Eye on the States

Sarah Ferguson asked a number of questions about GPs claims, such as

What checks and measures were made to ensure only legally allowable claims were made? How frequently have these checks been made in the last 10 years and in what form? Has evidence of other practices been looked for or found? If so, what action was taken?

The reply by Ann Pryke, Health Minister didn't reply directly to the bullet points of Sarah Ferguson's question, which is always a bad sign, indicating that there is going to be something missing which should perhaps be looked at more closely. I've noticed that Ministers are quite good at evading issues like this, and the Health Minister seems to do it a lot of the time.

Claims are checked automatically using embedded business rules within the Department's IT system before processing and invalid claims are rejected, according to those business rules. These rules include automatically rejecting multiple claims for the same consultation and alerting the Department if a patient has more than one visit/claim within 24 hours from a single surgery. In the latter scenario, payment is not made unless the surgery can confirm that it is a genuine instance of 2 separate claims. When claims are rejected, this information is provided to the GP, as each batch of claims is paid.

And she also notes that:

The claims submitted by GPs include information on the identity of each patient and the date and time of their consultation. If a GP were to falsify claims, this might amount to fraud and could be referred to the Police for investigation accordingly.

But here's the bombshell, buried in the depths of the reply. One tiny sentence, with no extra details:

Between 1 October 2011 and 30 September 2012 2,438 claims were disallowed

Now claims can be disallowed if out of time - six months is the time frame that Social Security works with or there could be multiple claims because of bad accounting. It's not fraud, but 2,438 claims disallowed (which admittedly is a small percentage of the whole - more than 400,000 over that period, although that wasn't mentioned in the written reply, and also we don't know the total value of these claims) suggests extremely poor and lax management at medical practices, and we have no idea from the very bland reply why that is. This is a written reply, so there is really no excuse at all for that lack of information, or for that matter, what steps are being taken to improve matters. After all, if a lawyer you dealt with suddenly sent you invoices dating back years on time on their records, would you regard it as acceptable, even if it only happened with a small percentage of cases? It's only £8,000 - nothing to worry about! But apparently doctors may be doing this with late claims over six months, or bad accounting and claiming twice!

Sarah Ferguson also asked about the Liverpool Care Pathway raising concerns. The reply noted the following:

The training covers 4 main areas which are ( in bold) communication and the need to discuss and engage with relatives at all times, to support a shared agreement in care, to provide support to relatives, to establish points of contact.

To date 23 patients have been cared for using the Liverpool Care Pathway within the General Hospital. There have been no complaints since its introduction.

It seems pretty amazing that this could be given out as a reply without addressing what certainly seems to be a very clear complaint. As Leah
Ferguson reported on Channel Television:

Islander Alan Booth says doctors forced his wife, Sue, to die, by withdrawing food and water for two days, without the family's consent. Although Sue had battled breast cancer for 7 years, she'd been told her cancer was under control. Alan Booth says, "The doctors murdered my wife. She didn't die naturally, she didn't die of cancer. She was put on a Pathway which is designed to kill. That was professed to be 'care'." "Her lips were dry and cracked and her tongue was completely solid - she was completely dehydrated. It was very disturbing to see her like that."

Reading that "the need to engage and discuss with relatives at all times", and "there have been no complains" seem a very hollow reply. At a time when the new Health Secretary in the UK, Jeremy Hunt, has announced an inquiry into the Liverpool Care Pathway, the Health Minister just doesn't seem in touch with what is going on here and elsewhere. I was speaking to a doctor who I know and they said they had very serious misgivings about the pathway. Why doesn't Ann Pryke? It looks very like a knee-jerk reaction to defend her department without actually looking into the matters except to get assurances from her medical team.

My own concerns about the Pathway are noted here:
http://tonymusings.blogspot.com/2012/11/where-does-pathway-lead.htm  

Stripped of its euphemistic covering of "peaceful, pain-free, dignified death", a patient is put into a near comatose state with drugs, and it appears that often liquids removed, which the official documents say is not a necessary part of the procedure, but appears to be what is happening in practice. Death obviously follows fairly quickly.

I'm reminded of Boxer, the horse in Animal farm, carted off to the knackers' yard at the end of his life. "Three days later it was announced that he had died in the hospital at  Willingdon, in spite of receiving every attention a horse could have."  As ever, George Orwell punctures the way in which rhetoric can so easily deceive.

Deputy Higgins was asking a question about the cost of vehicles used by the States of Jersey Police, and there's some interesting facts in the reply:

The States of Jersey Police currently has forty nine vehicles, a reduction of ten since last December. We anticipate a further reduction in the coming year. Of the forty nine vehicles, twenty eight are marked and twenty one are unmarked. The unmarked vehicles comprise of six vans, three bespoke dog vans and 12 cars, which are utilised by departments including firearms, roads policing, crime scene investigation and plain clothes units such as CID and financial crime. For obvious operational reasons, the Chief Officer is unwilling to disclose any further details of the unmarked vehicles.

So alas, we don't know what the unmarked cars are like, although most of the marked cars are either a Skoda or a Volkswagen, so I'd suspect if they bulk bought, it could be the same model of car. Or it could, of course, be the Ford range of cars, so beloved of the Sweeney!

And the spirit of Dixon of Dock is alive and well! As well as four motorcycles, they also have six marked police pedal cycles which are used by
uniform 24 hour response departments. Mostly in St Helier, I assume. Cycling off to the wilds of St Ouen would not be exactly fast response, but it's an interesting initiative, as cycles can often get past traffic jams and to locations around Town speedily. Do they have specially marked police cycle helmets is a question I would love to know, purely as a matter of trivia!

A reply to the question asked about the Electoral Commission noted that if the Constables were retained, that they would be elected on a Parish basis, not a district basis, in fact, just as they are at present:

All voters in St. Helier would elect and be represented by a 'whole' Constable, not half of a Constable. The fact that the parish would be divided into two districts for the Deputies elections would have no bearing upon the election, or representation, of the Constable. Under the present system, for example, there is no misconception that the electorate in St. Saviour District No. 3 is only represented by one third of a Constable. They are represented by the Constable of St. Saviour and their elected Deputy.

There's something rather comic about this idea of half a Constable representing a Parish! It conjures up a Jekyll and Hyde image of a Constable whose right half side votes with the Establishment, and whose left half side votes with Trevor Pitman, Geoff Southern, etc. It's like that Steptoe and Son episode where they split the house in half, and each saw half a TV set. But if you are sitting in the States Chamber, which side is the button to vote - your left or right? Obviously we need to know which half-Constable has the vote!

Incidentally, I notice that there are arguments on the left against a referendum. Sam Mezec says "The worst part of a referendum is that it accepts the principle that issues should be decided by the majority. That is not democracy. Democracy is about much broader principles than just doing what 51% of people want.  It is about inclusion, freedom and choice." I'll come back to that in a later blog, and his "straw man" argument that follows, but I sense that Plato's philosopher king, who knows what is best for the people, is lurking in the wings.

Gerard Baudains was asking about flooding particularly at high tides. It's a wonderful question, because of the curious historical reference in it. Is he talking about recent floods? No - 1812, of course! I've not been able to trace any details of the 1812 floods myself.

Can the Minister advise whether his department still acknowledges that in the event of, for example, severe southerly storms coinciding with a high spring tide (as happened in October 1812), certain southern areas of the Island would become a 'disaster area' and, if so, would he further advise whether this area includes the Green Street car park?

The reply by Deputy Kevin Lewis noted that there were problems, but

I acknowledge that in extreme weather events which coincide with high tides, areas of the Island are susceptible to coastal flooding which can cause varying degrees of disruption and damage. This most recently happened along the southern coast in March 2008. Whether the results of these events are considered "disaster areas" is subjective and depends on the severity of the event.

Alas, no further mention of  the past in his reply to Deputy Baudains 1812 overture! Actually, most dictionaries have a very similar definition, which is not really subjective at all - "An area that officially qualifies for emergency governmental aid as a result of a catastrophe, such as an earthquake or flood."

And finally from the 5 November 2012 Hansard, about a hole in the decking at the play area at Plat Douet School, Senators Farnham and Ozouf became briefly a comedy double act:

Senator L.J. Farnham: A very brief point of clarification, has the hole been fixed or not?

Senator P.F.C. Ozouf: I am advised that as of yesterday, because it had not been reported, it had not been but if it has not by lunchtime, then the Assistant Minister and I will go down with our hammers and solve it ourselves.

Does he go everywhere with his handy hammer? I think we should be told!