Health and Social Services: Fee increases prescribed under various legislation to support establishment of Care Commission: Law drafting instructions

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A decision made 22 October 2015:

Decision Reference: MD-HSS-2015-0036
Decision Summary Title :	Fee increases to support establishment of Care Commission		Date of Decision Summary:	19 October 2015
Decision Summary Author:	Head of Professional and Care Regulation		Decision Summary: Public or Exempt?	Public
Type of Report: Oral or Written?	Written		Person Giving Oral Report:	-
Written Report Title :	Fee increases to support establishment of Care Commission		Date of Written Report:	7 October 2015
Written Report Author:	Head of Professional and Care Regulation		Written Report : Public or Exempt? (State clauses from Code of Practice booklet)	Public
Subject: Fee increases to support establishment of Care Commission.
Decision(s): The HSSD Minister has decided: 1) in accordance with Financial Directions 4.1, to request that the Minister for Treasury and Resources approves fee increases above the 2.5% anti-inflationary target. These increases relate to fees prescribed under: Nursing and Mental Nursing Homes (General Provisions) (Jersey) Order 1995; Residential Homes (General Provisions) (Jersey) Order 1995; Nursing Agencies (General Provisions) (Jersey) Order 1978; Piercing and Tattooing (Jersey) Law 2002 2) To request the Law Draftsman to draft the Orders necessary to enable the increase in these fees, subject to approval being received by the Treasury and Resources Minister.
Reason(s) for Decision: The Regulation of Care (Jersey) Law 2014 provides for the establishment of a Health and Social Care Commission to oversee the regulation of health and social care activities on the Island. That Commission must be appointed in Shadow form before that Law can be fully implemented. The costs associated with establishing a shadow Commission in 2016 are £27,770 and these costs, like all additional costs associated with the new regulatory regime, must be met through fees paid by regulated services, providing these fees are proportionate (in accordance with the States decision in relation to P94/2014). The fees currently charged by the HSSD Minister under the Nursing and Mental Nursing Homes (General Provisions) (Jersey) Order 1995; Residential Homes (General Provisions) (Jersey) Order 1995; Nursing Agencies (General Provisions) (Jersey) Order 1978 and therefore to be increased. In addition, fees will be levied for the first time under the Piercing and Tattooing (Jersey) Law 2002. Whilst that law provides for registration and renewal fees no charge has been met to date. The fee increases, as set out on the attached report are significantly more than 2.5%, however they are still proportionate in that: whilst they help met the additional costs incurred by the shadow Commission, they do not cover the full cost of regulatory services, the majority of which is still borne by the States of Jersey; the fees for tattooing and piecing are comparable with the mid-range of fees charged by UK Local Authorities and the fees charged to other agencies and practitioners remain significantly below UK fees.
Resource Implications: There are no known resource implications for the States of Jersey
Action required: Treasury and Resources Minister to give consideration to fee increases. Officers to forward the necessary information to the Law Draftsman to support preparation of the necessary Orders.
Signature:		Position: Minister for Health and Social Services
Date Signed:		Date of Decision (If different from Date Signed):

Health and Social Services: Fee increases prescribed under various legislation to support establishment of Care Commission: Law drafting instructions

REPORT

Fee increases to support establishment of Care Commission

Piercing and Tattooing (Jersey) Law 2002

Nursing and Mental Nursing Homes (General Provisions) (Jersey) Order 1995

Residential Homes (General Provisions) (Jersey) Order 1995

Nursing Agencies (General Provisions) (Jersey) Order 1978

Background

In July 2014 the States approved the Regulation of Care (Jersey) Law 2014 (P94/2014). This provides for the establishment of a Health and Social Care Commission to oversee the regulation of health and social care activities on the Island. In adopting the Law, the States agreed that additional costs associated with the new regulatory framework should be met through the fees paid by regulated services, and that those fees should be proportionate.

The new Law cannot be fully implemented until secondary legislation, in the form of Regulations and Standards are in place. Those Regulations must be adopted by the States and the Standards must be developed and adopted by the Commission.

This means that:

Commission must be established in shadow form [1] in order for the new Law to be implemented, and
in accordance with P94/2014, the fees paid by regulated services must be increased to cover the Commission’s costs.

The Regulation of Care (Jersey) Law 2014 sets out that the Commission must be established by the Chief Minister.

Anticipated costs for 2016

It is anticipated that in 2016, the costs associated with setting up and running the Shadow Health and Social Care Commission will be £27,770. This includes: recruitment costs; travel and subsistence and the daily rate paid to the Commissioners (£570 per day for Chair of Commissioners; £370 per day for other Commissioners)[2].

The 2016 fees, as set out in Section 3 below, are intended to raise an estimated £27,999 more income in 2016 than was raised via fee income in 2015. The income will be raised by the Health and Social Services Minister (HSSD Minister), who is responsible for the relevant laws.

The HSSD Minister intends, however, during 2016 to transfer the additional income generated to the Chief Minister, in order that the Chief Minister can establish the shadow Commission.

2016 fee increases

3 (a) Piercing and Tattooing (Jersey) Law 2002

The Piercing and Tattooing (Jersey) Law 2002 (the Law), sets out a requirement for both individuals and premises to be registered to undertake certain skin piercing and tattooing procedures.

Under Article 2 of the Law registrations lapse each year on the 31st December, and under Article 3 of Law the Health Minister may prescribe, by Order, a registration fee to accompany an application to register or renew a registration.

To date no fee has been charged and the States of Jersey is currently bearing the cost of regulating this sector.

The HSSD Minister has therefore determined that, subject to approval from the Treasury and Resources Minister, the following fees should be charged for all registrations or renewal of registrations for a premise or a person administering piercing or tattooing treatments for 2016 and therefore (or until the point at which those fees are further amended by Order)

Table 1

Fee to apply for registration or renewal of registration 2016.

A Person registered under the Piercing and Tattooing (Jersey) Law 2002

£55

A Premises registered under the Piercing and Tattooing (Jersey) Law 2002

£100

Proportionality of fees: Whilst the 2016 fees represent an increase in costs for piecing and tattooing premises and practitioners, as no fee is currently charge, it should be noted that:

whilst 2016 fees help met the additional costs incurred by the Shadow Commission, they do not cover the full cost of regulatory services provided to piecing and tattooing practitioners and premises, the rest of which are borne by the States of Jersey;
the fees equate to £0.96 per week for practitioners and £1.92 per week for premises. This is comparable with the mid-range of fees charged by UK Local Authorities which vary from £42.50 - £286.

The HSSD Minister requires the Law Draftsman to draft a new Order prescribing that the fees, as set out above in Table 1, should accompany any application for registration or renewal under the Article 3 (d) of the Piercing and Tattooing (Jersey) Law 2002.

3 (b) Nursing and Mental Nursing Homes (General Provisions) (Jersey) Order 1995; Residential Homes (General Provisions) (Jersey) Order 1995; Nursing Agencies (General Provisions) (Jersey) Order 1978

The fees prescribed under the above Orders are normally increased annually by 2.5% in line with States policy. The HSSD Minister has determined however, subject to approval from the Treasury and Resources Minister, that the following fees should be charge for 2016 registrations, applications and renewals.

Table 2

Residential Homes (General Provisions) (Jersey) Order 1995 amended	2015 fee as currently charged	2016 fee to be set out in updated Order
Registration of Person in Charge - Article 3	£79.18	£250
Registration of Person Carrying on the home - Article 3	£186.96	£710
Annual Fee - Article 4 (1)	£95.48	£361
Nursing Agencies (General Provisions) (Jersey) Order 1978 amended
First application for a licence – Article 2 (2)	£272.65	£710
Renewal of a licence – Article 2 (2)	£134.66	£361
Transfer of licence to different premises – Article 2 (3)	£107.08	£200
Nursing Homes and Mental Nursing Homes (General Provisions) (Jersey) Order 1995 amended
Registration of Person in Charge - Article 3	£79.18	£250
Registration of Person Carrying on the home - Article 3	£186.96	£710
Annual Fee - Article 4 (1)	£95.48	£361

Proportionality of fees: Whilst the 2016 % fee increases are significant, it needs to be noted that:

• the total fees incurred will remain significantly below those incurred by comparable business in the UK (see below),

whilst 2016 fee increases help met the additional costs incurred by the Shadow Commission, they do not cover the full cost of regulatory services provided to nursing agencies and care homes, the rest of which are borne by the States of Jersey;

• the daily costs, when presented as a daily rate, are minimal. For example, the annual fee per care home and nursing agency licence renewal equates to only £0.98 per day.

Table 3: UK fees and charges

Care Homes	Initial Registration	Annual Fee
Scotland	£3, 842	£157 per bed
England	None	£276 - £13,838
Nursing Agencies
Scotland	£1,262 – £2,798	£676 - £1,476
England	None	£796 - £35,403

The HSSD Minister requires the Law Draftsman, in drafting the Health and Social Services (2016 Fees) (Jersey) Order 2015, to bring forward the necessary changes so that fees, as set out in Table 2 above, can be applied for 2016.

Fees beyond 2016

The fee increases set out above will be brought forward under existing legislation relating to the regulation of care. At the point at which the new Regulation of Care Law comes into force, an entirely new fee structure will be introduced. It is anticipated that this structure, which has yet to be developed, see fees incrementally increase over a five year period until they are broadly comparable with the UK fee structure.

Consultation on 2016 fee increases

Relevant providers, managers and practitioners were advised by letter (July 2015) of the proposed changes to the fees, and offered an opportunity to meet with officers to discuss any concerns.

Letters were sent to 56 care homes, 66 piercing and tattooing premises and 80 registered piercing and tattooing practitioners. Response was limited. Eight people attended the meetings; two from the care sector who understood the need to increase the fees but expressed concern about future cost pressures on the sector; six representing the piercing and tattooing industry, two of whom acknowledged the need to apply charges and four who disagreed with the proposed level of fees.

In addition correspondence was received from:

• the British Acupuncture Council, raising concerns about piecing and tattooing fees being applied to acupuncturists, plus

• two care sector providers who raised objections to the care home fees being increased.

Decision

The HSSD Minister has decided:

1) to request that the Minister for Treasury and Resources approves the fee increases as detailed above. This is in accordance with Financial Direction 4.1 which sets out that any increases, above the 2.5% anti-inflationary target, must be approved by the Minister for Treasury and Resources;

2) to request the Law Draftsman to draft the Orders necessary to enable the increase in fees, set out in Section 3 above. This is subject to the approval of the Treasury and Resources Minister.

The HSSD Minister then intends, in early 2016, to transfer the additional income generated via the fee increases to the Chief Ministers Department, in order that the Chief Minister can establish the shadow Commission as set out in the Regulation of Care (Jersey) Law 2014.

The Health and Social Services (HSSD) Minister has responsibility for care regulations under existing legislation, including responsibility for raising fees by Order. The Chief Minister has responsibility under the new Law, including establishing the Commission. The HSSD Minister has therefore agreed to increase fees levied under current legislation and transfer the increased income to the Chief Minister’s Department (CMD) in order that the Commission can be established

[1] The Commission can only be set up in shadow form until the point at which the Regulation of Care (Jersey) Law 2014 comes into force.

[2] These daily rate is broadly comparable with rates paid to other external advisers, for example: Jersey’s Independent Safeguarding Chair. It is however higher than the rate paid to UK commissioners due to the comparatively low number of total contracted days and need to attract appropriately qualified people to travel to Jersey.