Report
Background
Jersey is facing a possible pandemic, following the global spread of the Influenza A (H1N1) virus. This is a highly contagious virus but initial fears of a very rapid spread have somewhat diminished in the short term. It is vital at this stage not to become complacent but to ensure that all preparations are in place for the likely return of the virus, possibly in a more virulent form, within a number of months.
Effective management of a possible pandemic will include more home visits by GPs, to seek to prevent the spread of infection in the early stages and to relieve pressure from hospital services in the most serious phase.
GP services are not provided free in Jersey and the individual makes a co-payment towards the cost of the consultation. Most Jersey residents are covered by the Health Insurance Law which provides a flat rate of £15 benefit towards the cost of each GP consultation. As the gross cost of a home visit is considerably higher than a surgery visit, the co-payment made by the patient is likewise much higher for a home visit.
The aim of these Regulations is to create a set of new medical benefits, which provide for higher benefit rates in respect of home visits at different stages of a pandemic infection. For the purposes of these Regulations, the beginning and end of each stage will be declared by the Minister for Social Security, acting on advice from the Medical Officer of Health.
Reduced lodging period
These Regulations are being lodged with a request for a very early debate, under Standing Order 26(7), which states:
“ The States may reduce a minimum lodging period if they are of the opinion that the proposition relates to a matter of such urgency and importance that it would be prejudicial to Jersey to delay its debate.”
The Regulations deal specifically with the current threat of pandemic raised by the H1N1 and H5N1 viruses and possible combinations thereof, and the definition of the term “influenza” within the Regulations reflects this specific remit.
Use of Health Insurance Fund and Income Support Special Payments
The Health Insurance Law provide benefits to individuals who have been resident in Jersey for at least six months and have made any relevant Social Security contributions. Individuals who take up residence in Jersey are not covered by the Health Insurance Law for the first six months. During this period, they normally meet the full cost of any GP consultations themselves. These Regulations create a specific Income Support Special Payment to provide the same level of benefit as the benefit created under the Health Insurance Law to ensure that all residents are entitled to the same level of financial assistance.
These Regulations do not apply to individuals who are not resident in Jersey, for example tourists. These individuals should be covered for medical costs under their travel insurance policy.
Containment Phase
A key strategy to manage the spread of the virus is that of “containment”. During this phase, individuals who believe that they may have been infected are strongly advised to seek a home visit from a GP, rather than visit a surgery. This helps to reduce the spread of the infection. These Regulations encourage individuals to take this advice and ensure that there is no cost pressure to avoid a home visit, by seeking a surgery visit instead.
The Island is currently in the containment phase in respect of the Influenza A (H1N1) virus.
During this phase GPs will provide home visits to anyone who reports symptoms compatible with infection with the influenza virus. GPs will act on advice provided by the Medical Officer of Health as to those symptoms which are likely to be associated with influenza. When the GP attends the individual, and confirms that the individual does have symptoms compatible with influenza, the individual will be entitled to the benefit, whether or not the individual actually has the infection. The level of increased benefit is such that the co-payment required from the individual should be no more than the normal cost of a surgery consultation.
Some individuals, once confirmed as infected, will need medical services over and above the first-line treatment. These should also be provided at home, with the patient making a co-payment for the consultation equivalent to the cost of a surgery consultation.
Pressure on Hospital Facilities
During the later stages of the containment phase and throughout the management phase GPs will provide medical services to some individuals who would, in normal circumstances, be treated in hospital. As hospital services are provided free in Jersey, the medical benefit payable in respect of visits to these individuals is set at a higher rate to cover the full cost of the GP consultation, and it is not anticipated that the individual will be charged in addition by the GP. The use of GPs in this way will contribute towards the most effective deployment of available medical resources at each stage of the pandemic.
Management Phase
During the management phase the infection is widely spread throughout the population and the advantages of keeping individuals who may be infected away from GP surgeries no longer apply.
Recovery Phase
The final stage of the pandemic is a recovery phase, where the level of infection decreases. At this stage, the medical benefits provided for in these Regulations fall away. The hospital will return to normal activity levels and there will be no need to encourage patients to seek home visits.
Summary of Benefits Payable
| | Day time hours | Out of hours | Additional patient in household |
Containment consultation | Benefit payable | £45 | £90 | £15 |
Typical co-payment | £30 | £30 | £30 |
| | | | |
`Hospital replacement consultation | Benefit payable | £75 | £120 | £45 |
Typical co-payment | £0 | £0 | £0 |
Financial and Manpower Implications
These claims will be processed manually, and this will have an impact on other benefit processing tasks. However, given that this benefit is only payable during the course of a pandemic, and the pandemic itself will have a much greater impact on the available manpower, any resource requirements will be met from existing manpower.
It is impossible to make any accurate estimate of the number of GP visits that would be covered by these Regulations. This will depend on the nature of the spread of infection. The following estimates are based on theoretical models and the actual expenditure may be considerably more or less than suggested.
The cost of the medical benefit is almost all to be met from the Health Insurance Fund, which currently contains an accumulated surplus of £72 million. A small proportion of the total expenditure will be met from the Income Support budget.
The containment phase is likely to cease once there are 150 confirmed cases in the Island. Evidence from the UK suggests that there are approximately 5 suspected cases for each confirmed case. This would suggest 750 investigations in the containment phase. Once individuals are confirmed as infected, approximately 30% will require some additional medical support. This would give rise to an additional 45 visits, and a total of approximately 800 visits.
Assuming that 90% of the visits are undertaken in working hours with 10% attracting the higher out of hours rate, the total additional cost would be £28,000. This figure excludes the £15 medical benefit that would be payable if these Regulations were not introduced.
It is estimated that for every 100 patients with flu symptoms, up to four of them may require hospital admission, if there are beds available. The UK government is planning for an attack rate of up to 50% of the population. Half of these individuals will show symptoms of flu, i.e. approximately 22,500 people in Jersey. If 4% of these individuals require hospital treatment, this would equate to 900 possible admissions, lasting an average of 6 days.
GPs providing medical services to individuals who would otherwise be treated in hospital would have a maximum of 900 individuals to care for. (This would be made up of both flu patients and other patients displaced by flu cases).
Assuming that the GP would visit once per day, this is equivalent to 5,400 visits at a total cost of £453,600.
gov.je