Proposed introduction of specific pathology charges

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While there is a presumption toward publication to support of transparency and accountability, detailed information may not be published if, for example, it would constitute a breach of data protection, or disclosure would prejudice commercial interest.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 on 23 September 2009 regarding: Proposed introduction of specific pathology charges.

Decision Reference: MD-HSS-2009-0055
Decision Summary Title :	Proposed Introduction of Specific Pathology Charges		Date of Decision Summary:	22 October 2009
Decision Summary Author:	Directorate Manager of Medicine		Decision Summary: Public or Exempt? (State clauses from Code of Practice booklet)	Public
Type of Report: Oral or Written?	Written		Person Giving Oral Report:	N/A
Written Report Title :	Proposed Introduction Of Specific Pathology Charges		Date of Written Report:	21 October 2009
Written Report Author:	Directorate Manager of Medicine		Written Report : Public or Exempt? (State clauses from Code of Practice booklet)	Public
Subject: Proposed introduction of charges for General Practitioner test requests for specified services in Haematology and Clinical Chemistry.
Decision(s): The Minister agreed, subject to the approval of the States and the endorsement of the Minister for Social Security, to introduce a charge of £10/episode (i.e. request form) for General Practitioner test requests for specified services in Haematology and Clinical Chemistry with effect from 1st January 2010.
Reason(s) for Decision: The introduction of the proposed charge will aid the Health and Social Services Department to address the financial impact of primary care activity on Haematology and Clinical Chemistry and remain within its departmental cash limit for 2010 (as approved by the States in September 2009).
Resource Implications: The introduction of the proposed charge will be met from the existing Health Insurance Fund and is estimated to be approximately £750,000/annum in 2010. No additional manpower or finance is required to administer the proposed scheme by Health and Social Services and the Social Security Department.
Action required: Instruct the Directorate Manager of Medicine to liaise with the Social Security Department to implement an appropriate, effective and efficient administration process for this scheme by 1 January 2010 (the proposed implementation date of the charge). The Minister for Health and Social Services to lodge ‘au Greffe’ a proposition seeking approval for the proposed charge.
Signature:		Position: Minister for Health and Social Services
Date Signed:		Date of Decision (If different from Date Signed):

Proposed introduction of specific pathology charges

HEALTH AND SOCIAL SERVICES DEPARTMENT

PROPOSED INTRODUCTION OF SPECIFIC PATHOLOGY CHARGES

INTRODUCTION

The Health and Social Services Department is seeking to introduce a charge for specific Haematology and Clinical Chemistry services provided to General Practitioners, with effect 1st January 2010.

The introduction of the proposed charge will aid the Health and Social Services Department to address the financial impact of primary care activity on Clinical Chemistry and Haematology and remain within its departmental cash limit for 2010 (as approved by the States in September 2009).

The Social Security Department has agreed to introduce an additional benefit, funded through the Health Insurance Fund to match the cost of this charge. This ensures that there will be no cost to the patient as a result of the new charge.

PROPOSAL

It is proposed that the £10 charge will be based on a laboratory episode which is defined as a request form for Haematology or Clinical Chemistry services (irrespective of the number of individual tests within the request form) from a General Practitioner (GP) providing services which fall within the remit of the Health Insurance (Jersey) Law 1967.

In broad terms the affected services cover the investigation of symptoms, the care of existing medical conditions in primary care lead by a General Practitioner (GP), and the testing of well individuals according to screening programmes approved by the Royal College of General Practitioners.

It should be noted that:-

a consultation between a GP and patient which requires laboratory investigation usually generates an episode for Haematology and one for Clinical Chemistry; and,

under this proposal, the charge of £10 per episode raised only covers those direct costs associated with GP test requests in Haematology and Clinical Chemistry.

EXEMPTIONS

This proposal does not supersede or affect the current raising of charges made by the Health and Social Services Department to GPs in respect of tests for commercial BUPA style health screening of well individuals (e.g. for local finance companies etc).

ADMINISTRATIVE ARRANGEMENTS

In order to minimise the administration required to manage this charge it is proposed to introduce the following arrangement:-

The patient will sign a declaration at the time of the GP consultation, agreeing that the benefit(s) be assigned to the Health and Social Services Department.

The Health and Social Services Department will submit a list of patients receiving tests to the Social Security Department

The Social Security Department will check that the patient is eligible for the benefit(s) and make payments directly to the Health and Social Services Department.

On a quarterly basis, the Health and Social Services Department will reconcile its activity data against the payments made by the Social Security Department and raise any issues of concern with that Department with a view to ensure that the scheme is recovering its agreed costs.

The Social Security Department will undertake periodic audits of the benefit claim process.

FINANCE AND MANPOWER

In broad terms the impact of the proposal is as follows:-

The generation of approximately £750,000 per annum income in 2010 for Health and Social Services.

No additional manpower or finance is required to administer the proposed scheme by Health and Social Services and the Social Security Department.

There will be no detriment to patients or GPs.

RECOMMENDATION

The recommendation of this report is to introduce a £10 per episode user charge to General Practitioners in respect of specified Haematology and Clinical Chemistry services.

Mark Littler

Directorate Manager of Medicine

21st October 2009.