My speech on the budget debate focused on health and social care.
Sir, There are 9 pages devoted entirely to Health and Social Care in this budget and a good chunk of Deputy St Pier’s speech was taken up with it, so it would be remiss of me not to say a few words. However, rather than seeing this as a symptom of the service being a problem child to the States of Guernsey, I believe that Members should be heartened that it actually demonstrates the desire for States’ Committees to work together to address what is increasingly becoming an unsustainable service.
Since it was published I have been asked by the media and the public, ‘do you think you will meet this budget’ After all, as was made clear in the most recent Independent Fiscal Monitoring Report, the service has only met its budget in 2 out of the last 9 years.
I have to say, here and now, it will be a challenge. It includes known unknowns, such as the income likely to be generated from the Emergency Department and unknown unknowns arising from off-island acute care. However, the Committee has worked closely with P&R to get to the figure of £120.1m. Clearly it is a compromise but the Committee is aware of the pressures on other Committees to make savings next year.
However, I have to make it clear now that, if we are to meet that budget and to have any hope of making anything approaching the savings of £2m that we are expected to make in 2018, we will need to think differently and work differently. Yesterday, I, together with CEO, Chief Secretary and others gave a series of presentations to staff on this very subject. We made it clear that this is not something that the Committee can, or should do alone and that management consultants don’t have the answers, but that we need to work as a team along with our partners, to make change happen. It has become clear to me that the structure and culture of health and social care has been a barrier to change and staff must feel empowered.
But change has begun to happen. Whilst I am still nervous of the financial reporting forecasting within Health and Social Care, as the President of Policy and Resources has said, the trend line has gone down and it is hoped that we can reduce it below the forecast given in the budget. Thanks for this, in particular, goes to the Chief Secretary and Senior Operating Officer, who have worked together to get what we call ‘system grip’ on spending since May.
We now have improved controls over off-island acute care, but this is an area where we are very much demand led. I therefore welcome P&R’s acknowledgement of this fact and that it will increase the Committee’s authorised budget where it looks like there will be cost pressures.
Now I would like to refer members to paragraph 5.21 where it states that the Committee intends to bring a plan for system transformation to the States in 2017. I think it important to make it clear that this doesn’t mean nothing will done before that policy letter. Rather it will set out what has been done to date and what is proposed for the future overall high level operating model.
This is not and never could be, a big bang, but, at the risk of sounding evangelical, is a journey. Neither should we get the idea that there is a perfect system out there, or that, even if there is one, it will never change. What we are looking to do is develop a sustainable system that meets the needs of the people of Guernsey and Alderney, that is flexible and can adapt to those needs.
At the same time, I don’t want the first time members to hear what we are doing to be via a policy letter published a few weeks before a States debate. I do think is important is that Members are aware of the progress being made by the Committee leading up to that policy letter and with that in mind intend to provide regular briefings to Members about the work being done and direction we are going.
It has become evident to me over the last 2 years since I have been involved in HSSD and now HSC, that a very real problem when it comes to managing budgets is the current funding structure. Not only does it mean that we don’t have a full picture of what is happening in the service, but it is also inefficient in terms of time and resources. This is something I mentioned in my June Statement and has been reinforced by the Independent Fiscal monitoring Report. I am therefore pleased that P&R and ESS are willing to work with us over the next year to develop a more appropriate funding model.
Now moving away from the Committee’s direct spend, I would like to focus on a couple of health and social care issues connected to the budget, namely obesity and alcohol abuse. Paragraphs 4.48 to 4.51 refer to the position with regard to sugar tax as set out in the Healthy Weight Strategy agreed by the last States. The evidence for a sugar tax is mixed and at the same time there is uncertainty over the introduction of such a tax in the UK. What is clear, however, is that the public health messages around obesity, the devastating effect it can have on people’s lives through diabetes and heart disease, have had limited effect to date. That is why the strategy included the proposal to set up a separate body responsible for promoting healthy weight and active lifestyle. Work has already commenced on this and an update will be provided next year.
In relation to alcohol abuse, in paragraph 4.43 it sets out the relevant extract of the Drug and Alcohol Strategy and the aim to reduce the availability of cheap and heavily discounted alcohol and irresponsible promotions. It has become very apparent to me since being involved in health and social care the immense impact alcohol abuse has on our society. From physical and mental health problems to domestic abuse and violence. It costs the Island over £20m a year to deal with issues arising out of the effects of alcohol, more than the £12m revenue we raise through duty.
And Whilst duty is clearly a favoured option from a revenue generating perspective, it is not a targeted approach and we need to do more. Last week, Scotland’s Court of Session ruled that Scottish Government’s landmark policy to introduce a minimum 50p unit price on alcohol did not break EU law after a legal challenge of the Scotch Whisky Association. The Committee is keeping a close eye on developments in Scotland and whether there will be a further appeal and will consider whether similar legislation should be proposed here in accordance with the Drug and Alcohol Strategy.
Sir, just to finish, I should like to reiterate that the budget for health and social care is a challenging one, there’s nothing new there. The last decade has demonstrated that developing a Health and Social Care budget is just a method of worrying both before you the spend money as well as after it. However, if, and only if we think differently and work differently we have a chance and we need to make that a reality, not just within the States but by all those who provide health and social care.