Health and Social Services
Minister’s Decision Report
2014 Entitlement to health CARE (“THE pOLICY”)
- Purpose of Report
To recommend the Minister for the Health and Social Services Department approves the revised Health and Social Services policies for provision of health care and patient travel to residents, non-residents, overseas visitors and foreign nationals (including UK nationals and visitors) and its’ new title of ‘Resident and Non-Resident Charging Policy’ effective from June 9th 2014.
- Background
The existing Health and Social Services policies for the provision of health care and patient travel within the Department require updating to ensure policy appropriately reflects changes implemented under the Control of Housing and Work (Jersey) Law 2012 and regulations which came into effect in 2013, and the Long-Term Care (HSS Charges)(Jersey)Law 201-, together with providing further clarification around current rules of eligibility to health services.
The revised policy has been renamed “Resident and Non-Resident Charging Policy” which replaces the existing policy title “Provision of hospital treatment and care to residents, non-residents, overseas visitors and foreign nationals (including UK nationals and visitors)” – also known by its short title of “Overseas Patient Policy”. These changes clarify that the policy not only relates to non-residents and visitors, but also to new Jersey residents and those former residents who return to the island.
The wording within the current policy has been open to misinterpretation by members of the public and the amended version has also sought to address a number of areas where clarification was required.
In line with the changes to the main policy, the Patient Travel Policy and Charges Appeals Policy have also been updated and are incorporated into this report.
The revised policy includes an introduction and purpose outlining the scope of the policy and to whom it applies.
- Introduction
The Health and Social Services Department has been through a protracted exercise to update existing policy relating to charges for health care and services.
Formerly known as the Overseas Patients Policy, the revised and renamed Residents and Non-Residents Charging Policy has been subject to much discussion since this exercise was launched in 2011, and what were initially considered simple anomalies very quickly and evidently became complex and, if not controversial, then certainly sensitive.
In addition to this, it was subsequently recognised that revision of the Patient Charging Policy needed to be aligned with the content and principles of both the Patient Travel Policy and the Charges Appeals Policy (Terms of Reference).
The complexities around the Patient Charging Policy were a consequence of a distortion of the primary purpose of the original policy which was originally established to:
- discourage health tourism
- ensure that people accessing free healthcare made an appropriate social and/or economic contribution to the Island.
Instead, the Policy was being perceived as a mechanism to reduce budgets by restricting access to high cost care to immigrants with less than five years residency.
In line with this, further discussion was generated around proposals to introduce cost and further residency thresholds. However, concerns raised through consultation made it clear that the practicalities of implementing and managing thresholds, determining the services for which thresholds should or should not apply, and aligning this position with the intended overriding principles of the policy, highlighted the challenges facing the review and the discussions served to further stall progress on the policy revision.
Nevertheless, a number of key areas and anomalies within the policies have been subject to consideration and discussion involving:
- Corporate Policy managers
- Finance Department
- The Charges Appeals Panel
The outcome of these discussions, which considered public, financial and political ramifications of policy as it stands, as well as its proposed amendments, is a revision of the relevant policies.
They have been revised to ensure compliance with changes in legislation – primarily the Control of Housing and Work Law 2012 – and to address a lack of clarity around a number of key issues which have created confusion about the key purpose of the charging policy and the rights to appeal.
These interim Policies have been proposed to meet the needs of the Health and Social Services Department while a detailed review and drafting of a comprehensive States “Entitlement to Services Policy” – being led by the Central Policy Unit in the Chief Minister’s Department – is completed.
The Central Policy Unit Review and the drafting of a States “Entitlement to Services Policy” is likely to take several years to come to fruition and, as such, it is incumbent on the department to have in place an appropriate interim provision for dealing with issues relating to charging for services.
It is important to note that these policies are neither legal nor statutory documents and there is currently no legal foundation for the charges that have been put in place. However, like all Ministers, The Minister for Health and Social Services is mandated to make policy for charging for services within the department and, as such, these policies have been developed to support Ministerial direction on charging.
The following Draft Policy documents are attached to this report:
Draft: Residents & Non-residents Charging Policy
Draft amendment to Section 4: Long Term Non-Acute Care, to be incorporated from July 1st 2014 in place of current Section 4 content
Draft: Patient Travel Charges Policy
Draft: Charges Appeals Policy (Panel Terms of Reference)
- Key areas of change
The following highlights the updated sections of the Policy, what has been amended and the reason for the changes being required.
Residents and Non-Residents Charging Policy
Formerly known as the Overseas Patients Policy, the Policy has been renamed to respond to concerns raised by the Law Officers at the use of the term “Overseas”.
INTRODUCTION & PURPOSE OF POLICY |
Objective | To clarify the purpose of the Residents and Non-residents Charging Policy, ensuring compliance with changes to the Control of Housing and Work Law |
What | J-Category status qualification has been replaced with Entitled and Permanently Entitled Qualification, which accommodates former J-Cat requirements, while also ensuring fairer recognition of pensioners and Jersey born / long term Jersey residents |
Why | - To comply with new Control of Housing and Work regulations
- The previous policy had the potential to unfairly discriminate against Permanently Entitled residents and people in receipt of a pension or allowance, which would be liable for tax assessment, but not previously taken into account when assessing a 6/12 months qualification period
|
SECTION 1: EMERGENCY TREATMENT |
Objective | To clarify the definition of emergency treatment (where charging for non-eligible patients begins) |
What | Emergency care: defines the limitations of ‘emergency care’ Non-eligibility for treatment beyond emergency care is clarified |
Why | Determining where charging should begin has cause considerable confusion and has been difficult to address, in that there are widely varying view around what constitutes ‘emergency care’. The new policy defines that ‘emergency treatment’ will be considered as treatment and care providing within A&E and/or the first 24 hours following an emergency admission of a patient to EAU/ITU/CCU (this does not include the transfer of a a patient already on another ward who may subsequently be transferred as an emergency to ITU/CCU) Further urgent care for visitors covered by a current RHA is restricted to the provisions made within the individual agreement A visitor not covered by an existing RHA is classified as a non-resident and not eligible to free care beyond ‘emergency treatment’ as defined above |
SECTION 4: LONG TERM NON-ACUTE CARE |
Objective 1 | To highlight changes to Long Term Care with effect from July 1st |
What | The Policy has been amended to incorporate information about the new regulations relating to Long Term Care – in line with new Long-Term Care (HSS Charges)(Jersey)Law 201-, with effect from July 1st 2014. |
Why | To ensure the policy complies with the new regulations in the Long-Term Care (HSS Charges)(Jersey)Law 201-. |
Objective 2 | To clarify the position on eligibility rules for medical elements of long term condition |
What | To clarify that medical elements (e.g. drugs; care by HSSD consultants) is 6 to 12 months |
Why | The position relating to long term conditions required clarification and amendment as current policy, which presumes long term conditions such as diabetes and rheumatoid arthritis should be treated as long term care and, as such, subject to the 5-year rule. This position unfairly discriminates against patients with long terms conditions that may consultant medical treatment and care, but not reasonably fall within the category that would be assessed as requiring long term care. |
SECTION 6: PAYMENT FOR TREATMENT |
Objective | To highlight Data Sharing agreement with Social Security |
What | A paragraph highlighting the Data Sharing Agreement between Health & Social Services and Social Security has been included |
Why | To ensure compliance with Data Protection Law, notification of date sharing must be advised NB: The existing Data Sharing agreement relating to Long Term Care expires June 30th 2014, and is currently being renegotiated. |
SECTION 7: CARE DURING PREGNANCY AND BIRTH |
Objective | To clarify the position regarding maternity care |
What | Clarifies eligibility of mother and baby for free antenatal, birth and postnatal care and treatment, in line with residential and non-residential status qualification. Pregnant women will only be eligible for if they are eligible for free non-emergency hospital treatment Once the baby is born in Jersey it will be eligible for free care and treatment, regardless of whether the parents are, or are not, eligible for free care and treatment, providing: (a) that the mother can provide evidence to demonstrate that neither she, nor her unborn baby, had any previously-diagnosed condition that may result in the baby requiring specialist care AND (b) that baby and parent(s) are to remain living and working in Jersey. Evidence of the intent to remain in Jersey is required |
| - to ensure Human Rights compliance and requirement to protect life of children (born and unborn)
- introduce a degree of deterrent for “birth” tourists
|
SECTION 8: DISPUTED CHARGES & EXCEPTIONAL CIRCUMSTANCES |
Objective | To reinforce process of Appeal against Health Charges and highlight a patient’s Right of Appeal |
What | Details of the rights of appeal and the appeals process has been incorporated into the Policy. Responsibility for hearing Appeals against Patient Travel charges is transferred from the Finance Director to the Charges Appeals Panel. Highlights the role of the Charges Appeals Panel and refers to the Charges Appeals Policy (Terms of Reference) for further information Responsibility for final decision on all appeals against charges will now rest with the Assistant Minister for Health and Social Services |
Appendices | |
Appendix 1 | Clarifies nationals eligible to qualify as ordinarily resident once the qualification criteria has been met |
Appendix 2 | Clarifies the eligibility rules on Jersey residents returning to live in Jersey |
Appendix 3 | Includes the definition of a Visitor for the Purposes of RHAs |
Appendix 4 | A new exemption has been added to the list to include: A member of the UK armed forces who sustained injury or ill health as a result of their active service, regardless of whether they had previously been resident in Jersey |
Appendix 5 | Highlights that: Term of residency (i.e. 6/12 months) must be a consecutive period, immediately prior to requiring treatment. That responsibility for providing evidence to support a eligibility/ appeals claim rests with the patient That eligibility for access to benefits differs between individual department and that it is the responsibility of the patient to check their position on eligibility for Health & Social Services |
Appendix 6 | Clarifies medical exemptions on notifiable diseases |
Patient Travel Policy
The Patient Travel Policy has been undergoing revision by the Patient Travel Manager to clarify details of eligibility and the process for seeking assistance with Patient Travel.
A detailed review of patient travel by the CSR team in 2013 resulted in options for changes to thresholds for eligibility being proposed. However, for a number of reasons, a decision has been taken that those proposals would not be progressed at this time.
The Patient Travel continues to be managed by the Patient Travel Manager. Responsibility for dealing with appeals against Patient Travel Charges, however, is transferred from the Director of Finance to the Charges Appeals Panel, and will be managed through the same process.
Information about the right to appeal and details of how to appeal have been included in the charging policies and the process structured to ensure a consistent approach. The section also directs patients to the Charges Appeals Policy (Terms of Reference) for full details of the process and an appeals submission form.
Charges Appeals Policy (Terms of Reference)
The Charges Appeals Panel was established in January 2011, to coincide with the introduction of the Health and Social Services Department’s Overseas Patients Policy (OPP), to be superseded by the Residents and Non-residents Charging (RNRC) Policy, February 2014.
Its role is to consider and decide on patient appeals against charges for health and social care services provided through the Health and Social Services Department and it has the power to waive, reduce or override health treatment and care charges in exceptional circumstances.
Formal Terms of Reference for the Panel, which includes roles and responsibilities, membership and details of the appeals process, have now been established, which provides a detailed explanation for patients about who can appeal, when and how.
In addition, responsibility for considering patient appeals against travel charges transfers from the Director of Finance to the Charges Appeals Panel.
- Recommendation
It is recommended that the Minister of Health &and Social Services approves the changes to policy for eligibility and entitlement to free health care that the policy is made effective from June 1st 2014.
- Reason for Decision
These Policies have been amended to meet the needs of the Health and Social Services Department while a detailed review and drafting of a comprehensive States “Entitlement to Services Policy” – being led by the Central Policy Unit in the Chief Minister’s Department – is completed.
They have been revised to ensure compliance with changes in legislation – primarily the Control of Housing and Work Law 2012-, and the Long-Term Care (HSS Charges)(Jersey)Law 201-, and to address a lack of clarity around a number of key issues which have created confusion about the key purpose of the charging policy and the rights to appeal.
- Resource Implications
c£2k will be needed to support a Communications Plan, including the production and distribution of leaflets and posters
- Consultation and Approval
The revised policies have been subject to internal consultation across relevant Health & Social Services Departments, and approved by the Executive (Corporate Directors) Board.
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