Committee for Health & Social Care - P.2017/114
The States are asked to decide whether, after consideration of the Policy Letter entitled "A Partnership of Purpose: Transforming Bailiwick Health and Care", dated 9th November 2017, they are of the opinion:-
1. To reaffirm the States of Guernsey's commitment to a process of transformation of health and care services in the Bailiwick of Guernsey, based on the key aims of:
- Prevention: supporting islanders to live healthier lives;
- User-centred care: joined-up services, where people are valued, listened to, informed, respected and involved throughout their health and care journey;
- Fair access to care: ensuring that low income is not a barrier to health, through proportionate funding processes based on identified needs;
- Proportionate governance: ensuring clear boundaries exist between commissioning, provision and regulation;
- Direct access to services: enabling people to self-refer to services where appropriate;
- Effective community care: improving out-of-hospital services through the development of Community Hubs for health and wellbeing, supported by a Health and Care Campus at the PEH site delivering integrated secondary care and a Satellite Campus in Alderney;
- Focus on quality: measuring and monitoring the impact of interventions on health outcomes, patient safety and patient experience;
- A universal offering: giving islanders clarity about the range of services they can expect to receive, and the criteria for accessing them;
- Partnership approach: recognising the value of public, private and third sector organisations, and ensuring people can access the right provider; and
- Empowered providers and integrated teams: supporting staff to work collaboratively across organisational boundaries, with a focus on outcomes.
2. To direct the Committee for Health & Social Care to develop a health and care system premised on a Partnership of Purpose bringing together providers to deliver integrated care which places the user at its centre and provides greater focus on prevention, support and care in the community and makes every contact count;
3. To direct the Committee for Health & Social Care and the States' Trading Supervisory Board to work together to identify suitable sites for the development of Community Hubs;
4. To direct the Committee for Health & Social Care to work together with all health and care providers to produce a schedule of primary, secondary and tertiary health and care services that shall be publicly available as the Universal Offer either fully-subsidised or at an agreed rate;
5. To direct the Committee for Health & Social Care, the Committee for Employment & Social Security and the Policy & Resources Committee, together with any non-States' bodies affected, to consider how the current States' funding of health and care can be reorganised to support the Universal Offer and, if necessary, to report back to the States at the earliest opportunity;
6. To direct the Committee for Health & Social Care to work with:-
- the Committee for Employment & Social Security to create a Care Passport for islanders, establishing their individual entitlement to health and care services and to explore how it could be linked with existing benefits or new opportunities to encourage individuals to save for their costs of care, in an individual Health Savings Account, a compulsory insurance scheme, or otherwise;
- the Policy & Resources Committee and representatives of the voluntary sector, to explore a scheme of "community credits" to incentivise more volunteering within the health and care system;
7. To agree that the Committee for Health & Social Care should investigate ways in which a technological interface could be developed that serves to create an aggregated service user record from the various patient records maintained across health and care providers;
8. To agree that, in line with the States of Guernsey's Digital Strategy, the Committee for Health & Social Care shall seek to provide user-friendly online access to services, including providing service users with secure access to their own summary care record, where appropriate, their Care Passport and information on maintaining their own health and wellbeing;
9. To agree that the processing of health and care data should be premised on the equally important dual functions of protecting the integrity and confidentiality of such data and its sharing, where in the interests of the service user or the delivery of a public health function, and to direct the Committee for Health & Social Care and the Committee for Home Affairs to explore legal or practical mechanisms to achieve this;
10. To agree that the Committee for Health & Social Care shall be responsible, in accordance with its mandate, for:
- Setting health and care policy for the Bailiwick;
- Commissioning, or otherwise ensuring the provision of, health and care services,through the Partnership of Purpose;
- Conducting a series of Health Needs Assessments, constituting a Comprehensive Health Needs Assessment for the Bailiwick, in order to plan ongoing service delivery with a view to improving health and wellbeing and reducing health inequalities;
- Ensuring the good governance of health and care services;
- Managing the public budget for health and care; and
- Ensuring that there is effective regulation of health and care;
11. To agree that the Committee for Health & Social Care should report back to the States on the legislative changes needed to disband the roles of Medical Officer of Health and Chief Medical Officer and, where relevant, transfer their functions to existing services or statutory officials whilst exploring the potential for creating reciprocal arrangements for the independent challenge and peer review of respective health and care policy on a regular or ad hoc basis by other small jurisdictions;
12. To direct the Policy & Resources Committee to undertake a strategic review of the terms and conditions attached to nursing and midwifery professionals employed by the States of Guernsey, and to consider whether such a review may also be appropriate in respect of any other staff group;
13. To direct the Committee for Education, Sport & Culture, together with the Committee for Health & Social Care, to review the training and education provided by the Institute for Health and Social Care Studies to ensure that it continues to meet the health and care needs of the Bailiwick, and to explore options for supporting a wider range of on- and off-island training opportunities;
14. To agree that the Committee for Health & Social Care shall review the processes used to:-
- consider the merits of whether new drugs or medical treatments should be funded to ensure that a consistent approach is used across all decision-making bodies (including the Committee for Employment & Social Security's Prescribing Benefit Advisory Committee);
- determine access to child or adult social care services, along with reviewing the transition between the two;
- access long-term care in the community or in residential or nursing homes and work with the Committee for Employment & Social Security to produce a single assessment process in accordance with the resolutions of the Supported Living and Ageing Well Strategy;
and in so doing ensure that clear, user-friendly information about the processes and criteria shall be made publicly available;
15. To affirm that the States, in all its policy decisions, should consider the impact of those decisions on health and wellbeing, and make use of any opportunities to improve health or reduce health inequalities, across all government policies;
16. To direct the Committee for Health & Social Care, working with other States' Committees and voluntary and private sector organisations, to establish a Bailiwick Health and Wellbeing Commission that shall be responsible for health promotion and health improvement activities within the Bailiwick;
17. To direct the Committee for Health & Social Care to report to the States in 2018 with proposals for the comprehensive regulation of health and care services and practitioners;
18. To direct the Committee for Health & Social Care to:-
- Develop, market and manage an attractive private offer in addition to its universal provision which should be run, as far as possible, on a commercial basis;
- Investigate opportunities to incentivise people to use their private insurance where that option is available;
- Work with the Committee for Economic Development and other interested parties to explore whether the Bailiwick could develop and market itself as a "destination for health and wellbeing";
19. To note that the Committee for Health & Social Care will continue to work with the Alderney community and the States of Alderney to rebuild confidence in health and care services, including those provided by the satellite campus, and ensure that they are proportionate and responsive to the needs of the island;
20. To direct the Policy & Resources Committee, as part of its ongoing work through the Sark Liaison Group, to engage with the Sark Authorities to establish the merits and cost implications of closer working in respect of health and care, and to report back to the States with recommendations;
21. To direct the Policy & Resources Committee to consider, as part of future budgets, what steps, if any, are required, over and above the transformation of health and care, to ensure the sustainability of funding for health and care services;
22. To increase the authority delegated to the Policy & Resources Committee to approve funding from the Transformation and Transition Fund for Transforming Health and Social Care Services by £2,000,000 to £3,500,000.
The above Propositions have been submitted to Her Majesty's Procureur for advice on any legal or constitutional implications in accordance with Rule 4(1) of the Rules of Procedure of the States of Deliberation and their Committees.
