Health and Social Care

Deprivation of Liberty Safeguards

HSSD presented its proposals for a new Capacity Law at the last States meeting. Included within this were recommendations for deprivation of liberty safeguards (DOLS) to protect the most vulnerable in society. It was subject to an amendment to delay until the UK has decided what it was going to do to amend its legislation. The amendment was defeated and then there were calls from the proposer of the amendment to take it out completely. I set out below my speeches urging members not to support the amendment and then in main debate, to support the policy letter in full. The policy letter ended up being passed fully and without amendment.

Speech – main debate

Sir, this isn’t a health issue at all, although it’s more applicable in health and care settings. It’s a human rights issue. It’s about how we protect the liberty and dignity of those citizens among us who are most vulnerable to having their freedom of choice taken away.

I think HM Procureur has made it very clear that this policy letter has been written to be human rights compliant. Just taking out the DOLS will just lead a coach and horses through it. It is the flip side of the same coin – the capacity law results in giving powers over someone without capacity. DOLS gives that person without capacity protection. It’s as simple as that. That is why it is required. That is why, if we don’t include DOLS, the Privy Council are quite likely to throw it back. That is the risk.

Now to cost. Comments made yesterday by Deputy Dave Jones just exemplify why mental health services have been the Cinderella of our services for so long. So much easier to spend money on drugs and operations that you can see.

Of course, we would like more investment in community nurses and social workers. It is needed, but it must not be a binary choice between one or the other, because that’s simply not he reality.

This is, as Deputy Perrot has said, a good news story, and I urge members to support this policy letter in full.

Speech – amendment

Sir, Deputy Hadley is nothing if not consistent. Here he is laying yet another unnecessary amendment. This policy letter is the result of extensive consultation with those professional concerned. Deputy Hadley references a meeting with 2 psychogeriatricians and I think I need to make it clear what actually happened at that meeting.

At the Board meeting where this policy letter was discussed, Deputy Hadley said that a couple of psychogeriatricians did not like it the DOLS and therefore he couldn’t support it. Following that meeting, I agreed to meet with them and Deputy Hadley, together with the States’ consultant psychiatrist of adult mental health, head of older adults services, director of communities and the law officer involved.

At that meeting it was clear that the psychogeriatricians has been led to believe that this policy letter was actually the law. They were advised this was not the case. It was also clear that there was a lack of awareness as to the legislative process here and that we would have little ability to develop a law different from the UK. The final concern was with regard to the term Deprivation of Liberty. It is a phrase that is tainted due to the system that has been put in practice in the UK.

It was explained that the term comes from Article 5 of the EU Convention of Human Rights, which Guernsey has incorporated into its law through the Human Rights (Bailiwick of Guernsey) Law, 2000. Article 5 states that;

“Everyone has the right to liberty and security of person. No one shall be deprived of his liberty save in the following cases and in accordance with a procedure prescribed by law”. Therefore, in order for our law to be compliant with the convention we have to use the same phraseology.

However, that does not mean this has to be used as the standard term, merely that it is made clear that wahtever term is used it has to be referenced to the term Deprivation of Liberty. I believe the proposals suggested by the Law Commission when they went to consultation included changing the term in the UK to ‘protective care’.

It was made clear at that meeting that no-one wanted to follow the UK. We wanted a balanced and proportionate law for Guernsey. In fact this is an opportunity for Guernsey to be ahead of the UK and set the benchmark, not follow. AND, AND, we could do that and would do that through working with the professional to develop the legislation, regulations and subsequent codes of practice. There is nothing in this policy letter that says this will be anything like the UK.

At the end of that meeting the professionals, just note, the 2 profesioanls with concerns, were assured. Deputy Hadley said that he was, if they were. Great! It was a good meeting. Then, 2 days later, we heard Deputy Hadley wasn’t happy and couldn’t support the policy letter – again!

Sir, the problem here is, I’m afraid with Deputy Hadley, not this policy letter. Sir, Deputy Hadley is alone on this and I urge all members to reject this amendment.

States Welfare and Benefits Investigation Committee Report

A major policy letter that hit the meeting of the States was that produced by SWBIC. Here is my speech.

 

Sir, This is a good report. It is well-balanced, which I think reflects the diverse make up of that Committee, which I mean in a positive way. I would just like to comment on one aspect of the report and that is in relation to the implications of moving people from rent rebate to supplementary benefit.

On page 1956, paragraph 161 it states that the proposed unification of the system will potentially bring an additional 930 households, comprising 2,275 individuals, into scope of free medical and para-medical cover.

Now, I don’t want Members to think I believe that wrong. Quite the contrary. The report published a year ago by CICRA on the primary healthcare market stated that 50% of those respondents to their consultation has been put off going to the GP because of the cost. We don’t want that. All that means is people aren’t treated in time which in the end can result in more serious long term conditions and proportionately more expensive treatments.

However, I think it is important that Members are made aware of the impact that this might have on health services, at least in the short term, before things settle down, as we see increased demand arising from referrals from GPs. We don’t know the impact at this stage but it is not rocket science that it will result in greater demand.

I had drafted an amendment on this area but decided that, after discussing this with Deputy Le Lievre, that it was sufficient that I just make my concerns known for the record. However, I do believe that the future Committee for Health and Social Care with that of Employment and Social Security will need to keep this under review, possibly at the same time as addressing the recommendations of the CICRA report in relation to charges for GP consultations in general.

Having said that, it makes complete sense to me merging the rent rebates into supplementary benefits. It results in greater transparency and that has to be a good thing. So, finally, I would say well done to SWBIC and hope everyone supports these proposals.

Sugar Tax

An amendment was placed against the Healthy Weight Strategy by Deputy Hadley to introduce a sugar tax from the beginning of 2017. The Strategy sets out that this will be researched before bringing it in. My speech against the amendment is set out below.

 

Sir, I do urge members not to support this amendment. The policy letter makes it clear that HSSD, Home and Treasury & Resources will investigate the potential  for administration and implementation of a tax on sugar sweetened beverages.

Why do we say that and not go the full hog and do what Deputy Hadley wants?

Well, for a start, the evidence of the effectiveness is contradictory. Yes Deputy Hadley refers to the Cancer UK and UK Health Forum reports which assert the potential to introduce a sugar tax.

A report published by Christopher Snowden of the Institute of Economic Affairs last month raises considerable doubt on the effectiveness of sugar taxes. From research done ono the impact of said taxes in other jurisdictions, the report concludes that;

  1. demand for sugary drinks, snacks and fatty foods is inelastic.
  2. Consumers respond by switching to cheaper brands of the product or shopping in cheaper shops. This leads to the consumption of inferior goods rather than the consumption of fewer calories.
  3. Taxes on sugary drinks leads consumers to switch to other high claorie drinks such as fruit juice, milk or alcohol.
  4. Taxes on energy dense food and soft drinks take a greater share of income from the poor than the rich, exacerbated by low income consumers being less responsive to price changes than the rich.

and finally and perhaps most pertinent here, no impact on obesity or health outcomes has ever been found.

So, faced with that research are Mebers happy to support the introduction of a sugar tax today?

Sir, as I have made clear more than once in this Assembly, I believe in making evidence based decisions. I know that I’m not the only here either. I can’t agree to bring in an indirect tax when its effectiveness is open to question and cant do it on the basis of purely money raising. And on the latter front, we have no idea what could be raised and how much it will cost to administer.

That is why proposition 4 says what it does, that is why we should focu on education and awareness and consider the healthy carrot rather than the stout stick of yet more taxes.

With the creation of an independent body, with the sole purpose of implementing the healthy wieght strategy, it can work.

The strategy to date has hardly been an overwhelming success. More of the same would not represent value for money. We need to engage and partner with others, and that includes in terms of funding. It would be easy saying yes to an extra £250k but we can’t keep on clobbering the taxpayer. We have to think directly.

So, for all these reasons, I urge members to reject this amendment.

Breastfeeding Strategy

March 2016 saw the States approve HSSD’s breastfeeding strategy. I opened debate and my speech is below.

 

Sir, I’m pleased to present the first breastfeeding strategy for Guernsey and Alderney. Sadly, it has taken longer to get here than originally directed by Deputy Burford’s successful amendment, for which we apologise. However, I can assure members that this did not mean the Board were not wanting to give it the attention is deserves. The Minister in his previous incarnation was a seconder of the amendment after all.

What we want to achieve through this strategy is for breastfeeding to be considered the normal thing to do for mothers and what they will want to choose to do.

 

So what? Well, there is clear evidence of the health benefits to both mother and baby of breastfeeding. Mothers have a lower risk of acquiring diseases such as breast and overian cancer whilst babies benefit in the short term from lower infection rates and in the longer term as adults through lower risks of obesity and diabetes.

The focus on prevention and early intervention is, as we have made clear already in previous debate, an essential element in the transformation to a sustainable health and social care service. And so this strategy has a part to play in that.

Now, we haven’t set any targets. Something I am sure Deputy Burford will be pleased about, although given the scant information on breastfeeding, we had little option and that is something I will address in a minute.

So, no targets, but the objectives are to increase rates of initiation of breastfeeding and for continuation to 6-8 weeks, an increase in places where women can breastfeed and attaining the UNICEF baby friendly imitative accreditation.

TO achieve this we are looking at 4 areas. Firstly through data collection and analysis, so we know what’s happening and can target resources where they are needed. At the moment it is not easy to extract valid statistics to monitor breastfeeding initiation and continuation and so, when data needs to be obtained it has to be done manually and whilst exercises have been undertaken in terms of numbers breastfeeding, we don’t have reasons why the rates are as they are. As an example, we know that in January this year only 67% of women were breastfeeding, either fully or partially, on discharge from Loveridge Ward. We don’t know why. Further details on December figures from the 6-8 week health visitor visit showed that 50% were fully artificially fed with 25% bottle-fed from birth. Again, we need to know why.

 

Through education and awareness, we need to let Mums know the benefits. These aren’t just medical, which tends to be the general focus but also psychological, as the closeness helps the bond between mother and baby. I breastfed both my children, something that as teenagers they don’t wish to be reminded about. I can’t say whether it has helped me from a health point of view but I do know it is something that created a bond, well quite literally, but certainly emotionally.

The third area of focus is the need to help women breast feed. Most importantly we need to improve support to new mothers. It can be quite daunting thinking about it. Some mothers to be may worry they may not be able to do it as they won’t be able to produce enough milk. Well, on that front all I can say is, speaking  personally, I can confirm that size really doesn’t matter when it comes to breastfeeding.

Women need consistent, helpful and up to date advice to enable them to make informed choices. That latter point is crucial. What we don’t want is Mums being made to a feel guilty for not breastfeeding and not force themselves to breastfeed if it is not working for them. At the same time it does take practice. For some it is easier than others to start but, practice more often that not does make perfect and supportive consistent advice has a big role to play to help Mums from the beginning.

Finally, we want to ensure there is wider community support and acceptance. One of the things we would like to do is bring in a scheme that enables employers and businesses to demonstrate they are breastfeeding friendly. Things have moved on from only a few years ago when Mums were told to stop breastfeeding in public but we really need to make women feel comfortable breastfeeding in cafes and restaurants. There should be no stigma associated with breastfeeding, it is what our bodies were designed for after all.

At the same time we need to raise awareness amongst employers about the need to support who are breastfeeding. Now, that doesn’t mean bringing in baby for the mid-morning snack. But it does mean helping Mums who wish to express milk.  The less a Mum breast feeds, the less milk she produces the more she needs to top up with formula. For me, going back to work was beginning of the end of breastfeeding. And I suspect I’m not alone.

So, in terms of funding, in the long term, through increased prevention and early intervention that raising breastfeeding rates will contribute to this strategy should save money. However, in the short term, we will be reprioritising funding to kick-start the implementation. In particular to enable us to work with the third sector to develop a peer support programme. The latter is, I believe going to be crucial. The problem in any strategy like this, just as healthy weight, is that it is far too easily seen as government telling people what to do. Whether it is right or wrong, it can make it harder to get buy in. That is why a peer support programme is important and, just like the HWS that’s whay working with the 3rd sector makes so much sense.

Sir, breastfeeding is best for Mum, baby, the health service and taxpayer. From the evidence we do have, we know rates in Guernsey demonstrate both poor uptake and continuation of breastfeeding. Whilst there is good work done by many, a co-ordinated strategy is needed to increase rates and support future Mums to be.

I therefore ask Members to support this policy letter.

Children and Young People’s Plan

I made the following speech at the February 2016 States meeting.

Sir, so here we have it, another strategy, but one that has an integral part to play in the transformation of HSSD. As the Plan makes it clear, it is just part, although an incredibly important part, of a wider whole.

Key to this is providing a joined up service to users, in this case the children and young people rather than the current labyrinthine structure of different services that they have to find their way through.

Early intervention is another theme that runs through this plan. Again, a key strand to the overall transformation of our health and social care services.

We all know it makes sense, deal with an issue before it blows up into something that will require more expensive and complicated intervention.

Of course, this is always a difficult approach to take, as the results can take years rather than weeks or months.. BUT that is where a difference will be made. We have seen how short termism through annual targets in the FTP led to tactical savings whereas what was really needed was more strategic transformation.

This is the nub of the problem.

 

Will the next States and the one after that, hold its nerve as the service goes through its transformation? It isn’t going to be a short journey after all and it will not be achievable without the support of other departments, because that is the point. The transformation of the health and social care service is part, a huge part, of the overall public service reform.

This Plan makes that fact very clear. It will not be achievable without partnership and engagement both within and outside the States.

For instance, the Committee for Education, Sport and Culture has a part to play.  It was clear from the report that children wanted more support available in school. That makes perfect sense.

We also have to remember that issues that children face can occur irrespective of their backgrounds. Loneliness, abuse, neglect, concerns over sexual and gender identity can happen irrespective of where a child or young person lives or what their parents or carers do. In fact it can sometimes be harder for children in a very loving family to discuss their issues for fear of causing upset which in turn affects their mental wellbeing. That’s why schools have a major part to play.

But we do know that for some children, their life story could be written before they are born. They may be few in number, but the amount of time and resources expended on them and their families is disproportionate to the wider population. On social workers, health workers, police and education services, to name just a few.

That’s what makes the  strengthening families initiative so important. But we also need to stop the cycle and that’s where the 1001 days programme comes in.

Now I attended the presentation on 1001 days in January last year. It was absolutely fascinating and what made it compelling for me was the science behind it. How a childs brain development can be directly affected by various influences on it from conception to 2 years old. The groundwork for good citizenship occurs in the first 1001 days. A society which delivers this for its children creates a strong foundation for almost every aspect of its future. A society which fails to deliver it generates enormous problems for the future in terms of social disruption, inequality, mental and physical health problems, and cost. The programme seeks to ensure that happens.

All sounds great, but The States can’t do it itself and it can’t do it without funding. How do we do it without cutting services elsewhere or raising taxes, neither of which hold much appeal after 5 years of FTP. The use of social finance, or ethical investing, could really make a big difference here

Ethical investing already exists here. Some members here like me may put money towards micr-finance initiatives like Kiva that help entrepreneurs in the developing world. Social finance is very similar, but on a larger scale and directly benefiting the Guernsey community. Investors only get a return, if the desired outcomes are met. Of course it means detailed planning to get parameters right, setting out responsibilities and putting reporting structures in place, but we aren’t reinventing the wheel here and based on experiences elsewhere, this could be  the right solution for what we are trying to achieve.

So, where are we now? As with SLAWS, HSSD has not been put everything on hold to awit the strategy.

Well,  it was clear from the Children’s Diagnostic undertaken just after the Board took office that we could not afford to wait for this strategy to come here today. We really couldn’t. It made stark reading which made it clear we were failing our most vulnerable children.

Work has already begun with a prototype MASH, or Multi-Agency Support Hub. It is already making a difference but we now need to take it to the next level. We need to bring in the strengthening families scheme and 1001 day programme in as soon as we can. If we don’t the intergenerational transmission of disadvantage, inequality, dysfunction and child maltreatment will continue.

And  through partnership and engagement this is an area we can make a difference.

So, there we have it, the CYPP reflects the wider transformation through integrated services, early intervention, thinking differently in terms of funding and partnership and engagement. It all looks great on paper and we are seeing it begin to look great in action. But we now need to raise our game and do so now.

Supported Living and Ageing Well

I made the following speech at the February 2016 States meeting.

 

Sir, Being not far short of 400 pages, this is a beast of a document but in my opinion a seminal work.  It covers every aspect of the subject matter BUT,

It is also a sad reflection of  the failure of government over many years to take a strategic approach to our ageing demographic. Instead, we have seen a haphazard build up of services and funding, which is now completely unsustainable.

If there is anyone here who doesn’t realise we have a problem, and I can’t believe there is, – just go to page 585 and look at the graph – a forecasted doubling of expenditure in 20 years on extra care and benefits.

We just can’t continue to do what we have been up to now. It reinforces the conclusions of the BDO work. That is why a transformation of our health and social care system, not just the department,  is critical.

I’ll demonstrate that by focusing on just one area that is well covered in this report and something that over the last year I have learnt a lot about, and that is dementia.

Dementia is a cruel, insidious parasitic monster that eats away at a person’s essence and soul. It turns the most eloquent and intelligent human being who you have loved all your life into a hollow fractured shell. And what makes it worse is that is does so in the  knowledge of the person being attacked taunting them, frightening them, resulting in anger, frustration and depression. It is relentless, it is merciless in its actions and impacts not only the person unfortunate enough to be afflicted but those they love and who love them.

And because it doesn’t happen overnight, but gradually and progressively, the transition from bring the partner, son or daughter to carer happens without those providing that care actually realizing that is what they have become. It starts, perhaps with helping to find a pair of glasses, then it can lead to helping put a coat on, then doing all the cooking, cleaning, washing and ultimately to more personal and intimate help.

At the same time, a carer has to keep track of the myriad of medicines that are prescribed, which is amplified when that person has another condition, which is quite often the case. It is cocktail of drugs that constantly have to rebalanced.  It is not an exact science, so sometimes a change in prescription can completely change someone behavior overnight and the carer has to deal with that. Often alone and not knowing where to turn and with no support or training.

Now, I don’t share Deputy Lester Queripel’s talent for poetry, although I do enjoy reading it. Poems can clarify issues and get at human realities beyond the jargon. And recently I have been looking at poetry about dementia. One in particular was so powerful that I don’t think I’d be able to get through it. However, I did find one that really set out very well the position of the carer and I will read just an extract of it now;

There’s no end to the daily grind,
No button which could time rewind,
Each and every effort undermined,
No way out that anyone can find,
Life of carer and caree so entwined,
Yet each in their own way lose their mind,
To our fate we all must be resigned,
It’s just the blind leading the blind…

 

At the CWP conference we hosted at the weekend, in this very chamber, and how fantastic it was seeing every seat occupied by women – certatinly more colourful!, delegates spoke about the value of carers. We has a particular speaker, Dr Tazeem Bahtiia from Kings College London who talked about the need to monetarise the value of carers to the economy. The fact that they are unpaid, means that their value is not taken into account in policy making. In the document, it is estimated that the value to this island of carers is £29m pa. and yet we have no strategy for carers and  indeed the only member of the BIC that does not have one.

We must start doing something now a view shared by Ageing Well in the Bailiwick in their recent letter setting out where they see action is required in the near term.

In terms of dementia specifically, they state that, ‘There is a feeling that specialist provision for dementia is stretched and that generalist services are not well-eqiupped to provide good support to people with dementia. Both are areas in which further development would be welcome. Members also lack of continuity and coordination between services.

I’d actually say it is more than a feeling.

They refer to Community care and not being geared up to provide care in a preventative way. I would also say that things continue until something goes wrong.

In terms of respite care – there is a lack of provison and support for carers with a lack of formal respite care options – true

And finally, Information – there is a lot of concern among its members about the lack of comprehensive, accessible information about the range of services and support available to people who may need to use them and about how to navigate the system. I can verify that– I’m Deputy Minister of HSSD and been left not knowing where to turn next.

Now I am all too aware that 12 of the 30 recommendations in this policy letter are directed at HSSD many others will involve HSSD input. With the best will in the world these will not be achievable at once, but some things can and must be done as a matter of priority and, in my view that means co-ordinated and focused support for carers. It does not need a strategy to start making real changes.

Now  this is just one aspect of this incredibly complex but critically important policy letter. And iIt is a shame that it comes at a time when we have so many other highly important matters to consider.

Because The Supported living and ageing well strategy, like the CYPP which we will be debating shortly, have a key part to play in the transformation of our health and oscial services.

And how we support carers go to the heart of HSSD transformation. – co-ordinated care – an integrated service going to the user or carer, not the other way round.  Early intervention and partnership and engagement.

The cases of dementia are expected to double in the next 20 years, and we can therefore assume that the same will be the case for carers.  That is unless we can find a big pot of money at the end of a rainbow and the States does it all. So, we now need to see action not words.

So, this is a hugely important document and one that is long, long overdue, but what really matters is making the vision a reality.

Work has begun in HSSD but it can’t do it alone, it will need partnership and engagement within the States and from the third sector and other outside parties. I am confident that with that desire for change and support, it will aftr many years begin to happen and with commitment will be achieved far sooner than currently envisaged.

HSSD – increased funding request

HSSD presented a policy letter to the States in July 2015, requesting funding for 3 areas: work required following the Nursing and Midwifery Council’s Extraordinary review, recruitment and retention and finally children’s services. The NMC review arose following the very sad death of a baby in 2014 and concluded there were significant failings that gave serious cause of concern for patient safety. A series of recommendations were set out and the NMC made it clear that they would be monitoring progress over the next 12 months. Recruitment and retention relates to problems experienced not only on Guernsey but worldwide, in relation to the recruitment of nurses. The CEO of the States of Guernsey set up a taskforce to address the issue and a series of recommendations were provided for consideration by the Board. A review of children’s services, commissioned by the Board earlier in the year made it clear that there were major weaknesses that needed to be addressed and that, were Ofsted to review the service it would likely to give a ‘no assurance’ report.

The Board came to the States requesting £3.4m with reduced funding for later years. However, this was not about throwing money at a problem. The funding is needed to help towards the transformation of our health and social care services. This is no easy job and requires setting of key objectives and prioritisation if it is to be achieved. This is what I elaborated on in my speech during the debate.

The policy letter was approved by the States.

 

Sir,

I believe the report makes it clear the challenges that face HSSD at this present moment in time. Let me rephrase that, this report gives a high level picture of the challenges that face HSSD at this time.

 

It is fair to say that a lot needs doing, but it is not possible to do everything at once. The setting of key objectives and prioritisation has been and continues to be essential. With that comes a need for discipline.

A scattergun approach to issues goes contrary to what we are aiming to do for the short, medium and long term transformation of HSSD. That does not mean that this should prevent early identification and mitigation of safety issues. Patient safety is paramount and whenever this has been raised as a concern it has been investigated.

A disjointed approach whereby work is done based on who shouts the loudest is not acceptable and will only makes matters worse, rather than better. That has been frustrating for each and every member of the Board, of course it has, but if any positive change is going to happen it is essential we remain focused.

I would also like to thanks our 2 non-States members, Dr Alex Christou and Mr Roger Allsopp for their contributions which have been knowledgeable, reasoned and measured over the last 9 months.

Those members who attended the presentation given by our Chief Officer earlier this year will be aware of the integrated programme of reform that has been developed for HSSD. A programme that focuses on doing the right thing for those we serve, in the right way, to achieve the right outcomes and deliver the right organisation.

The aim, of course, is better outcomes for service users, staff, taxpayers and the States of Guernsey as a whole.

The funding requests today related to children’s services, the workforce and secondary healthcare represent just 3 of those programmes.

The Costing, Benchmarking and Prioritisation exercise has been invaluable. It is not about cost cutting but transformation. For the first time we have real information with which we can make evidence-based decisions, in the short, medium and long term. But it is not going to be something that can be achieved overnight, as the Minister pointed out yesterday in response to Deputy Bebb. Neither can it be done without some upfront investment. How we manage that is for another day but what we are requesting today is the start of a journey.

I didn’t agree to join the HSSD Board lightly as the Minister I’m sure will attest to. It did take some persuasion.  I knew it was going to be a difficult job and it has certatinly proven to be so, in more ways than one. There is so much to do but already the Department has come a long way and for that a huge thanks must go to all those staff, within and across Departments who have already made a positive difference in what have been difficult circumstances.

Green Acres Dementia Care Home

It became obvious to me very early on as a member of HSSD that the ageing demographic of Guernsey would result in growing pressures on the department in the next ten years. We want to be able to see people supported to be able to live independent lives as far as possible in their own homes and that it is a major strand in the transformation of health and social care services that we are now developing. It makes sense economically and socially.

However, there is currently, and there will increasingly be, a need for specialist care homes for those of our community who can sadly no longer look after themselves as a result of dementia.

After a long saga of refusals and appeals, the application finally went to an open planning meeting. I spoke at the meeting and my speech is below. In it I focussed on the discrepancies in Commerce and Employment’s argument that Guernsey could not afford to lose the bed stock. I supported the planning application and change of use request for Green Acres whilst on the Commerce and Employment Board and I continue to believe that the Department needs to review its policy of opposing any application for change of use of existing tourist accommodation.

Common sense prevailed in the end and the application was granted.

Speech to Open Planning Meeting

“I would like just to focus on the adequacy of bed stock both now and in the foreseeable future.

The 65% occupancy level set by C&E is stated in the RAP supplementary booklet as

‘minimum occupancy rate which, it considers, will be necessary to sustain a viable sector. It states, and I quote ‘the quality of accommodation offered by the Island’s visitor sector has been in overall decline, relative to the market. This is probably due to a lack of investment resulting from low average occupancy figures.’

The cumulative average occupancy rates for the last 10 years has been 56.77%, lower than the 57.42% in 2004, with an all time low of 51.17% last year. Not only that, but this is signifcantly below the 65% minimum occupancy levels set by the Department. So the Department is actually resisting a planning application that supports its policy.

Reference to seasonal occupancy levels are a red herring. If demand increases in the winter period, hotels may look to open year round, or extend their operating periods, to meet it, especially if it means that the room rates they can charge do not have to be heavily discounted.

In terms of losing bed stock were Green Acres disappear, it shouldn’t be forgotten that it is not included in the Aries figure. Were it to be, given it is has zero occupation, the average occupancy levels will reduce further. It should also be remembered that plans were submitted and permission approved to build a new hotel with roughly the same number of rooms as Green Acres, just a mile down the road at Jerbourg.

In terms of the future adequacy of bed stock, reference is made to  C&E having developed a policy for the future for tourism and that is to grow tourist population to 400,000 by 2025. It should be pointed out that this is an objective, forming part of its strategic plan. It has not been approved by the States of Deliberation and does not represent States policy. Set out in that strategy are action plans, some of which will require funding. The one that stands out being the extension of the runway. Given that the strategy has not been approved by the States and the Department will have to go to the States to obtain funding, the success of the strategy is far from assured.

Whilst it is an excellent document certain statements do raise question marks over  comments made by the Department in its submissions.

For example, in its submission the Department makes the point that there are very restricted opportunities in planning terms for the development of new or additional visitor accommodation. However, in the strategy it lists one of its action plans being to facilitate access to States land and property for Tourism Development.  By resisting this application it implies that the Department doesn’t hold out much hope of success.

Finally, and going back to the objective of increasing the tourist population to 400,000 by 2025, this represents a 25% increase in tourist numbers. If it is assumed, and there is no reason to believe it shouldn’t be, that this will also mean a 25% increase in staying visitors, there will still be sufficient capacity to absorb the increase for the next 10 years based on occupancy levels over the last 10 years, averaging just 57%.

It is clear that there is a surplus of bed stock that is unsustainable. Far from seeing Green Acres as a problem, this should be seen as an opportunity both to maintain a sustainable and viable tourist sector, and to support a desperate need for members of our community.”

 

 

Medical Officer of Health 115th Annual Report

This report was criticised by the Minister of HSSD as being neutral when;

“It should pioneer, inform and shape the core a reas of health and social care strategy within our Bailiwick, especially bearing in mind the mounting pressures our Island faces in terms of emerging healthcare needs, plus the ageing demographic, where we want people to age well in our Island.”
I totally agree with this statement. I responded to comments made by a previous HSSD Minister, Deputy Hunter Adam.
Sir, I was very surprised by Deputy Adam’s comments about priority setting. As a Member of the Treasury & Resources Board he should be well aware of the benchmarking process currently being undertaken jointly by HSSD and T&R, and a major aspect of this is a prioritisation exercise, a process which has already begun and in which, by the way, the Medical Officer of Health has been involved.
Deputy Adam is correct that prevention is only one of the criteria that need to be used to be
able to prioritise effectively. It also includes safeguarding, urgent and crisis response, early
intervention – to name just three others. That process has begun, as I say, and we are considering various criteria and how to prioritise. I query Deputy Adam’s comments that we cannot compare with other islands. Well, we should. The point is to compare our own costs to similar jurisdictions, whatever their delivery structure is.
How else can we determine whether we are delivering services in the most effective way unless we do?
And finally, the Medical Officer of Health mentions the importance of public engagement.
Well, Members may recall that in the Personal Tax and Benefits Review I mentioned the HSSD Board’s desire to do just that later this year.
Finally, I need to respond to Deputy Adam’s comment that he would have expected a fuller
response from the Board in the covering Report, and I would just like to say that we were given only a few days in which to read it and comment; so that might explain the brevity, but it does not mean that we have not taken it seriously.

Tobacco Strategy 2015-2020

I am pleased to have been a member of the HSSD Board that proposed the Tobacco Strategy for the next 5 years. Amongst the recommendations were the banning of smoking in cars with children present, the introduction of plain packaging and consideration as to whether there should be regulation of e-cigarettes. I focussed on this issues in my speech, which is set out below.

Sir, I believe the strategy speaks for itself and is fully aligned to the 2020 Vision of promoting, improving and protecting the health and social wellbeing of all. Whilst some may have concerns regarding smoking in cars with children present and plain packaging, these are hardly new ideas. We are really just playing catch up.

In terms of smoking in cars, this will shortly be introduced in England & Wales. Scotland is looking to do the same thing and similar restrictions exist in many other countries such as Australia, Canada, Cyprus, South Africa and several US States.

Of course We must continue to focus attention on preventing children from taking up smoking. Those who start under 18 are the ones that find it hardest to give up and succumb to the worst illnesses. But that is not enough. Children are far more sensitive to tobacco smoke because their lungs and bodily defence mechanisms are still developing, because they inhale far more pollutants per pound of body weight than adults, and because they are more likely to have allergies or other conditions which make them more sensitive to airborne pollutants.  We protect adults from smoking in pubs but not those who have no choice but to get into a vehicle full of pollutants. We require seatbelts in cars, we require children to be strapped into appropriate care seats for their age, BUT we don’t try to protect them from what they breathe in.

This is not about being a nanny state, this is about the future health of our Islanders and our Island.

In terms of plain packaging, again, this is not new. Whatever the tobacco companies like to say, this has been a success in Australia and will shortly be introduced in England & Wales. Claims by the spokesperson  for those with tobacco interests in the Channel Islands that this is illegal have no basis in fact. Indeed, in Australia, the big 3 tobacco manufacturers Imperial Tobacco, BAT and Philip Morris made a legal challenge in 2012 but the High Court ruled ruled that it was not illegal as it did not represent an appropriation of company trademarks by the government. The government was using the brands for its own profit, it was prohibiting their use by the tobacco companies.

Plain paper doesn’t mean plain white. In Australia they are sold in standardised dark brown packaging with large graphic health warnings. There are no tobacco industry logos, brand imagery, colours or promotional text on the packaging. Brand and product names are printed in small text. The only reports that claim that it does not work are those funded by the tobacco companies, unsurprisingly.

I also found it ironic that the spokesperson said that by having plain packaging in Guernsey and not Jersey will make it less viable to import cigarettes. I’d say that was a result. And then to be told in the last line of his email that CITIMA exists to promote balanced and informed debate around smoking issues in the Channel Islands took the biscuit for me. A bit like American National Rifle Association wants a balanced and informed debate about firearms I suppose.

Finally, e-cigarettes. They sound like the perfect solution – guilt free smoking BUT E-cigarettes maybe smoke-free and tobacco-free, but they’re not nicotine-free. The liquid in e-cigarettes is typically a combination of nicotine, flavorings, propylene glycol, and other additives. The amount of nicotine depends on the mixture of the particular liquid-nicotine cartridge installed in the device. Some products contain nicotine amounts comparable to regular tobacco cigarettes, while others contain levels closer to that of a light or ultralight cigarette. And the problem is the liquid nicotine. According to the American Centers for Disease Control and Prevention, The number of calls to poison control centers regarding e-cigarette nicotine-infused liquids rose sharply every month between September 2010 and February 2014, from just one call per month to as many as 215 As many as 51.1 percent of those calls involved accidental poisoning of children under the age of 5. Research has also shown Certain e-cigarette devices may also release metals during use — including tin in some cases — as well as other impurities known to be toxic and/or carcinogenic.

Concerns in the US led to the Family Smoking Prevention and Tobacco Control Act last year that requires manufacturers to disclose all ingredients in their products, and have FDA approval before marketing them. Additionally, e-cigs can’t be sold to children and all labeling must include health warnings; free samples and vending machine sales are also prohibited. Ecigarettes are also banned in public venues in Australia, Canada and several US States. Despite the marketing claims that e-cigarettes are safer than smoking tobacco, researchers are finding e-cig users experience diminished lung function, airway resistance and cellular changes, regardless of whether or not they currently (or ever) smoke cigarettes. And research has shown cells exposed to e-cigarette vapour show unhealthy changes similar to cells exposed to tobacco smoke.

So, ecigarettes may be the perfect solution but not for those using them. It is no surprise that the major tobacco companies, faced with falling customers for traditional cigarettes in the West are piling into this market. Marketing them as safe alternatives and getting them placed next to the sweet counters in shops. It is for all these reasons we must look at regulation and control of e-cigarettes.

 

The SOG tobacco strategy has been a great success over the years and I urge members to support this, the latest phase in that strategy to enable the good work to be continued.

 



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Email: heidi@heidisoulsby.com