Health and Social Security Scrutiny Panel Government Plan 2023-26 Review

Witness: The Minister for Social Security

Thursday, 10th November 2022

Panel:

Deputy G.P. Southern of St. Helier Central (Chair) Deputy P.M. Bailhache of St. Clement (Vice-Chair) Deputy B. Porée of St. Helier South

Deputy B. Ward of St. Clement

Witnesses:

Deputy E. Millar of St. John , St. Lawrence and Trinity , The Minister for Social Security Deputy M.R. Ferey of St. Saviour , Assistant Minister for Social Security

Mr. I. Burns, Director General, Customer and Local Services

Ms. S. Duhamel, Associate Policy Director, Cabinet Office

[10:30]

Deputy G.P. Southern of St. Helier (Chair):

This is the first of 2 sessions we are going to run, the first one on the Government Plan for an hour, then break for 15 minutes and then come back on the second one, the normal quarterly hearing.

The Minister for Social Security: Quarterly hearing, yes.

Deputy G.P. Southern :

Okay. Can I just remind you that this hearing will be filmed and streamed live? A recording and a transcript will be published afterwards on the States Assembly website. For the purpose of the recording and the transcript, I would be grateful if everyone who speaks can ensure that you state

your name and role, and for anyone not at the table invited to speak. There is nobody today, although we had a full football team yesterday from Health, 11. I am glad to see we have less than that. We will introduce ourselves and then you can introduce yourselves. So, I am Deputy Southern . I am the Chairman of the Health and Social Services Scrutiny Panel.

Deputy P.M. Bailhache of St. Clement : Philip Bailhache , Deputy Chair of the panel.

Deputy B. Ward of St. Clement : Deputy Barbara Ward for St. Clement .

Deputy B. Porée of St. Helier South :

Deputy Beatriz Porée , St. Helier South and member of this panel.

Deputy G.P. Southern : Officers on the end?

Scrutiny Officer:

Sammy McKee , committee and panel officer.

The Minister for Social Security: Elaine Millar , Minister for Social Security.

Assistant Minister for Social Security:

Malcolm Ferey , Assistant Minister for Social Security.

Associate Policy Director, Cabinet Office:

Sue Duhamel, Associate Policy Director, Cabinet Office.

Director General, Customer and Local Services:

Ian Burns, Director General, Customer and Local Services.

Deputy G.P. Southern :

Thank you. I will start, to kick us off today, with something very straightforward, I hope. Minister, are you satisfied with the departmental budget proposed in the Government Plan 2023-26 and do you consider this sufficient to deliver key legislation and policy areas within your remit? If not, why not?

The Minister for Social Security:

Yes, I believe I am. I think we have budgets for income support that we think will meet our needs. I have not been told by officers that we have any issues with pressures on staffing or the operation of the department, so I do not have any reason to tell me that I should be concerned about the resources available to me.

Deputy G.P. Southern :

Okay. In terms of key policies, what would you say are your key policies?

The Minister for Social Security:

Key policies? Well, my key priorities are ... well, they are largely ministerial plan. One area that I am most concerned to review is the long-term care scheme, how it operates. It has developed or elements of the care sector have developed since it was introduced, and I think we need to review how it operates for certain providers, particularly the domiciliary care market, which that particular sector was in its infancy when the law was introduced and the law was ... sorry, if I am ...

Deputy G.P. Southern :

We will come to that at some stage.

The Minister for Social Security:

Okay. So, long-term care and particularly how we communicate it. I would like to look at all our benefits to make sure that they are ... there.

Deputy G.P. Southern :

Okay, we will come ... could I introduce Philip to ...?

Deputy P.M. Bailhache :

Yes. Minister, the panel has some concerns around the Health Insurance Fund and I want to put a few questions to you about that, if I may. The Government Plan proposes the transfer of an additional £12.4 million from the H.I.F. (Health Insurance Fund) for the purposes of the Jersey Care Model and associated digital schemes. In fact, a total of £22 million for 2023 and 2024. Do you think this is appropriate, given that we do not yet have the actuarial report which is due and the last one of which was as of 31st December 2017?

The Minister for Social Security:

Well, my understanding, Sir Philip, is that those amounts were actually agreed in a previous Government Plan. They will not be paid out without the approval of the States Assembly, that while there has been a decision to allocate those payments from the Health Insurance Fund actual

payment on a year by year basis has to come to the States annually for the States to approve. I cannot just say: "I am going to pay this money." The States Assembly has to approve it. I am not familiar with the rationale as to why that decision was made. I think it has to be considered carefully. I know the Minister for Health and Social Services is conducting a review into how we fund health in future, the economics of health funding, and I am sure that that review will take into account the Health Insurance Fund. You are quite right, I think there is an actuarial ... there is an actuarial review which has been instructed. I expect to see the draft report by the end of March and we will be able to publish the findings once we have considered the implications. We will be able to publish some of the findings in quarter 2 next year.

Deputy P.M. Bailhache :

Can you give some indication of when the actuarial report might be published?

The Minister for Social Security:

It will be there ... I would hope the early part of quarter 2 next year it will be published. I will see ...

Deputy P.M. Bailhache : Before June 2023?

The Minister for Social Security:

I would certainly hope so, yes. I would certainly hope so. I have made it very clear that I want to see the draft report before the end of quarter 1, because that was ... because we need to see that in a timely fashion. We will consider it with the Council of Ministers if need be. We will consider what the implications are for future use of the Health Insurance Fund and it will be published, I hope, in the early part of quarter 2.

Deputy P.M. Bailhache :

Right. On 14th December 2021 the States adopted an amendment of the previous Scrutiny Panel, which provided that the actuarial review should include specific analysis of the uses of the H.I.F. and consideration of the impact of all the withdrawals on the fund since 2020 and consideration of the future of the H.I.F. should withdrawals take place. Can you just confirm that those instructions were given to the actuary?

The Minister for Social Security:

I am going to have to ask an officer. Yes, Ms. Duhamel says yes.

Deputy P.M. Bailhache : They were given?

The Minister for Social Security:

I knew actuaries have been instructed.

Deputy P.M. Bailhache :

Right. When was he instructed?

The Minister for Social Security: Can you help?

Associate Policy Director, Cabinet Office:

Okay. So there is some preparatory work going on at the minute with some modelling work that needs to be done as a result of the 2021 census. That is under way at the minute with the U.K. (United Kingdom) Government Actuary and the U.K. Government Actuary will then carry on to do the review of the Social Security Fund and the Health Insurance Fund, which is the same as they did last time. Those instructions from the 2021 Government Plan will be absolutely included in their remit. So the contracts have already been signed but the work has not yet started.

Deputy P.M. Bailhache :

Okay. Minister, were you aware before the Government Plan was put together that your predecessor gave a commitment to the States in 2020 not to take more money from the H.I.F. before a sustainable health model had been agreed?

The Minister for Social Security:

I personally was not aware of that, but the sustainable model is being worked on. I think that all of these elements will have to come into the Minister for Health and Social Services' review. I know that we have ... I was not aware until very recently that payments have been made further ago. I thought payments had only been made very recently and I now know that payments were made in the early part of 2011, for some years in 2011 to 2015. I know that has happened previously. I know that there was a law made to allow payments to be made with the States Assembly approval from the Health Insurance Fund and that all withdrawals have had the approval of the States Assembly.

Deputy P.M. Bailhache :

Right. I appreciate that the Assembly has approved the ... has passed a law to that effect, but you were not advised by officials of this undertaking by the previous Minister, an undertaking by the previous Minister not to withdraw money from the H.I.F. before the sustainable funding model had been agreed?

The Minister for Social Security:

It was not something that we have specifically discussed but I have never had it in my mind that the Health Insurance Fund is just generally available for people to dig into. My understanding has always been that it is there for a specific purpose and that in recent years funds have been taken and contributed towards ... if I use my own language, they have been contributed towards the costs of the Jersey Care Model work that was already under way, where those costs were for developments that would enhance primary care in some way.

Deputy P.M. Bailhache :

My next question I think then is for the Director General. Director General, why was the Minister not informed of this undertaking?

Director General, Customer and Local Services:

Sir, I think the comment you are referring to is the previous Minister for Social Security in a debate. That at the time was the belief, that the first part of the Jersey Care Model would develop a sustainable funding model by I think the third quarter of 2021. That was the intention at that time when the Minister made that statement, in which case that would have obviously been in terms of timeline exactly right. That plan changed and that plan was changed and it was changed into the next Government Plan iteration. Things do change and in that case the order of which the health team would get ... J.C.M. (Jersey Care Model) would get to a sustainable funding model for health was moved further down the order of development. On that basis, obviously the previous ...

Deputy P.M. Bailhache :

I am sorry to interrupt but that is not really an answer to my question. The Minister, Minister Martin, was quite specific. On 17th December 2020 she said: "I understand the Deputy 's concerns. I do not share them because we will not be taking any more money out until we find that sustainable model. It will come back to the Assembly. It needs to come back to the Assembly and it will be amendable but it has to be done, as I said, before we can just carry on taking money out of the Health Insurance Fund." A very specific undertaking by the Minister and my question is: why was this Minister not alerted to the undertaking that her predecessor had given?

Director General, Customer and Local Services:

Because the point I was trying to get to was the next Government Plan, which was obviously debated in 2021, before this Minister, had a different plan in it. So the States Assembly agreed a different plan, so there was no need to advise the Minister of that because the plan had already changed. So, from that perspective, the States Assembly had agreed the Government Plan. The ordering of the Jersey Care Model activities had changed. I think this is well discussed, discussed at great length, in Scrutiny Panels, and sustainable funding was pushed out as one of those objectives. So, from that perspective, States Assembly ... we have obviously briefed the Minister on what the latest States Assembly had agreed, so from that perspective I think the Minister has been informed correctly of where we are today as opposed to where we were in 2020.

Deputy P.M. Bailhache :

I am sorry, can I ... is this right? The undertaking was given at the end of 2020. We had a debate, in fact, on 3rd November 2020 when the Minister for Health and Social Services said in his closing speech: "Yes, there is concern about we will not be in a position to debate sustainable funding but we are going to be working on a sustainable funding measure over the next 9 months and the commitment is to bring it forward in the 2022 Government Plan. That is what the proposition asks for. That is in the present Government Plan in a commitment to do so." So then we have 2 commitments from both the Ministers that in the 2022 Government Plan we would have the sustainable funding. Now, we know that that has not happened and I have not really had a very satisfactory answer from health officials as to why not, but anyway, we accept that is the position at the moment. But the undertaking remains, does it not, that the Health Insurance Fund, which was the subject of a law debated in 2021, was not going to be plundered any more without a sustainable health plan? It seems to me really important and I cannot understand why officials would not have drawn the attention of the Minister to this undertaking.

[10:45]

The Minister for Social Security:

Could I possibly add something? I think in fairness to the officials there has been no discussion with me as yet about making further withdrawals. My understanding is that we have paid ... in December 2020 it was agreed that funds could be withdrawn in 2021. Those were paid against actual spend, so funds were paid out for 2021 in 2022, and although the States have approved funding for the 2022 spend, that money has not yet been paid out because they have not yet confirmed to me what the spend was. I had my first meeting on this subject yesterday where I was given a vast amount of ... tables and tables of numbers and we have asked quite a number of questions, but that was the first meeting we have had. So there has not really been an opportunity. There possibly has not been an appropriate moment for the officers to say: "By the way, your predecessor made this commitment", but I do not think any commitment is being breached because whatever commitment was made in 2020 the States made a further decision in 2021 and my understanding is that it is that decision of December 2021 that we are still acting on. I have not been asked to commit new monies from the H.I.F., so that may be why we have not had that detailed discussion. But I am fully aware that monies have been taken from the H.I.F. because we have discussed some of the background to it as part of my education, if you like, into the department.

Deputy P.M. Bailhache :

Well, I am not sure that I would accept that an undertaking given by a Minister simply fades away because of another debate, because the commitment given in 2020 related, did it not, to the legislation that was passed in 2021?

The Minister for Social Security:

But the States ... I can only suggest that the States made the decision in 2021 in the knowledge of the commitment of 2020 and that, as Mr. Burns suggests, that somewhat superseded the undertaking. Because the States decided in 2021 to authorise the withdrawal of further funding, which is for ongoing work on the Jersey Care Model.

Deputy P.M. Bailhache :

It authorised funding for 2021 and 2022.

The Minister for Social Security: 2021 and 2022.

Deputy P.M. Bailhache : But not for 2023.

Associate Policy Director, Cabinet Office:

There has not been, sorry ... if I explain, yes, that has not been ...

Deputy P.M. Bailhache :

No, but the undertaking related to 2023 and 2024, did it not, to onward years?

Associate Policy Director, Cabinet Office:

So the Government Plan each year provides a one-year detailed plan, which is what you are approving, and then provides estimates for the following years, so you can see the kind of trajectory of things going forward. But the Minister brings forward a specific law each year or the previous Minister has taken forward a specific law each year only to release money for that following year, and then the next year you do it again. So there is only ... there has been no commitment whatsoever as things stand today for 2023 or 2024. It is written in the estimates to give people an idea of what is going forward in the future but you are not approving that as part of the Government Plan.

Deputy G.P. Southern :

That spend has not been authorised?

Associate Policy Director, Cabinet Office: That spend has not been authorised at all, no.

The Minister for Social Security:

No, it would have to come to the States Assembly.

Associate Policy Director, Cabinet Office: It has to come again this year.

The Minister for Social Security: By way of a law.

Associate Policy Director, Cabinet Office: Yes.

The Minister for Social Security:

Which is what has happened to previous payments.

Deputy P.M. Bailhache :

Yes. It is a pity, is it not, that the Government Plan, which simply states baldly that the Minister for Social Security will bring forward legislation to action a transfer of up to £30 million from the Health Insurance Fund did not refer back to this controversy as to whether any more money should be ...

The Minister for Social Security:

I think the £30 million has already been passed. The £30 million for 2022 has already been sanctioned.

Deputy P.M. Bailhache : No, this is for 2023, is it not?

Associate Policy Director, Cabinet Office:

But no money has been sanctioned for 2023 yet. Absolutely no money has been ...

The Minister for Social Security:

No, no money has been sanctioned and I have not been asked to sanction money for 2023.

Deputy P.M. Bailhache :

I am sorry, perhaps I am confusing myself, but this is the Government Plan that we are talking about now and the Government Plan says ...

Associate Policy Director, Cabinet Office: That is for next year.

Deputy P.M. Bailhache :

... at page 78 that the Minister will bring forward legislation to action a transfer of up to £30 million from the H.I.F. to support the J.C.M. and health digital care strategy project budgeted for 2023.

Associate Policy Director, Cabinet Office:

Sorry, yes, so this Government Plan, the one that is going to be developed for this year, will ...

Deputy P.M. Bailhache :

Yes, so my question is: why was it not thought appropriate to draw attention to the undertaking given by both the Minister for Health and Social Services and the Minister for Social Security in the previous Government and say: "We have considered this but things have changed, things have moved on"? Why was that not done?

Director General, Customer and Local Services:

As you quoted, both Ministers in 2020 committed that the sustainable financial health model would be completed in 2021 and that would be done before the next set of health insurance transfers were prepared. That plan changed and so both those Ministers were still in place in 2021 when they were also in the Council of Ministers who proposed a new Government Plan that the States debated, so that commitment in 2020 has been superseded by the debate in 2021 for the 2022-2025 Government Plan. So that is I think just bringing that to hopefully some clarity. The Ministers made a commitment. The Ministers then realised that the plan they had hoped to be executed was not going to be able to be executed and changed that plan and, therefore, changed that commitment and still brought forward proposals to draw money out of the H.I.F. that the States had agreed.

Deputy P.M. Bailhache :

All right. Well, thank you for that explanation. I want to think about it. I am not sure that I accept that. At a public hearing with the Minister for Health and Social Services earlier this week, we learned that she was intending to bring an amendment to the use of the H.I.F. for funding the Jersey Care Model following the publication of her Jersey Care Model review. You have had discussions with the Minister for Health and Social Services about this?

The Minister for Social Security:

Not directly, no. I had one meeting yesterday which ... it was a preliminary meeting and involved lots of numbers being on the table but we need to have much ... we need to have a further discussion. The Minister for Health and Social Services was not at that meeting.

Deputy P.M. Bailhache : Okay. Well, I am ...

The Minister for Social Security:

So I think that is a discussion which has to take place and I think I agree, personally I agree with the Minister for Health and Social Services that we do need to look at how we fund healthcare in the Island and whether our models are really fit for purpose, modern and are really serving the Island well. But I think the Minister for Health and Social Services really has to lead on what the healthcare model looks like and then how we fund it, and that work is still under way, I believe.

Deputy B. Ward :

Chair, if I could just say ... especially if things have changed, because now the Jersey Care Model has paused and has been paused since July this year and we still have not had figures of why more money is still being used when you have a system that has been paused. We are waiting for that information. I do not know whether you are aware of that.

The Minister for Social Security:

From my discussions yesterday I believe that while some things have been ... the overall project, shall we call it, that has been paused for review. However, there were work and projects already under way that have continued. So those projects have continued so there has been continuing spend over this year on some of those projects. Now, I cannot tell you off the top of my head because, as I say, there was a huge amount of information and it was mostly tables of numbers. So there has been some work ongoing, I think possibly in terms of I.T. (information technology) developments. I genuinely cannot remember which elements of projects have been ongoing. So it has not just ... it is not just a case that everything has stopped. Some work has continued in the background while the overall project model is being considered.

Deputy B. Ward :

We have seen a list of the I.T. stuff and it is nearly all in-house hospital. It is nothing about community.

Associate Policy Director, Cabinet Office:

I think at the meeting yesterday the point was made that where funds have been used to improve patient services it would be inappropriate to remove those services, having just introduced them, so those services are ongoing. So there is continuing spend from those services.

Deputy G.P. Southern : Spend from the H.I.F.?

Associate Policy Director, Cabinet Office:

So the money that was allocated has not been transferred from the H.I.F. yet because nothing gets transferred until you have seen ... everybody has seen the papers and signed them off, yes.

Deputy G.P. Southern :

But the intention is to use the H.I.F. money to do that?

Associate Policy Director, Cabinet Office:

For some ... to support some patient-facing services, yes.

The Minister for Social Security:

It is the money that has already been sanctioned for 2022.

Deputy G.P. Southern :

Can I move us on because we have spent 20 minutes on this?

Deputy B. Porée :

Minister, this is with reference to the long-term care funding. The chair of Jersey Carers Association recently voiced her concerns regarding the funding currently available for those receiving long-term care support, particularly in light of the cost of living crisis. We are aware that a review of the scheme is due to be carried out in 2023. Have any conversations taken place with the Jersey Carers Association regarding their own concerns?

The Minister for Social Security:

I have met directly with 2 providers. I have met with a provider of residential care who have expressed their concerns about the cost of living. I have met with one of the smaller homecare providers, who have also made their concerns very clear to me. So I do understand that. We have had discussions, and we must just check on announcements, but we have had discussions about increasing the rates for long-term care. I should be able to announce those ... those will up rate in January, but I have asked to be able to announce what those uprates will be very soon. Hopefully, those will make some difference because people will see that they are having increases to rates that will reflect some of the current pressures.

Deputy B. Porée :

Thank you for that. What about in terms of short-term support to help carers and care agencies to navigate the cost of living crisis prior to the long-term care review being completed? Has any consideration been given to that?

The Minister for Social Security:

I think it is difficult just to pull something out of the bag without a full understanding, without just saying: "We will give you something." We will make the uprate and I just ...

Associate Policy Director, Cabinet Office:

I think you are talking about short-term measures, so the uprate the Minister is talking about will take place in January.

The Minister for Social Security: Yes.

Associate Policy Director, Cabinet Office:

So that is before the review, so I think that is what you are asking for. Is there some short-term issues? Yes, there are, yes.

The Minister for Social Security:

So there will be an increase from January in the amounts of money they receive and ... my mind has gone blank. I think I would rather wait until we have the announcement ready to tell you what the uprate is going to be.

Deputy G.P. Southern :

Does that extra money reflect R.P.I. (Retail Price Index) or not?

Associate Policy Director, Cabinet Office:

The Minister is going to make her announcement in due course.

The Minister for Social Security:

I will make an announcement in due course. I will be making an announcement. There is work on that and clearly it would be inappropriate just to tell you that until the announcement has been made properly.

Deputy G.P. Southern :

Okay. When is the announcement likely ...

The Minister for Social Security:

I hope very soon. We had discussions a couple of weeks ago and then someone went on leave and I realise that we have not picked it up again. Because I have asked for that announcement to be made as soon as possible, so I will be seeking to make that announcement as soon as possible.

Deputy B. Ward :

Minister, moving on to the period products under the 100 Day Plan, we understand that the pilot scheme to produce free period products to Islanders has been launched. Have you had any feedback to date from that?

The Minister for Social Security:

Not directly, no. I know that the products are available. They are available in the 2 libraries, town and up at Communicare, the C.L.S. (Customer and Local Services) building, and I saw them. I was taken into the public ... the ladies ... it is not just the ladies' facilities, they are also in the men's facilities so that if you have a male carer or a father, a single father, they can go in and collect them as well. So, that is across all the supply points, if you like, for want of a better word. So they are available. I think some of the foodbank providers, so Salvation Army, certainly received a big delivery. They have told us they received a delivery. I have not received direct feedback, but in conjunction with the rollout we have also launched a full consultation. Again, I would encourage anyone to participate in that consultation. The point of the consultation is really for people to give us their views on what products they would like and how they would like them delivered or supplied. I am very keen on finding a mechanism where they could be delivered to people rather than people having to come into town or go somewhere to collect them. We have spoken to a couple of people about how that might be achieved using existing mechanisms that are already there. So the consultation will be a very important part, but the provision will continue and the consultation will help us model how that works going forward.

Deputy B. Ward :

Okay. In some ways you have answered my second question in response to the first, but thank you for that, Minister. Was there any consideration given to removing the G.S.T. (goods and services tax) on period products in tandem with the proposed scheme for those who purchase period products from their local shop?

[11:00]

Because you go into Boots, and you have heard on the media, maybe because people have misunderstood, they think: "Oh, they are free." No, they are not and there is no G.S.T. been removed either.

The Minister for Social Security:

I do think we need to work on the communication. They are free in cases of need, where people need them, and part of the big ... one of the main drivers around this initiative is about period poverty. It is about that women and girls and other people who cannot ... we cannot allow people ... it cannot be right that people cannot leave their house or to go school or work or education because they cannot afford, so it is really about affordability and making sure that women who need them have access to them. The G.S.T. element, I think the view was that making them free in cases of need was better than removing G.S.T. because G.S.T. would take pennies off rather than ... is it better to have a free product than have a product that would have been £1 but is now 95 pence? I think the issues with removing G.S.T. are that some of the concerns around it previously, that had previously been expressed, were that taking the G.S.T. would not be helpful because of the cost of administering a product without G.S.T. So I think the providing free, if the main driver is affordability and access, giving a free product is better than simply removing the G.S.T.

Deputy B. Ward :

Has any consideration been given by yourself and the department to include incontinence pads and maternity pads in this scheme going forward?

The Minister for Social Security:

Not at this stage, although it is something that has been raised with me. I think there is some learning to be done around period products in terms of delivery and demand. Incontinence products I think are a different beast almost in the sense that ... not a beast, it is a different demand, a different demographic. So we would need to do some quite careful research into that, but the Minister for Health and Social Services and myself have both been approached about that. I think it is something that will have to be given consideration in due course, but I can say no more than it has been raised with us as an issue of which we will be giving consideration in due course.

Deputy B. Ward :

Yes, because you have the 1,000 births approximately, 1,000 births each year. Not every woman has flooding afterwards but the maternity pads are different to your period ones and they do need that support. Sometimes it is looking at incontinence pads to help the women manage that because, obviously, they are having to look after their little ones and it is a very difficult time.

The Minister for Social Security:

Absolutely, and, of course, Deputy Ward , the issue with incontinence is it is not just women.

Deputy B. Ward : Oh, true.

The Minister for Social Security:

One of the people who has made representations to me is a man who has told me about the ... he has not given me details of the cost but he has said, so that is why I am saying there is a different demographic on the subject of incontinence and we would need to understand. We are absolutely aware and I absolutely foresaw this being an issue as soon as we started issuing free period products that this would be the next question.

Deputy B. Ward :

Yes, because there is a difference between the pads and the pull-up ones.

The Minister for Social Security: Yes, absolutely.

Deputy B. Ward :

Yes, there is a different ... well, massive cost.

The Minister for Social Security: Yes.

Deputy B. Ward :

So if these products are to be included, would you say that the amount of funding that you have requested from the Government is going to be sufficient?

The Minister for Social Security:

Well, I did not say it would be included. I said we would consider it and I think there has been no request for funding. We have a pot of money which we believe will meet our costs on period products. We have not, I believe, even begun to estimate what the cost would be of incontinence products. If we were to provide incontinence products, I believe - I am sure Mr. Burns will correct me if I am wrong - there would have to be a business case and a funding bid for that.

Deputy B. Ward :

So we are running a pension scheme. Has this been put to the actuary? Because if you are introducing or taking monies out of the Social Security Pension Fund, then there will be a cost attached to that and they need to be aware.

The Minister for Social Security:

I do not believe it would come out of the pension fund because it may not be addressing pensioners' issues. Relatively young people have issues with incontinence so I do not believe the pension fund would be funding incontinence products. That would be a separate benefit.

Deputy B. Ward :

The Social Security Fund, yes, whatever.

Director General, Customer and Local Services:

This currently is coming out of what we would describe as tax-funded revenues, so it is not coming out of the Social Security Fund or the Health Insurance Fund or the Long-Term Care Fund. It is coming out from general tax revenues.

Deputy B. Ward : Right, central, okay.

The Minister for Social Security:

Yes, and incontinence products I would anticipate coming out of the tax-funded so we would have to bid.

Deputy B. Ward : Thank you, Minister.

Deputy G.P. Southern :

Barbara, does that encompass question 13 as well or do you want to come back on that?

Deputy B. Ward :

I might as well take it now, yes, if you would like, Chair. It is about free medical dressings. I know you are aware how I feel.

The Minister for Social Security: Yes.

Deputy B. Ward :

We asked this question to the Minister for Health and Social Services. It is about when people are out, they have long-term dressing needs and it is prescribed treatments for those leg ulcers, pressure sores, whatever. It is not just older persons. There may be some younger people.

The Minister for Social Security: Absolutely.

Deputy B. Ward :

Those prescriptions are not regarded under the H.I.F. to be funded where it is if you go in for tablets or whatever, you get them for free. But for some unknown reason they seem to have slipped through the net. Why can we not be using these prescribed dressings ... the medical treatments for these ulcers be treated as free? Because at the moment there are people who are having to spend hundreds of pounds each month. Can something be done? Are you looking at this?

The Minister for Social Security:

I am aware it is an issue. I think there are some concerns about simply adding dressings to the prescribed list. I think there may be other ways of ... and again, I think this would be a bid for new money, but myself and the Minister for Health and Social Services are aware that there is an issue around dressings. It seems to me, as you say, a very long-standing, historic issue. I do not know, Deputy Ferey , do you have anything else to add to that?

Assistant Minister for Social Security:

Yes. So just to add some clarity from Monday's meeting, for people on low incomes, income support special payments are available for people who have needs such as medical dressings or other medical long-term needs. So for people on low incomes there is that protection there. Obviously, the income support special payments were changed a number of years ago but medical requirements were not part of those changes.

Deputy G.P. Southern : Is that as a grant?

Assistant Minister for Social Security: It is as a grant, yes.

Deputy G.P. Southern :

Are the public aware that this service is available?

Assistant Minister for Social Security:

Part of the communications is that we allow people to get a good understanding of all the benefits that are available to them and that will be part of the communications going forward.

Deputy G.P. Southern :

Are you sure that is happening?

Assistant Minister for Social Security:

That is what we plan to do going forwards, Chair.

Deputy B. Ward :

Because there are people immediately who need that help now. One parishioner that I am involved with since July has been paying £300 a month. It is ridiculous. Do I get her to send you the bill?

Assistant Minister for Social Security:

If it is an individual's circumstances perhaps we can talk that outside of the meeting.

Deputy B. Ward : Okay. Thank you.

The Minister for Social Security:

I would say it is probably not isolated. I am aware of young people who have ... a young person who has issues with dressings, so again, it is something we are aware of and that it will need consideration and possibly a growth bid or a funding bid, whatever we call them now, to get more money.

Deputy B. Ward : Thank you.

Deputy G.P. Southern :

A starting point for that might be the pilot scheme that was run 2 or 3 years ago, I think, about this issue in terms of bandages.

Deputy B. Ward : Health did that.

The Minister for Social Security: That was Health, yes.

Deputy G.P. Southern : Could we move ...

The Minister for Social Security:

It is one of the things that seems to cross 2 portfolios.

Deputy G.P. Southern : Indeed.

Deputy B. Ward :

Yes, and that is what came out on Monday. It is why we have raised it again.

The Minister for Social Security: Yes, so where it sits really, yes.

Deputy B. Ward : Thank you.

Deputy G.P. Southern :

Turning to the Government Plan and the 100 days cost of living support, in response to a recent letter from the panel you advised that details of the cost of living support scheme will be announced before the end of 2022 and that at this stage you are unable to advise how many families would benefit from the scheme. How has the figure of £400,000 been calculated without knowing how many individuals might need support through this mechanism?

The Minister for Social Security:

I think I may need officer support on this. I believe the £400,000 was an available budget and it was probably based on what we are aware of in terms of our experiences in the pandemic supporting people for under 5 years ...

Director General, Customer and Local Services:

Yes, so we are currently doing the analysis and designing the scheme and so we can come back to the Minister to make a recommendation on a proposed model. The Minister has said she would like to communicate this before the end of the year and to ensure that payments can be made in January. We are trying to work on options at the moment and that does include an analysis of what we know. Of course, for this particular benefit this is also about families ... this is targeted at families who have children and the family has been here less than 5 years. There is a slight unknown here. There has been previous comments made that we perhaps do not know as a Government or are not aware of

all the children who might be on-Island and so there is an element of estimate and forecasting in that that is a bit of an unknown. So that is what we are trying to work through at the moment, but we are trying to work from a base of what do we know and what might there be on top of that to work out how much money might be available to each family or to each child.

Deputy G.P. Southern :

Do you believe that the £400,000 is the right figure to be ... is that likely to be in the ballpark of where you are looking?

Director General, Customer and Local Services:

I think at the moment that is a number which should allow us to be able to pay some money to families and also administer it. There is indeed the design of the scheme and the administration included within that, so it should be sufficient, yes.

Deputy G.P. Southern : Right, so where are we now?

Deputy P.M. Bailhache : Fourteen.

Deputy G.P. Southern :

Oh, yes, down to me. I was waiting for somebody else to speak. What funding pressures face the services under your remit and are they being addressed by the proposals contained within the proposed Government Plan and, if so, how?

The Minister for Social Security:

By funding pressures do you mean are we being asked to make efficiencies?

Deputy G.P. Southern :

The word "efficiencies" was about to pass my lips, yes.

The Minister for Social Security: I do not believe we ...

Director General, Customer and Local Services:

C.L.S., which obviously operates slightly more services than just the Minister's, has a £67,000 figure to deliver next year, which I am very comfortable we will be able to deliver from minor adjustments to non-staff budgets.

Deputy G.P. Southern : To, sorry, again?

Director General, Customer and Local Services:

To non-staff budgets, so things that ... obviously staff are our key resource and also one of the largest costs of the department, so in addition to that we have obviously other non-staff expenditure and £67,000 is an amount that we can look to remove small amounts of budget from a number of different budget codes where we perhaps are not spending as much because we have an ongoing programme of trying to do things better. I am very comfortable that we can find £67,000 across all our budgeted expenditure.

Deputy G.P. Southern :

Whereas "efficiencies" was the word in the last Government Plan, I think the phrase being used on this Government Plan is "value for money." So what value for money savings have been identified, if any, from the policy services areas under your portfolio?

Director General, Customer and Local Services: It is the £67,000.

The Minister for Social Security: The £67,000, yes.

Director General, Customer and Local Services:

That is what is in the Government Plan under that heading.

Deputy G.P. Southern :

Okay. When those business cases were put forward, what requirements are in place to, in effect, make sure that they actually cover staffing issues as well as non-staff issues?

Director General, Customer and Local Services: You mean the business cases for the growth bids?

Deputy G.P. Southern : Yes.

Director General, Customer and Local Services:

For example, period products, that includes money there to set up the scheme in addition to the actual cost of the products. So we have built that into the business case for period products. The other business cases are around Beresford Street Kitchen and Women's Refuge and there is no staff costs for Government in those. I think the only other one was the old age ... sorry, the older persons forum.

The Minister for Social Security:

The older persons forum, yes. We did not have very many growth bids, but equally we ... obviously, Mr. Burns knows more, but I have not had someone coming and saying: "You must go and make all these savings." So as far as I am concerned we have the resources we need to keep doing what we are doing.

[11:15]

Deputy G.P. Southern :

The old persons forum, could you tell us something about that? What is that intended to do or deliver?

The Minister for Social Security:

It really is intended to make sure that we have input from older people in terms of our policymaking across Government. It will principally, I believe, sit in C.L.S. or in my area. There was a launch event a few weeks ago, which was held at Age Concern, which is a really great facility. It was really good to go and see that. So we did a launch there. Government as a whole are running more of the closer to home events, which hopefully will enable older people and anybody really to go to the parishes and other venues and have information about Government support, the charitable sector, any organisation that can help them. There is a meeting of an older person ... there is a terms of reference and a format has been drawn up. The older persons forum I believe is all people who are over 65 and they will meet for the first time, I believe, on 30th November. I do not know what is on the agenda for that meeting, but there is a scheduled meeting on 30th November and they will meet on a regular basis. I have seen the terms of reference. I cannot remember how often they are going to meet. Is it quarterly perhaps?

Associate Policy Director, Cabinet Office: I think it is every 3 months, yes.

The Minister for Social Security:

Every 3 months, yes. They will meet quarterly and we have a budget for people to come in to support people to get their teas and biscuits, sandwiches possibly, I do not know. But we have a ...

Director General, Customer and Local Services: I think it is £25,000, I think.

Associate Policy Director, Cabinet Office: Yes, it is just a small ...

The Minister for Social Security:

It is not a huge amount of money, no.

Director General, Customer and Local Services: For that and a bit of secretariat support.

The Minister for Social Security:

Yes. That will come from the department.

Deputy G.P. Southern :

If I can just return to the cost of living support and those who have not been here for 5 years, what have you got in place to reach to those people who might not have English as a first language, a different culture? That has always been a problem with delivering services: how do we get to the people who need those services?

The Minister for Social Security:

Absolutely. Every time I meet an agency I say to them ... they will say: "We have an issue with people who have been here ..." For example, I will not name names, you might meet a sector who will say: "We are seeing people who are under 5 years." I will say: "Well, how many? How many are there? How do you know? Where do we find them?" We have spoken to some of the foodbank providers and said: "Can you help us?" So we are using all of those agencies and bodies who have connections with the under-5-year sector to try and reach them and to make sure that we are dealing with language issues. So people like the Salvation Army, Caritas, these people, the Grace Trust, we regularly speak to them and say: "People under 5 years, can you spread the message?" as well as the charitable and voluntary sector. I am sure that the department are doing their own research as well.

Director General, Customer and Local Services:

Yes. There is a crossover particularly with that benefit potentially with the international cultural centre because there is obviously a very wide-ranging group of people involved in that. The launch of that steering group could be very helpful in helping promote this benefit, but there is also obviously

community groups we already are in contact with who we will be able to promote this via, or even to the people we have on our database directly and so on. We are still designing that but there is an obvious crossover with - I think some of you are involved in that - the international cultural centre. So it may not be quite timed perfectly but hopefully there is a crossover we can leverage to make sure that no one misses out.

Deputy B. Porée :

Can I just add to that? Obviously, I did hear what you are saying and the fact that there are different centres, different places where people can reach out for information and support, from what I understand, and you are still trying to find out where these people are, which it makes I suppose your work more difficult in a way to really assess which people need ... are there to access that support you are trying to give. I know especially this question is for the Minister. We have been there before and I am sure I have asked that question. Logically, we have the Customer and Local Services. That is where everyone needs to go to pay their contributions and to deal with anything that is a legal matter in terms of accessing work and benefits. My question is: have any plans been formed to open the Customer and Local Services store full-time so people can access ...

The Minister for Social Security:

It is open full-time. It has been open full-time for a long time.

Deputy B. Porée :

Thank you for that. Although you do say it is open full-time, it is not open as it was prior to the pandemic. If I may just finish that, I do have continuously people in the community coming to tell me, sometimes in tears, how stressful it is right now to access that support. When you say the door is open, and we have just mentioned in terms of people as English being their second language, when they go to Social Security the support is not there. What they do get signposted is to a telephone where they should access the services. To ring somebody on the telephone you are still going to have that barrier of language. Although it is open, it is not open as it was prior to the pandemic and I think that is a big thing that is being missed by Social Security. It is looking into the needs of people who need to access the services and how important that organisation is.

The Minister for Social Security:

I think that is an operational matter which Mr. Burns can probably give you more details on. I believe the door is open. We could go there right now and the door would be open.

Deputy B. Porée : Of course it is ...

The Minister for Social Security: It has been open.

Deputy B. Porée :

... but not to offer the services that people need to access.

Director General, Customer and Local Services:

So the Minister has asked us to ensure by the end of the month that in addition to appointments that we currently operate, which is very convenient for many people, that we also operate a walk-in for most of our services. There are some services that ... long-term care, for example, the complexity of it, you would need an appointment there anyway. But for other services that we have a walk-in service that perhaps we would consider to be similar to before. Of course, things have changed in the last 2 years and many of our services now are online and are easy to translate online, but not everyone likes that. So that is why the Minister has asked us to ...

Deputy G.P. Southern :

Some people sitting round this room.

Deputy B. Porée :

Sometimes it is not about liking, it is about having the skills to access those services.

Director General, Customer and Local Services:

Yes, indeed, and that is why they would not like it. The Minister has asked us to have that in place by the end of the month and that is what we are currently working on.

The Minister for Social Security:

However, I would say, Deputy Porée , if you do not mind, that I really would appreciate it if States Members did not say La Motte Street is closed because it is clearly not closed. The door is open. It is open between ... what time does it open?

Director General, Customer and Local Services:

8.30 to 5.00.

The Minister for Social Security:

It opens from 8.30 to 5.00. The door is open, and I accept your point that some people may struggle with the services there but as a matter of fact the door is open. People will be able to drop in. They can go in. They can go in and speak to someone. I take your point that there may be some people with language difficulties who will not find a speaker there at the point they go in, but the door is open and there are people in La Motte Street who work very, very hard to provide good customer services. It is really not helpful if the message they are hearing from States Members is that the door is closed. If you have a service issue, I accept that, but I really would ask that States Members do not continue the idea that the door is closed because it is not.

Deputy B. Porée :

So it would be fair to say, then, that there is no intentions to open as it was prior to the pandemic? This is where we are at?

The Minister for Social Security:

What is missing prior to the pandemic? I do not ...

Deputy B. Porée :

Prior to the pandemic, we would go into Social Services, Customer and Local Services, you would address yourself to the front desk and specify what issue you had. You would take a ticket. You would sit down and you could see the person, the support there for you straight away. What we have now, the doors are open but, as you have mentioned, 8 or 9 until 5. When a person accesses the services there will be one officer at the door with a screen, so a person on its own who comes to access the service will approach that desk and will relay to their services and they ask to go and sit on the telephone to book an appointment. So it is not there as an open door access service, which means that people will have to go home and sit on a computer. A lot of people need to find somebody else to support them in that application.

The Minister for Social Security:

Yes, I accept that and that is what Mr. Burns has just said. From the end of this month people will be able to go back in and sit, but what we have been trying to do, what the department have been trying to do, is enhance customer experience. Because what is not helpful is for ...

Deputy B. Porée : It is not working.

The Minister for Social Security:

Well, for many people it does. For many people it is a better experience. If you go in, let us say you walk from one end of town to La Motte Street and say: "I have a question" and they say: "Well, you need to bring in this paperwork", they have to go away, get the paperwork and come back. Whereas if you phone: "This is what I need to do" and they say: "Come in, bring the paperwork with you." It can be a more effective experience. So we are trying to make it a better experience. I accept your point that some people, the phoning, the online is difficult, which is why we are going back to offering

people the ability to just go in and sit and wait and to have to go away and come back if that is the way they need to do things. We are going back to that but we are trying ... a lot of what we have done, there is a lot of things have gone online and I absolutely accept some people do not do online, but there are people, working age people, for whom filling in an online form is much more effective. They get what they want. You can get your registration card very quickly. You can fill in change of circumstances forms online. It is dealt with more efficiently. We do not have documents going astray. So there have been very many changes that do help a very big number of customers, but I do accept your point that there are some customers who do not benefit from those changes and we are doing our best to provide a service to those customers.

Deputy B. Porée :

Thank you for that, Minister. I suppose we will just have to see what happens further down the line, but I do believe you are making ... people, the most vulnerable, are missing out on that service, but I do accept your reply. Thank you for that.

The Minister for Social Security:

We are addressing that. We are trying to address that, yes.

Deputy P.M. Bailhache :

Minister, this is our first meeting with you, I think, and I know I would speak for the Chair and for the others as well in expressing the hope that we are going to be transparent with each other during the course of the next 4 years.

The Minister for Social Security: Absolutely.

Deputy P.M. Bailhache :

On that basis, I think it will be obvious that we have concerns about the withdrawal of money from the Health Insurance Fund.

The Minister for Social Security: Absolutely, I have heard that.

Deputy P.M. Bailhache :

Either a Member of the States or the panel will bring an amendment to the Government Plan in order to withdraw the proposed transfers to the Consolidated Fund from the H.I.F. that are planned for 2023 and 2024. I just thought I would tell you that for the avoidance of doubt.

The Minister for Social Security:

Thank you, no, that is valuable to know. It is a matter for the Assembly. I do not feel strongly about money ...

Deputy G.P. Southern :

At this stage I have to say that remains ...

The Minister for Social Security: What is important to me is ...

Deputy G.P. Southern :

... likely rather than otherwise, likely.

Deputy P.M. Bailhache : Likely, okay.

The Minister for Social Security:

I think the important thing is that the H.I.F. is used for its intended purpose, which is to support primary care, and if anybody wants to take money from the H.I.F. then it seems to me that they have to be able to persuade the States Assembly it is for support of primary care.

Deputy P.M. Bailhache : We did get the impression ...

The Minister for Social Security:

That is what I believe has ... the purpose of the previous withdrawals have been.

Deputy P.M. Bailhache :

... from the Minister for Health and Social Services that the H.I.F. has been used for a fairly liberal interpretation of what the law actually allowed.

The Minister for Social Security:

I cannot possibly ... well, I cannot comment.

Deputy P.M. Bailhache :

No, I am not asking you to comment.

The Minister for Social Security:

Deputy P.M. Bailhache :

I am telling you the impression that the panel got from discussion with the Minister for Health and Social Services.

Deputy G.P. Southern :

Basically, without sustainable funding in place, i.e. some sort of way forward for delivery of primary care, we are in a poor state because our primary care deliverers are running out of (a) money and (b) patience in terms of what service are we delivering and is that service respected. Because we have problems all down the line, I think.

The Minister for Social Security: Absolutely.

Deputy B. Ward :

We also need to know the result of the actuarial review. We should not be taking monies out or agreeing to something when we do not even know what the state of the fund is. We can guess but we need to ... we are paying a lot of money.

The Minister for Social Security: I agree, I agree.

Deputy B. Ward :

We need to know where we start.

The Minister for Social Security:

I agree. I believe I am responsible for that fund and I will certainly not permit it to be used as a slush fund.

Deputy B. Ward :

Good. I just have one last question ...

The Minister for Social Security: I can give you that assurance.

Deputy B. Ward :

... and it is very simple. You have the older persons forum on 30th November but you have not said where. Where?

The Minister for Social Security:

I am sure I have been told but I cannot remember.

Associate Policy Director, Cabinet Office:

I do not know. We can find out and let you know.

[11:30]

The Minister for Social Security:

I am not sure. I presume the people who are members ...

Deputy B. Ward :

There will be an announcement, will there not?

The Minister for Social Security:

Well, I think there is a group that has been formed. I do not think it is a general turn up and say what you think. I think the forum has a membership which has been drawn from our older community, so I think there is a board and a membership of the forum. I do not believe it is a general, open to the public, come in and say what you think.

Deputy B. Ward :

It is not a speakeasy free for all?

The Minister for Social Security:

It is not a free for all but there is a board of suitable representatives.

Director General, Customer and Local Services:

I think that the first meeting was an open meeting as part of our closer to home event. A colleague who is listening says that the next meeting is at Age Concern but it is a meeting of people who have been co-opted on to the board.

Deputy B. Ward : Okay, thank you.

Deputy G.P. Southern :

The Minister for Social Security: Excellent timing, Chair.

Deputy G.P. Southern :

A miracle. A quarter of an hour break and we will come back on some other issues. Hopefully it will not duplicate.

The Minister for Social Security: Thank you.

[11:31]