Health Minister's speech proposes changes to health care

24 October 2012

Health and Social Services Minister, Deputy Anne Pryke, made the following speech to the States Assembly on 23 October 2012:

The Proposition before us today is probably one of the most significant that we, as an Assembly, will debate. It sets out the case for fundamental change in the way we care for the health and wellbeing of all Islanders. It will have implications for everyone in Jersey today and into the future - our children, our grandchildren, our great grandchildren.

So why is there a need to change the way we deliver care as described in this proposition? Because we have reached a point where there is no option but to support a case for change:

• our population is ageing – a global trend, which is also a reality for our Island
• the rate of chronic disease and the burden that places on our society is increasing – international research and our own patient numbers tell us that
• demand for our services is growing and will continue to grow in response to demographic changes – we are close to running out of hospital beds and theatre capacity
• buildings and facilities across my department are reaching the end of their useful life. They fail to met modern standards – just take a walk around the hospital or Overdale
• our costs are spiralling as patient numbers increase, as drug and medical equipment costs increase and as demand for specialist treatment and support in the UK increases – as shown by the ever mounting pressures placed on our annual budget
• my front-line staff are under a level of pressure that is not sustainable in the future - I would like to take this opportunity to thank them on behalf of all Members, they are doing an amazing job

Change

The question is simple.  What does that change look like?

Over the last two years my department has asked this question of Islanders, health professionals and the voluntary and community sector. While there was some difference of opinion at the margins, the response has been the same - we need a new model of care.

As you know we have undertaken detailed analysis and consultation to established what the model should be:

• KPMG spent six months reviewing our data and services
• we produced a Green Paper, setting out three different scenarios based on KPMG’s work
• we listened to the responses before producing a White Paper
• based on what we were told, we then set before you this proposition

This has been a culmination of many years of work, of listening to people - our staff, our clinicians, voluntary and community sector organisations, parishes and focus groups - to name but a few.

Listening

The response to this consultation was that Islanders valued their health and social services; that the model did need to change, doing nothing was not an option and a wide range of services should be provided on island where possible. 

People also said:

• services should be free or affordable and available to all residents
• they want to be cared for in their own homes and communities for as long as possible
• having integrated care is important
• Jersey’s voluntary and community sector should be supported to take on a larger role
• co-payments for GPs need to be considered

Scenario three

In short, they said they wanted to have the right care at the right time by the right staff. It is the model of care, recommended by KPMG, which through the Green Paper process become known as scenario three.

Scenario three received significant support from the public and professionals alike. 86% of Green Paper respondents supported Scenario Three. It is the best way forward.  The evidence shows that.  It is scenario three that resonates with the model outlined only last month by the King's Fund – a leading UK and global health think tank.

We know that during the consultation phase some legitimate issues were raised in relation to Scenario Three. We have listened to those and responded where appropriate. As you will see from the report and proposition, we have made it very clear that decisions about the types of services to be delivered, such as early intervention for children and families, will be subject to the development of full business cases and a transparent commissioning process.

Business cases

We have placed a greater priority on our acute care plans and we have ensured that carers feature strongly in our plans, with their own Strategy being developed over the coming weeks. There are, however, still questions to be answered about the details of what services will look like in the future:

1. How will Primary Care work? 
2. What will the hospital look like?
3. How will this all be funded in the future?

The need to answer these questions is clearly set out in the Proposition. But that is the next stage of the process as we develop full business cases, a sustainable funding proposal and detailed plans for a new hospital.

New hospital

In part (b)(i) of the proposition, the Council of Ministers asks Members to co-ordinate investment plans and a detailed plan for a ‘new hospital’ (no decision as to where that will be has taken place) by the end of 2014.  

Be under no illusion - to sit with a loved one during their last hours of life is one of the hardest of all human experiences. To have to do so in a six bedded bay surrounded by the noise, chat and life of others, is simply not acceptable. Nor is it acceptable to come into hospital and acquire an infection because, despite the best efforts of the staff around you, your physical surroundings fail to meet modern standards.

Be in no doubt of the need for a new hospital.

Assessment

Atkins, a highly experienced hospital planning consultancy is working alongside a local firm of quantity surveyors on a pre-feasibility spatial assessment. One of their findings is that due to significant demographic pressure, the number of beds required will need to rise from a total of 245 to 418 by 2040 if community services are not put in place.

If this proposition is approved, the number of beds required is significantly reduced – although it will still need to rise to 304 beds by 2040.

Primary Care

Part (b)( ii) focuses on a new model for primary care. This includes GPs, high street opticians, pharmacists and dentists.  The Council Of Ministers recognizes that getting primary care right and the funding right is very important.

We must engage with the whole of the primary care sector, but that will take time. We have been working with GPs for more than five years now, but have yet to have a real engagement with the other sectors. We aim to achieve proposals by 2014 in time for the next Medium Term Financial Plan.

Part (b)( iii) asks members to request the COM to bring forward a sustainable funding mechanism for HSSD by the end of 2014. This will be led by the Treasury and Resources Minister and his department.

The implementation of the new services requires significant investment, both on a one-off basis and long term.  As Members are aware, there is a request in the MTFP for increased funding for 2013 to 2015.

In the following periods 2016 to 2021, further business cases with detailed planning and costs will be developed as part of future MTFPs.

Scrutiny

At this point I would like to thank Scrutiny for their review of the report and proposition. Their involvement has been wide ranging and their approach has been thorough. I agree with many of their 21 recommendations, and they will have a key role in helping to ensure that the design of future health and social care in Jersey is right for all Islanders.

I was heartened to see in recent media coverage that the Deputy of St Peter – who is the Chair of the Health Scrutiny Panel - supports the broad direction of this Proposition.

Detailed planning will still continue, as will working with our voluntary and community sector partners.

Voluntary and Community sector

I would like to take this opportunity to thank all voluntary and community sector partners and all the volunteers for the care they give to our islanders. Without them, this island would indeed be a poorer place. I look forward to continuing and enhancing our relationship as we go forward together to provide better services for Islanders.

It is an absolute given that our commissioning processes must be robust, as how can we ensure efficiency and effectiveness if they are not?

At the same time they must be proportionate and must not create a barrier to the voluntary and community organisations. We know those organisations have the ability to provide excellent care and some may do so for less money, but the importance of the voluntary and community sector goes way beyond service delivery. It is about the sector’s unique ability to create change and reach out to individuals in a way that the States cannot, and this very much includes the Parishes.

Governance

As we move forward with implementing our plans we will also consider whether the establishment of a non-executive board will complement our existing robust governance procedures.

With this proposition, Sir, Members have a unique opportunity to ensure that all Islanders receive the health and social care which meets their needs and which is accessible, affordable and above all safe.

As Members are aware, standing still is not an option for this Island. We have done that for too long. This is a once in a lifetime opportunity and one of the most important decisions we will make as we set out on the journey to ensure that we have the right care, in the right place, at the right time, for all Islanders.

I'll finish on a personal note.  From being a very young child I always wanted a career in nursing and I was privileged to be able to achieve that. I was then, and continue to be, passionate about the most vulnerable in our society, from the care of a premature baby, through to being with someone as they are dying.

This is why I am standing here before Members today. The future of our Island’s health and wellbeing is in Members' hands today and I urge Members to grasp this opportunity.

Thank you. I make the proposition.