

The Panel met Mrs K. Huchet to discuss Family Nursing and Homecare's views on the co-operative GP out-of-hours service.

1. Work of FNHC

The  Panel  was  informed  that  Family  Nursing  and  Homecare services were offered from 7:30am to 12:00am and that nurses were on call between 5:00pm and 12:00am.

The Panel was informed that nurses took phone-calls at Le Bas Centre and would need to decide whether a patient should be transferred to a GP.

The Panel was informed that 60% of referrals to FNHC came from GPs.

The  Panel  was  informed  that  discussions  were  occurring between  FNHC  and  Dr  R.  Geller,  Medical  Officer  of  Health, regarding the use of Le Bas Centre. It was further informed that some FHNC services were to be outsourced to the former La Pouquelaye School.

The Panel was informed that all nurses who undertook home visits  were  equipped  with  personal  alarms. It  was  further informed that certain visits would be undertaken by two nurses if there were concerns regarding safety. The Panel was advised that risk assessments for potential home visits were undertaken during daytime working hours.

The Panel was informed that Family Nursing and Homecare had access to an interpreter to assist patients who did not speak English. It was further informed that one of the receptionists spoke Portuguese.

The Panel was advised that a pilot scheme for Rapid Response' had been implemented in 1999. It was further informed that this scheme involved specialist staff attending patients at their homes to avoid the use of hospital facilities. The Panel was advised this scheme had ceased due to insufficient funding but that it had run twenty-four hours a day.

2. Matters Raised

During the course of its meeting with Mrs Huchet, the Panel considered the following matters:

The suggestion that the new service had been developed to meet the needs of GPs and the Department of Health and Social Services rather than of patients.

The alternatives that may have been considered during development of the proposals.

The consideration given to involving FNHC in out-of-hours service.

The Panel noted that FNHC would monitor the new out-of-hours service to see what impact would be had on it in terms of follow-

up care.

Mrs Huchet offered to forward to the Panel a copy of the notes she had prepared for the meeting.

3. Consultation

The  Panel  was  advised  that  FNHC  had  not  been  formally approached by the Department of Health and Social Services for its view on the out-of-hours service and that FNHC had made no official approach to the Department to express this view. It was informed that Mrs Huchet had had an opportunity to discuss the matter with Mr M. Littler, Directorate Manager of Medicine.

The  Panel  was  advised  that  Mrs  Huchet  had  spoken  with employees of Clinical Services on the following matters:

The cost-effectiveness of the new service.

The potential impact of the service on A&E.

The  potential  impact  of  the  service  on the  provision  of pharmaceutical products.

6. Parents Action Group

The  Panel  met  Mrs  Z.  Bisson  to  discuss  the  Parents  Action Group's views on the new GP Co-Operative out-of-hours service.

1. General Information

The Panel was advised that the Parents Action Group was an offshoot of the Early Years Association. It was further advised that  the  Group  comprised  eight  people  who  worked  for  the interests of a larger number of parents.

2. Consultation

The  Panel  was  informed  that  the  Group  had  not  been approached by the Department of Health and Social Services for its views on the new out-of-hours service.

The Panel was advised that the Group could consult with those parents it represented in effort to ascertain their views on the service.

3. Matters raised

The Panel considered the following matters during its meeting with Mrs Bisson:

The possibility that the service would impact on access to hospital services by sick children.

The potential responsibility of the telephonist to receive phone-calls and subsequently decide upon the appropriate course of action for the patient.

The levels of the fees charged by the co-operative.

The potential loss of discretionary charges for GP home visits.

The  possibility  that  on-call  GPs  would  not  know  the patients they would visit.

The possibility that private and sensitive information would be at the disposal of a greater number of people than previously.

7. Meeting with Dr. B. Perchard

1. Development of Proposals for an Out-of-Hours Service

The Panel was advised that proposals to establish a co-operative out-of-hours  service  had  been  repeatedly  mooted  during  the previous ten years and that an unsuccessful attempt to introduce such a service had been made five years previously.

The  Panel  was  informed  that  development  of  the  present proposals  had  involved  consultation  with  GPs  as  well  as presentations on the service offered in the Isle of Wight.

The Panel was informed that members of the Jersey Medical Society had agreed by 45 votes to 9 for an approach to be made to the Department of Health and Social Services regarding the creation of a co-operative out-of-hours service.

The Panel was advised the involvement of 70% of the Island's GPs was required for the co-operative service to be viable. It was informed that this figure had been achieved.

The Panel was informed that one practice that had chosen not to join  the  co-operative  had  been  split  in  its  decision  along generational lines. It was further informed that a second practice that had chosen not to join had done so due to its belief that the Department  of  Health  and  Social  Services  should  not  be involved.

The  Panel  was  informed  that  all  necessary  staff  had  been recruited for the implementation of the service on 3rd April 2006 and that appropriate training would be given.

The Panel was informed that 84 FTE (full-time equivalent) GPs worked in the Island and that there was therefore approximately one GP for every 1,100 people. Dr Perchard estimated that 70% of the population would be covered by the co-operative service.

The Panel was advised that the Joint Working Party had first met the JCRA in November 2005. It was noted the JCRA had been unable to give a firm date for when it would finish its investigation of the co-operative service.

2. Consultation

The  Panel  was  informed  that  the  Department  of  Health  and Social  Services  had  taken  lead  responsibility  for  Public consultation. It was advised that the Joint Working Party had considered  all  responses  made  as  part  of  the  Public consultation. Dr Perchard expressed a belief that the lack of Public response to the consultation was surprising but indicated the Public was not opposed to the scheme.

The Panel was advised that no Patient Body existed in Jersey to present patients' views.

The Panel was advised that Dr Perchard had consulted with GP practices and that informal consultation had occurred between GPs and their patients. It was further advised that Dr Perchard had given a radio interview on the out-of-hours service.

The  Panel  was  advised  that  participating  GP  practices  had chosen  not  to  advertise  their  involvement  in  the  co-operative service due to concerns regarding Public perception and a desire not to be seen denigrating those who had chosen to remain outside the co-operative.

3. Operation of the Co-Operative Service

1. Access to the Service

The Panel was informed that patients of practices which chose to remain outside the co-operative would not have access to the co- operative's services.

The  Panel  was  informed  that,  upon  implementation  of  the service, patients would need to dial two numbers to access the service. It was  advised that an  integrated call system  which would  allow  access  with  one  telephone  call  was  likely  to  be implemented within two months.

The Panel was informed that calls made between 6:00pm and 11:00pm  would  be  answered  by  the  receptionist  at  the  co- operative surgery. It was further informed that calls after this time would be answered at the Emergency Call Centre on a separate line to that used for the 999 service.

2. Driver Service

The Panel was advised that GPs would use a driver service for approximately 20% of on-call sessions although some 16% of the funding  for  this  service  would  come  from  the  Department  of Health and Social Services. It was noted that not every GP desired to use the driver service. The Panel was advised that a driver service would help with finding the location of home visits.

The Panel was advised that on-call GPs would be able to operate from Peter Crill House but that some GPs preferred to operate from their home during their time on call'.

3. Billing Arrangements

The  Panel  was  advised  that  GP  practices  presently  gleaned approximately  2%  of  their  annual  turnover  from  out-of-hours work.

The Panel was informed that fees for the co-operative service had  been  based  on  the  average  of  fees  charged  prior  to

commencement of the co-operative service.

The Panel was advised that individual practices would remain responsible for billing arrangements and that the GP who had undertaken a home visit would be entitled to the full fee for this visit. The Panel was informed that conciliation of accounts would occur  each  month  between  individual  practices  and  the  co- operative surgery.

4. Access to Patient Data

The  Panel  was  informed  that  a  visiting  GP  would  not  have access to the patient's records during the visit. It was advised that patient databases for individual practices were presently in a poor  state  and  that  work  on  a  central  database  for  the  co- operative service was ongoing. The Panel was informed that provision for remote access to the database would eventually be possible and that such remote access was currently available in the United Kingdom through the Adastra system.

5. Quality Assurance

The  Panel  was  informed  that  quality  standards  for  the  co- operative service would be based upon standards used in the United Kingdom. It was advised that GPs would not be required to meet the standards before entering the service and that to introduce  such  a  requirement  would  be  a  highly  contentious issue.

The Panel was advised that, upon implementation of the co- operative service, every patient would be asked to complete a questionnaire on the service but that subsequently every 30th patient would be given the questionnaire. It was further advised that this proportion could be subject to change.

6. Language Services

The Panel was informed that the GP co-operative would have access to the language service at the General Hospital and that the cost for this use would not be borne by the Department of Health and Social Services.

8. Meeting with the Association of Professional Ambulance and Paramedic Staff (APAPS)

The  Panel  met  Mr  M.  Judge  and  Mr  G.  O-Rourke  of  the Association  of  Professional  Ambulance  and  Paramedic  Staff (APAPS) to discuss the potential use of Ambulance crews to provide a driver service for the GP co-operative.

The Panel was advised that ambulance crews operated centrally from Ambulance Headquarters and would attend to emergency calls from there.

The  Panel  was  advised  that  indications  had  been  given  to APAPS that any driver service involving ambulance crews would have been stopped if it had been found to have an adverse effect on responses to 999 emergency calls.

The  Panel  was  informed  that  a  meeting  of  approximately  20 ambulance staff had occurred on 6th March 2006 to consider the possibility of using ambulance crews to provide a driver service for on-call GPs. It was further informed that the following three options had been considered and that the third option had been chosen:

To use the two established ambulance crews to provide a driver service

To undertake a trial period of one month, during which a third ambulance crew would be established, in order to monitor the potential impact of providing a driver service

To  have  no  involvement  of  the  ambulance  crews  in providing a driver service

The Panel was advised that no written notice had been received by APAPS of the decision not to involve ambulance crews in the provision of a driver service for GPs.

The  Panel  was  advised  that  workers  in  the  Emergency  Call Centre did not form part of APAPS. It was advised that concerns had been raised by workers in the Call Centre regarding the impact of the co-operative service on the Centre.

[20/03/06, 9. GP Out-of-Hours

Item 5] The Panel noted that the Out-of-Hours service would begin on

3rd  April  2006  before  the  Jersey  Competition  Regulatory Authority (JCRA) had completed its investigation into whether the service  would  be  granted  an  exemption  from  Article  8  of Competition (Jersey) Law 2005.

The Panel noted Act B4, dated 7th October 2005, of the former Health and Social Services Committee relating to work that had been  undertaken  on  developing  a  co-operative  out-of-hours service.

The Panel was advised that the Department of Health and Social Services had undertaken Public consultation at the behest of the former Policy and Resources Committee.

The  Panel  noted  that  the  Department  of  Health  and  Social Services had contacted the following groups directly as part of the consultation on the new out-of-hours service:

Citizens Advice Bureau

Age Concern Jersey

Hospice Care

It further noted an apparent contradiction to advice received from

Mrs D. Minihane that Age Concern had not been approached for

its view on the co-operative service. The Panel agreed to write to CA/WM Age Concern for clarification on this matter.

The  Panel  noted  it  would  need  to  consider  the  potential implications for the co-operative service of Health and Safety at Work (Jersey) Law 1989.

[20/03/06, 10. Income Support

Item 6] The Panel noted the Income Support Sub-Panel would next meet

on Friday 7th April 2006.

The Panel was advised that the Sub-Panel would consider the use of an adviser for the Income Support Review. The Panel noted  the  Sub-Panel  would  need  to  seek  the  Panel's endorsement to use its resources. It further noted the following provision under Standing Order 139 (3):

A scrutiny panel may not allocate any of its resources to a sub-panel  without  the  agreement  of  the  chairmen's committee.

[19/12/06, 11. Media Contact

Item 2] The Panel noted that recent comments made by the Chairman

relating  to  the  Minister  for  Home  Affairs  had  been  correctly reported in the Jersey Evening Post as his personal opinion and not the collective opinion of the Panel.

The Chairman requested that Panel members make it clear when speaking  to  the  media  if  an  opinion  expressed  were  their personal opinion.

12. Draft Strategic Plan

The Panel noted a request from the Chairmen's Committee for

each Scrutiny Panel to consider the Draft Strategic Plan 2006-

2011. It noted a further request that its comments on the Draft

Plan be ready for the Chairmen's Committee to consider at its

meeting on 20th April 2006. The Panel noted that a presentation

on the Draft Plan would be given to States Members on 11th

April 2006. The Panel agreed to meet on 12th April 2006 to

consider  its comments on  the  Draft  Plan. The Officers were CA/WM requested to make the necessary arrangements.

13. Budget

The Panel noted the quarterly budget update.

The Panel was advised that no consideration had been made in initial  budget  allocations  for  2006  for  the  appointment  of  an adviser for the Income Support Review.

14. Scrutiny Road Shows

The  Panel  endorsed  the  decision  made  by  the  Chairmen's Committee that a Public Meeting for Scrutiny would be held every six weeks. It noted that the Chairman of each Scrutiny Panel would attend the meetings but that other members of the Social Affairs Scrutiny Panel would be able to speak on matters for which they had been given lead responsibility. The Panel further noted that it would be able to hold Public meetings in its own name.

15. Topic Proposals

[20/03/06, a) Legitimacy Law

Item 9a] The  Panel  was  advised  that  the  Corporate  Services  Scrutiny Panel had received a Proposal Form suggesting amendments be

made to Legitimacy (Jersey) Law 1973 but had had agreed to defer a review of this subject as it felt the matter was being addressed elsewhere. The Panel requested clarification on who

was undertaking work that might address concerns raised in the CA/WM Proposal Form.

b) Completion of Proposal Forms

The  Panel  agreed  that  Deputies  D.W.   Mezbourian  and  A.E. DM/AP Pryke would consider the Proposal Forms if they were able to do

so. It further agreed that consideration of Proposal Forms would

be placed early on the agenda for 18th April 2006. CA/WM

16. Forthcoming Propositions

The Panel agreed that it would not seek to review the following proposition:

• P.33/2006 – Higher Education top up' fees – payment by the States

The Panel agreed it would not seek to have the following proposition referred to it under Standing Order 72:

• P.25/2006 – Draft Housing (General Provisions) (Amendment No.24) Regulations 200-

The Panel noted that Senator T.J. Le Main, Minister for Housing, had indicated the following proposition would be withdrawn. The Panel agreed that it would ask for this proposition to be referred to  it  under  Standing  Order  72  if  the  proposition  were  not withdrawn.

P.19/2006 – Draft Housing (General Provisions) (Amendment No.23) Regulations 200-

17. Questions to Ministers

The  Panel  was  informed  the  Chairman  would  ask  the  Chief Minister to expand upon comments he made at a meeting with the Corporate Services Scrutiny Panel.

The  Panel  requested  clarification  of  the  rota  for  Ministers  to CA/WM receive questions without notice.

18. Future Meetings

The  Panel  noted  that  the  next  meeting  would  take  place  at 9:30am on Tuesday 18th April 2006 at Trinity Parish Hall .

Signed Date ..

Chairman, Social Affairs Panel