Prescription Charges - Eastern Good Companions Club - Transcript - 8 July 2013

Health, Social Security and Housing Scrutiny Panel

Prescription Charges

MONDAY, 8th JULY 2013

Panel:

Deputy K.L. Moore of St. Peter (Chairman) Deputy J.A. Hilton of St. Helier (Vice-Chairman) Deputy J.G. Reed of St. Ouen

Witness:

Care Manager, Eastern Good Companions Club

[15:31]

Deputy K.L. Moore of St. Peter (Chairman):

We will begin. We are recording this hearing so for the record we all have to introduce ourselves. We will start by doing that. So I am Deputy Kristina Moore . I am the Chairman of the Health, Social Security and Housing Scrutiny Panel.

The Deputy of St. Peter :

Thank you. We welcome members of the public and remind them that we have a code of behaviour, which is displayed on the board over there. So basically switch off your telephones and sit quietly until we are finished, and when we are done if you could leave quickly we would appreciate it. Thank you for attending. Yvonne, thank you for coming in to speak to us. We were very interested to hear really what your views are in general of this idea of reintroducing charges for hospital outpatients' prescriptions.

Care Manager, Eastern Good Companions Club:

A lot of our members are not very happy because they are elderly members and a lot of them do have an awful lot of prescriptions and they are worried that they will not be able to afford them. The way we have spoken to them, their concerns are ... some have even said that they would stop going to either their doctor or the hospital because they cannot afford it or it is like: "Do I have a prescription or do I have a meal?" because of the way some of their budgets ... a lot of them are on a fixed budget and they have to weigh things up with rent and everything like that. So they are really concerned because not only that, the thing is they have to pay a doctor's fee as well. They are just worried, is the prescription charges going to be reintroduced with their doctor's fee? This is the way they are looking at it as well. So they are very concerned of what is going to happen.

The Deputy of St. Peter :

We have just held a hearing with the Minister for Social Security and he says that he will not reintroduce a prescription charge for the community until it is decided as a result of the review of primary care, and that review is not going to conclude for at least another year, 18 months, so that is one piece of information. Do you think that would reassure your members?

Care Manager, Eastern Good Companions Club:

No, not really because they do not look long term because a lot of them are reaching that age and they do tend to worry an awful lot about what is going on and how that affects them. Then that affects their health. But, as I say, a lot of them have raised issues saying it could be a toss-up, a ballot, at the end of the day, prescription or food, either way you look at that.

The Deputy of St. Ouen :

Are you aware of any discussions or communication, letters, exchanges between the Health Department and your clients regarding this particular proposal?

Care Manager, Eastern Good Companions Club:

No. I mean, the first they really hear about it is on the news, either in the paper or on the T.V. (television), and then we bring it up as a discussion because we like to do topics and also sometimes Jersey Radio wants to hear our views and that is how we get hold of the information, by talking to the members. I would say if you really wanted their point of view come down and talk to them yourself. It will give you more understanding than me just saying what they are all about. If you could get the feel of how some really feel passionate about things, you would understand.

The Deputy of St. Peter :

Ordinarily if there is a consultation going on are your members canvassed for their opinions by the different departments, say, for example, when the Health Department introduced their Green Paper about reform of the health service, would they have been included in that consultation?

Care Manager, Eastern Good Companions Club:

As I say, they only get to know some of these things if the media wants their opinions or the T.V. wants their opinions. If they do a documentary about it then they turn to us for our members' views. Because a lot of them do not really understand what is going on. They can see the headlines about something and it scares them.

The Deputy of St. Ouen :

We are talking about obviously people with all different levels of income obviously.

Care Manager, Eastern Good Companions Club:

Yes, I mean we have different people who own their own properties to being States tenants and things like that.

The Deputy of St. Ouen :

So we are talking generally all ... did you say "all" or particular groups of your ...

Care Manager, Eastern Good Companions Club:

No, I mean I was talking to them again this morning to get some more views, if they had anything else, but the majority of them are not happy about it because they do think they pay enough at the doctors. Like in England, they do not pay for the doctor, they do not pay for their prescriptions and they are wondering why they cannot be like England. Reach a certain age, and then have all ... maybe you would fix a fixed rate on prescriptions, say, I do not know, £2 end of ... and that is across the board or their doctors' fees could come down. I mean you hear about doctors' fees, they are all different. I mean we know some people pay £30-odd and we know somebody else who only pays £5 to go and see a doctor. That is fact. But how can the doctor do that? I am not sure whether they are on a fixed level, like they should all be charging the same.

Deputy J.A. Hilton:

No, the doctors basically run ... they are private practices so it is up to them to charge what they want to charge. It is subsidised obviously by Social Security and they get that flat payment but over and above that it is entirely up to them what they charge.

Care Manager, Eastern Good Companions Club:

As I say, doctors are £36, some are £39, and then they are thinking that ... for their prescriptions are introduced a lot of them are on more than 5 different tablets a month so you put that to the doctors' bills that is an awful lot. Then they will be really worried about food, heating, prescriptions. It is a very big balance for them.

The Deputy of St. Peter :

Are you aware that there will be a prepayment certificate available to people who do have lots of prescriptions so that they would be able to pay a fixed fee of £100 for the year and they would receive all of their prescriptions?

Care Manager, Eastern Good Companions Club:

No, that has not been talked about. As I say, I mean, there is not an awful lot that we know about so we just talk about what is in the headlines and things like that. I mean I read about the exemptions and that does not really apply to a lot of our members, to be exempt.

The Deputy of St. Peter :

Let us just stick with the prepayment for the moment and we will move on and talk about exemptions in a moment, if that is okay. So do you think a £100 charge is a realistic sum for somebody who takes a lot of prescriptions every year? I think they can spread that out in £30 chunks as well over the year, if they do not want to pay £100 up front. Do you think that is a reasonable rate?

Care Manager, Eastern Good Companions Club:

Yes, that does not sound too bad for them. If they have got something that they can do like that they might look at it a bit better and sort their budget out a bit more, as well. As I say, everything is done to a budget. Because of a lot of them are underneath the hospital to start with, so when you see a consultant and they say to you: "You need this tablet for however long" and then they have got to go down to the pharmacy and it is £5 per item, that is an awful lot for that.

Deputy J.A. Hilton: It is.

The Deputy of St. Ouen :

Would you help us here: would you say that many of the individuals that you support only would access medication from the hospital, via the hospital pharmacy or would they be accessing other medication outside of the hospital?

Care Manager, Eastern Good Companions Club:

Well, a lot of them go to their own G.P.s (General Practitioners) and it is like a monthly prescription. What I am saying is though, some of them need to go to the hospital to see a consultant so if they are put on certain tablets, medication, then it is going to be £5 per item. I think that is what is getting them. Because they know it is £5 per item and it all depends how many items they have got to have.

The Deputy of St. Peter :

Now you were talking about exemptions earlier. Do you feel that there are enough exemptions being proposed?

Care Manager, Eastern Good Companions Club:

I have not really read about what exactly the exemptions are but, as I say, I do not know whether it would qualify any of our members at all to be exempt.

The Deputy of St. Peter :

It is generally people who are receiving a personal care component from Income Support or cancer patients, those prescribed for public health reasons, like tuberculosis, and also it is specific vulnerable patients, which we have yet to question the Minister for Health to understand what they mean, but it suggests here psychiatric patients.

Care Manager, Eastern Good Companions Club:

I was going to say, when you say "vulnerable" that is the way I would have read it as well. That does not exempt any of our members.

The Deputy of St. Peter :

Also those who have essential care, receiving assistance from Social Security.

Care Manager, Eastern Good Companions Club:

Yes, that is residential but we do not ... Eastern is just a day care centre so it is not a residential home.

The Deputy of St. Ouen :

I am interested there, what sort of category would your clients fit into? They are not obviously not to do with cancer treatment.

Care Manager, Good Eastern Companions Club: No, they are not. No.

The Deputy of St. Ouen :

What sort of medical condition are they likely to have?

Care Manager, Eastern Good Companions Club:

Some of them have had strokes. Some of them are on heart medication. An awful lot of them are diabetics. That is one of the main ones, is like diabetes, arthritis.

The Deputy of St. Ouen : Would it also include dementia?

Care Manager, Eastern Good Companions Club:

Some of our members have got slight dementia, so yes they are on medication for that as well. I mean because that is an ongoing thing. You cannot cure that at all. You can hopefully try and stabilise it but every individual is different with that.

The Deputy of St. Ouen :

Also, and excuse my ignorance, what about respiratory diseases and problems? Does that require a lot of medication?

Care Manager, Eastern Good Companions Club:

It does not in our field but I would say in residential homes and all that, yes.

The Deputy of St. Ouen :

Because one thing that has been said is with regards to residential care those that are on income support and who benefit from funding to help with their residential care will be eligible for this payment, but all others will have to pay. How significant do you think that will be for those that are currently in or will be moving into residential care to have that extra cost?

Care Manager, Eastern Good Companions Club:

Well, the majority of our members live at home or are State tenants. We have a few that come from the residential homes purely because they started off with us independently, and then they have gone into homes. Most of ours are, as far as we are aware, that they are all independent.

[15:45]

We do not really know too much about their financial background unless we have been made aware of it.

The Deputy of St. Ouen :

Do they discuss with you their concerns around the cost of residential care?

Care Manager, Eastern Good Companions Club:

Yes, and they think it is extremely high. At one point they were worried about, especially the people who own their own properties, they were worried that they would have to sell their properties to pay for their residential care.

The Deputy of St. Peter :

What do you think would encourage your clients to feel better about this policy if the States were to introduce it? What sort of exemptions would they like to see?

Care Manager, Eastern Good Companions Club:

I am not 100 per cent sure on that. This is where I would say you to come down and really talk to them and get the feel of what they are all about. As I say, I am only one voice and if you could sit down with a group and really talk, they would probably be able to tell you an awful lot more than what I can, because we talk but sometimes they do not tell you everything that they would like to say about a subject. But they are definitely not in favour of prescription charges at all. That is a big no. A very big no.

The Deputy of St. Peter :

For both the hospital and in the community?

Care Manager, Eastern Good Companions Club: Yes, especially. Yes.

Deputy J.A. Hilton:

Can you tell us how many members you have at Eastern Good Companion? How many people access your services there?

Care Manager, Eastern Good Companions Club: We have just over 250 people.

Deputy J.A. Hilton:

And you are open every day presumably?

Care Manager, Eastern Good Companions Club:

We are open 5 days a week, Monday to Friday. Also there are evening activities that go on as well.

Deputy J.A. Hilton:

Can you just tell me the age profile of your client base?

Care Manager, Eastern Good Companions Club:

The majority of them I would say now we have got some from their late 60s to, I think, our oldest member, he was 100.

Deputy J.A. Hilton: 100?

Care Manager, Eastern Good Companions Club:

Yes, we have had a couple of 100s. We have done celebrations. They do live to a ripe old age, I must admit. So it is varied. We have a couple of mature ladies but they have come to us because some things have gone wrong in their lives so they need us. They need to have the social side but normally we ... we do not put an age on it now. We used to, I think 55 or 50. But we do not put an age on it now.

Deputy J.A. Hilton:

So your members, can they come to the club every day if they choose to do so?

Care Manager, Eastern Good Companions Club:

Yes, we have got a couple that do come 5 days a week, and some 2 or 3 times a week. I mean we provide lunch as well.

Deputy J.A. Hilton:

Just to confirm: most of the information they get is from the media, either the paper or the radio, so probably the information is a little bit limited. It would help if it was better portrayed to them really.

Care Manager, Eastern Good Companions Club:

Yes, because then if somebody could say what is going on they can understand it more so than just reading it in a paper or 5 minutes on the T.V., that was more in depth with these stories and that.

The Deputy of St. Peter :

Would they welcome, do you think, a Minister coming along to talk to them about their new policy or plan and finding out their views?

Care Manager, Eastern Good Companions Club:

Yes. I mean you would get some shy ones that would not but still sit there and listen to all your views. I mean it is like being in a room like here. You get the quiet ones and somebody who would really speak. I think they would. Then we would have a more better understanding ourselves as well.

The Deputy of St. Ouen :

Do you think that people make a conscious decision to go to the hospital as an outpatient rather than see their G.P.?

Care Manager, Eastern Good Companions Club: No.

The Deputy of St. Ouen :

The reason why you say "no" is because ...?

Care Manager, Eastern Good Companions Club:

Our members are all under the ... we know they are under their doctors and they only ever said ... I mean if it was an emergency, like a heart attack or anything like that, then they would call for the ambulance but normally they go through the hospital through their doctor to see a consultant.

The Deputy of St. Ouen :

Just to help me here: doctor would refer a patient to the hospital where they would become an outpatient, would you class that?

Care Manager, Eastern Good Companions Club: Yes.

The Deputy of St. Ouen :

And they would be referred to it because they had a specific problem where they needed specialist advice?

Care Manager, Eastern Good Companions Club: Yes.

The Deputy of St. Ouen :

Then what happens? Do you know what happens next, sort of, roughly?

Care Manager, Eastern Good Companions Club:

They just go and see the consultant and whatever the consultant has diagnosed, if they need medication then they get the medication from the hospital. If it is an ongoing thing I am not sure whether they have to go back to see the consultant or they can get the medication, their prescription, through the doctor. I think it all depends on whatever is wrong with them.

The Deputy of St. Ouen :

Presumably a consultant, if they feel that their patient can be provided for, or the G.P. can provide the appropriate care, the consultant would send that patient back to continue that care within the G.P. environment.

Care Manager, Eastern Good Companions Club: Yes.

The Deputy of St. Ouen :

Not request that individual to return.

Care Manager, Eastern Good Companions Club:

Not unless it is absolutely necessary. If the consultant wants to see them maybe on a 6-monthly basis or then prolong it to like a 12-month, they might do it that way.

The Deputy of St. Ouen :

Are you aware if there are any specific medication or drugs that can only be accessed through the hospital?

Care Manager, Eastern Good Companions Club: I do not know that side at all.

The Deputy of St. Peter :

Thank you very much, Yvonne. That is very helpful. We would like to take you up on your invitation of coming to visit the Eastern Good Companions Club. We would be very happy to.

Care Manager, Eastern Good Companions Club:

Yes, any time. Just give us a ring and we can make the arrangements, morning, afternoon or whenever you would like to.

Deputy J.A. Hilton:

Generally speaking, when would the most people be there? Are there more people in the morning than the afternoon?

Care Manager, Eastern Good Companions Club:

No, because they normally come all day on a Tuesday, Wednesday, and I think you would benefit more probably on a Wednesday.

The Deputy of St. Peter :

We will close the meeting at this point. Thank you very much.

[15:52]