Female Sterillisation: 'User Pays' Charge: Proposed Increase

Information about the publication of Ministerial Decisions

A formal published “Ministerial Decision” is required as a record of the decision of a Minister (or an Assistant Minister where they have delegated authority) as they exercise their responsibilities and powers.

Ministers are elected by the States Assembly and have legal responsibilities and powers as “corporation sole” under the States of Jersey Law 2005 by virtue of their office and in their areas of responsibility, including entering into agreements, and under any legislation conferring on them powers.

An accurate record of “Ministerial Decisions” is vital to effective governance, including:

demonstrating that good governance, and clear lines of accountability and authority, are in place around decisions-making – including the reasons and basis on which a decision is made, and the action required to implement a decision
providing a record of decisions and actions that will be available for examination by States Members, and Panels and Committees of the States Assembly; the public, organisations, and the media; and as a historical record and point of reference for the conduct of public affairs

Ministers are individually accountable to the States Assembly, including for the actions of the departments and agencies which discharge their responsibilities.

The Freedom of Information Law (Jersey) Law 2011 is used as a guide when determining what information is be published. While there is a presumption toward publication to support of transparency and accountability, detailed information may not be published if, for example, it would constitute a breach of data protection, or disclosure would prejudice commercial interest.

A decision made 24 April 2012:

Decision Reference: MD-HSS-2012-0009
Decision Summary Title :	Increase charges for female sterilisation		Date of Decision Summary:	20th April 2012
Decision Summary Author:	Director of Operations		Decision Summary: Public or Exempt? (State clauses from Code of Practice booklet)	Public
Type of Report: Oral or Written?	Written		Person Giving Oral Report:
Written Report Title :	Proposed Increased Charges for Female Sterilisation Surgery – Briefing Paper		Date of Written Report:	18th April 2012
Written Report Author:	Director of Operations		Written Report : Public or Exempt? (State clauses from Code of Practice booklet)	Public
Subject: Female sterilisation proposed increased charges
Decision(s): The Minister for Health and Social Services Department has decided to seek approval from the Minister for Treasury and Resources to increase the current charge associated with female sterilisation in order to enable full cost recovery. This increase is in excess of 2.5% and RPI.
Reason(s) for Decision: The existing charge, which has not been increased for over 7 years falls short of cost recovery for this non-essential procedure. The Minister approves the proposed increase in charge in order to fulfil the “user pays” principle in relation to this non-essential procedure.
Resource Implications: The proposed new charge will enable HSSD to recover costs associated with this non-essential procedure.
Action required: To seek approval from Minister for Treasury and Resources Director of Operations to increase charges
Signature:		Position: Minister for Health and Social Services
Date Signed:		Date of Decision (If different from Date Signed):

Female Sterillisation: 'User Pays' Charge: Proposed Increase

Proposed Increased Charges for Female Sterilisation Surgery – Briefing Paper

Purpose

The Minister for Health and Social Services has agreed in principle to the proposed increased charges to be made to service users who request the procedure of Sterilisation.

Background

At present, Health and Social Services (H&SS) charge the service user £125.00 for this procedure. The charge has not been increased for at least 7 years, and includes a payment of £83.00 to the surgeon undertaking the procedure. The service continues to experience a high demand and needs to respond accordingly whilst remaining within the existing budget.

Female Sterilisation – Proposed Increase in Charge

The National Health Service provides this procedure at an approximate cost to the service user of £1,400.00.

If this service is provided privately the current charge levied by HSSD is £1,045.00. These charges are currently under review, and do not include pre and post surgery outpatient appointments, Theatre equipment and supplies, and Semen Analysis. Insurance companies do not cover this charge.

The table below provides a financial breakdown of the costs of this service to Jersey H&SS.

Initial outpatient appointment	£59.20
Blood Test	£56.25
Semen Analysis	£105.24
Surgery (In Day Surgery Unit)	£651.18
Follow up appointment	£59.20
Total	£1,162.00

The proposed charge by H&SS for Female Sterilisation is £1,162. Yearly increase should occur in line with inflation

Scope

Sterilisation is a surgical procedure that permanently removes an individual’s fertility, normally tubal occlusion in women. This is carried out under General Anaesthetic usually as a day case. H&SS will fund in exceptional circumstances;

 Family in receipt of Income Support

 Any medical or obstetric condition which would make the a pregnancy dangerous to the health of the woman.

Estimated Financial Impact of Increased Charges

The aim is to introduce an increased charge to service users, reflecting the cost to H&SS. The financial objective for introducing this increased charge is to ensure the cost recovery of service provision to non-exempt service users.

H&SS provided this service to 33 patients in 2008, 31 in 2009 and 23 in 2010. If demand should reduce as a result of the proposed charge, other forms of contraception are available within H&SS. It is important to note that this charge will fall below the current charge of the National Health Service, so it is unlikely that the service user will choose to undergo the procedure outside Jersey.

Additional Information

H&SS policy for Female Sterilisation has been developed and is available on HSSNet.

Patient Information Leaflets have been produced and are in use in outpatient Gynaecology clinics.

A Female Sterilisation counselling list has been developed to ensure patients are well informed prior to agreeing to surgery. This is in use in outpatient Gynaecology clinics.

Recommendation

The proposed increased charge for Female Sterilisation should be introduced to meet HSS cost of providing the service.

Angela Body

Director of Operations