PROPOSITION
THE STATES are asked to decide whether they are of opinion -
In accordance with Article 11(8) of the Public Finances (Jersey) Law 2005 to amend the expenditure approval for 2007 approved by the States on 13th September 2006 in respect of the Health and Social Services Department head of expenditure, to permit the withdrawal of an additional £517,000 from the consolidated fund for its net revenue expenditure in order to fund expenditure already incurred on preparations for pandemic flu.
MINISTER FOR TREASURY AND RESOURCES
REPORT
Background
Under the Public Finances (Jersey) Law 2005 heads of expenditure for departments are, in the normal course of events, approved as part of the Annual Business Plan approval process by the States. The sum of such approvals is known as the “expenditure approval”. The Public Finances Law, does, however, state in Article 11(8):
“ … the States may, at any time, amend an expenditure approval on a proposition lodged by the Minister on the grounds that –
(a) there is an urgent need for expenditure; and
(b) no expenditure approval is available.”
Two such spending pressures have emerged in 2007 meaning that the existing expenditure approval is no longer adequate. The States have already approved an amendment to the 2007 expenditure approval in respect of the Social Security Department’s head of expenditure. This report seeks an additional expenditure approval in respect of the Health and Social Services Department’s head of expenditure for 2007. This would result in the department being permitted to withdraw additional amounts from the consolidated fund for its net revenue expenditure in 2007. This will, in itself, not increase the base cash limit of the department in subsequent years.
Funding for Pandemic Flu Preparations
Details of the need for the request for additional funding are set out in the attached report from the Health and Social Services Department (Appendix A).
The States are requested to approve the additional allocation of £517,000 in respect of expenditure already incurred on preparations for a pandemic flu epidemic. This would increase the 2007 net revenue expenditure of the Health and Social Services Department from £137,095,000 to £137,612,000.
Financial and manpower implications
There are no additional manpower implications arising from this proposal. The financial implications are as set out in this report and its Appendix.
Appendix A
Health & Social Services Department
Preparation for Pandemic Flu Outbreak
Phase Two (Reduced Scope)
(Supplementary Paper for States Members to support proposition from Senator Shenton)
1.0 Executive Summary
- In the annual review of our flu pandemic plans we have adjusted our predictions to assume that the pandemic (expected to be a strain of H5N1) will run its course in Jersey in only four weeks.
- Due to the adjusted predictions on the pandemic a larger stockpile of antivirals (Tamiflu) was identified as necessary along with various other preparations identified in the Phase Two plan to Council of Ministers.
- Council of Ministers originally endorsed the Phase Two plan but subsequently the plan has been referred to scrutiny for further consideration and assessment.
- Health & Social Services had already taken the opportunity to purchase the additional stocks of Antivirals at a cost of £517,000
- Due to the existing pressure on Health & Social Services expenditure the department is unable to absorb this additional cost within existing resources.
1.1 Recommendation
- In order to achieve a balanced budget for 2007 Health and Social Services request an additional £517,000 to be allocated to the Department budget.
2.0 Introduction
In January 2006 the Council of Ministers endorsed an approach to preparing the Island for pandemic flu. In April 2006 the Emergency Planning Board endorsed the health plan which set out this approach in more detail, the key components being an escalation plan for the hospital and a plan for treating pandemic flu in the community to cope with a surge of extra patients. In May 2007 the Council of Ministers endorsed the Phase Two preparations but subsequently the paper was withdrawn to give scrutiny an opportunity to review the proposal.
- Case for Purchase of Antivirals (Tamiflu)
Based on UK predictions, it was previously estimated that Jersey would experience 25,000 cases of pandemic flu over a 16 week period. We have translated from French the Inspecteur Medical’s (Medical Officer of Health) report from 1918 (a major flu pandemic year) which demonstrated that for a community of our size and area, a short sharp outbreak affecting some 25,000 people over a four week period is more likely than over a longer period. We have also reviewed the Guernsey data from 1918 which shows the same pattern.
Dr Muscat has discussed our revised hypothesis with the National Health Protection Agency and they have also confirmed that they feel that this pattern is more likely for small communities in the next pandemic.
Our plan to date has been to deliver antiviral drugs to patients as they are diagnosed with pandemic flu. In our opinion, this approach, based on prior medical/paramedical confirmation of influenza like illness would not be fully effective given the more intense anticipated nature of the outbreak.
“The epidemic of influenza of 1918 hardly lasted about thirty days, from October 16 to November 16, but its contagiousness was such that in a few days there were accounts of hundreds of patients, and the deaths were so abrupt that many times the doctors, who were completely flooded, could not arrive in time to see the patient”1
Dr Paul Chappuis, Inspecteur Médical 1889-1922
To minimise the risk highlighted above we would recommend patients start taking antiviral drugs, ideally, within two hours of onset of a fever to get optimal effectiveness.
We therefore propose the pre-distribution of antiviral drugs to the whole population at the time of declaration of the pandemic by WHO with very clear patient guidelines for use ONLY after onset of flu like symptoms including a fever.
- Current Situation
Due to the endorsement of the Phase Two preparation plan Health & Social Services Department took the opportunity to procure the additional Antivirals (Tamiflu) for £517,000. Unfortunately due to the time lapse the manufacture will no longer accept the return of the goods.
Even though the Phase Two plans have been referred to Scrutiny for further consideration, it is requested that these funds are still allocated to Health & Social Services to fund the purchase.
Dr Rosemary Geller - Medical Officer of Health
Russell Pearson – Director of Finance Health & Social Services Department
12 November 2007
1 Rapports d L’Inspecteur Médical et de L’Inspecteur Sanitaire pour l’année 1918
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