Independent Jersey Care Inquiry (8) ---- A Licence to Bill?

Next Tuesday the States is due to debate a proposition lodged by Chief Minister Gorst seeking approval for additional funding to enable the Committee of Inquiry (COI) to complete its review which is just about to enter its second year. Trying to come up with a figure for any Inquiry is not just difficult but almost impossible because no one knows how many witnesses will come forward or what evidence will come to light. The Jersey Inquiry is proving to be no different.

It was anticipated that around £6 million would be suffice but 12 months on not only has that figure been spent but a further £13.7m is being asked for. Senator Gorst has repeatedly proclaimed his support for the COI and although his proposition (see below) is well meaning I believe it is flawed so it's pleasing to see that Deputy Tadier has lodged amendments seeking to delete 3 of Senator Gorst's proposals.

The Amendments can be read below but in summary they seek to delete the sub-paragraphs which will cap the £13m, impose a time limit and interfere with the way the COI is conducting its Inquiry. All 3 sub-paragraphs have a single theme and that is to save money. That is a theme I don't have a problem with but Senator Gorst and the Panel Chairman Frances Oldham should be keeping a close check on how the money is being spent and whether it is justified. From the payments made to date it is evident that there is little monitoring particularly of the legal fees incurred by States Departments which appear to be obscene.

Although the proposition and amendments have been lodged there is no certainty they will be supported as there is a school of thought that much of the extra funding will go into the pockets of the Island's Lawyers. There may be more than a whiff of truth in that claim as can be seen from the answers given to a set of questions asked by Deputy Mike Higgins at the last States Sitting.

The full set of questions and answers can be accessed below and readers will see how the money has been spent to date. As anticipated a fair chunk of the money has been spent on set up costs, accommodation, travel and other expenses some of which will not be recurring. However one will note that several millions have already been spent on legal fees with over £1.8million paid to lawyers representing States departments and individuals. Who approved the appointment of the lawyers, why were they appointed, who are the individuals, do they include former staff and/or State Members, why is the money coming out of the Inquiry fund and not from the departments and individuals concerned? Perhaps if it came from Department funds they might be more than circumspect about spending it.

If £1.8m has been spent during the stage when only the victims have given evidence, how many more millions will be spent when the COI starts looking into the Departments (in)actions and Operation Rectangle. In football parlance we have only had the pre match warm up, the match is only about to begin.

It is also worth noting that on top of the £7m a further £4.6million has been spent in relation to the Redress Scheme. Ex-gratia payments totalling £1.8million have been made to 116 victims. The victims would have been entitled to compensation much earlier had the climate which prevails today been open to them in the past but the legal fees need an explanation. The legal fees incurred by lawyers representing the Care Leavers (Compensation Scheme) amount to £408k. However the lawyers representing the States have been paid over £2 million. Why is there such a discrepancy in the fees, who has authorised the payment and were the fees justified?

Whilst I have expressed concerns over fees paid to local lawyers it would be remiss of me not to comment on the £2.7million paid to the Inquiry Lawyers. I understand that there is a fee structure similar to that paid to those representing the Care Leavers and victims. It should be recalled that legal teams have travelled far and wide taking statements from witnesses. They have also spent a great many hours at the Hearings. Can that be said of the lawyers engaged by States Departments?

I want the COI to continue and whilst I accept there will be occasions when lawyers will be required they should not be given a licence to bill for work that is not justified and at exorbitant rates. Sub paragraph (iii) of paragraph C of Senator Gorst's proposition will require the Inquiry and the States to jointly publish on their websites details of expenditure on a monthly basis.  This is much welcomed and I look forward to a much more detailed breakdown of the expenditure incurred by States Department along with reasons as to why legal assistance was required.

Deputy Higgin's Questions can be read HERE
Senator Gorst's Proposition can be read HERE
Deputy Tadier's Amendments can be read HERE

Sativex---------A Glimmer of Hope??

In my previous blog I mentioned that this week the States was to debate 3 cannabis related propositions. The outcome was predicable but it was the quality of the debate that was disappointing.

States Members have the ability of lodging propositions seeking States approval on a variety of issues. There are many Members who never do but fortunately there are a handful like Deputy Monty Tadier who do and he is to be complimented for lodging the 3 propositions which sought to improve the lives of those who through no fault of their own suffer pain and discomfort.

One of the propositions (P127) which can also be read below requested the Health Minister to take steps to make Sativex Spray available without cost to MS patients. The other 2 propositions were much more contentious because Deputy Tadier was seeking support to allow for cannabis to be prescribed for medicinal purposes.

Deputy Tadier decided to debate the Sativex Spray proposition first as it was relatively straight forward and I shall devote this blog to that matter. I will declare an interest because my wife has MS and when asked if she would be the petitioner to represent other MS sufferers she readily agreed.

Before Backbencher’s propositions are debated the relevant Minister normally lodges “Comments” indicating whether the proposition is supported, if it is not, reasons are given. Deputy Tadier lodged his proposition on 16^th July. The Comments which are below were published on 8^th September however the debate was deferred due to the impending elections. It should be noted that after the elections there was a change of Minister. However the new Minister Senator Green did not lodge his Comments until the 8th of December which was the day before the debate but his comments differed from the previous Ministers. 

Both Ministers opposed the proposition but it worth noting their reasons. The previous Minister Deputy Anne Pryke’s Comments could be summarised as follows.

Sativex can be supplied by any pharmacy, in accordance with the doctor’s prescription. It is, however, only available as a private prescription and costs have to be met by the patient.

Previous application from a consultant to make Sativex available via the Hospital pharmacy – in that case specifically for patients suffering with MS (Multiple Sclerosis) – has been rejected by the Hospital Drugs and Therapeutics Committee, based on assessment of clinical evidence and cost-effectiveness.

This decision has recently been corroborated by NICE in its draft revised guidance which does not recommend the use of Sativex for MS patients.

Current Health and Social Services Policy directs that the Department will not provide treatments at public expense where NICE has rejected that treatment. Final NICE guidance on recommended treatments is expected later this year and, should the advice on the use of Sativex for MS patients be amended, this position will be reviewed.

The issue within this proposition, therefore, is whether funding for a NICE non -recommended treatment should be met by taxpayers, at the expense of other treatments that are approved by professional, clinical expertise. The cost to the taxpayer of providing Sativex to any one individual patient would be in the region of £4–£5,000 per year.

There is no way to predict how many patients may subsequently be prescribed this treatment and, therefore, the potential overall impact on the Department’s already stretched annual drugs budget.

While it is available for prescription, Sativex remains a non-NICE approved treatment, and I cannot support a proposition for its supply to be funded by the taxpayer.

It is evident that the previous Minister could not support the proposition, because Sativex is not recommended by NICE, it is expensive even though Health does know how many people might need it but the Hospital Drugs and Therapeutics Committee, has already rejected the one application from a consultant based on assessment of clinical evidence and cost-effectiveness.

One is left to wonder whether the officer briefing Senator Green was the same who briefed the former Minister because it was not the information conveyed by Senator Green to States Members on Tuesday and confirmed by email to me.

Three weeks before the debate I wrote to Senator Green with a number of queries, unfortunately his answer below which was the information he gave to States Members was not sent to me until a couple of minutes after the vote had been taken. The following is an extract.

I am mindful that, ordinarily, Sativex is only available on private prescription. However, there is an existing mechanism in place for a recognised Consultant in an appropriate specialism, to make a request for public funding of such a treatment on behalf of a specific individual.

The treatment of patients must always be based on clinical assessment and professional expertise. But where clinical judgement can demonstrate that there are exceptional circumstances in an individual case, which would support the prescribing of this licensed product, a special request can be made for the cost of treatment to be met through public funding. To date, no application has been for exceptional consideration in such circumstances has been received. For these reasons, Monty’s petition is, to all intents and purposes, redundant and that’s why I do not intend support it.

Although the former Minister said there had been an unsuccessful application Senator Green says there have been none. If there have been none it would not be surprising because I doubt whether GP’s or their patients are aware of what appears to be a policy change introduced by Senator Green. I can confirm that my wife and her MS circle of friends are not aware of the policy change but know full well that if recommendations have to go via a consultant the whole process could take many frustrating months.

I mentioned above that the quality of the debate was disappointing and that was because apart from Deputy Tadier who proposed the proposition and the Minister responding the only other Member to speak was the newly elected Senator Dr Zoe Cameron who had made it known that she had been elected to try to get the health service fit for the future.

She had featured in the Jersey Evening Post that day in which she had expressed her dissatisfaction with politics mainly because she had not been given the Health Minister or even the Assistant Minister’s post. However on Tuesday she had the ideal platform to speak about the plight of MS patients, the merits of Sativex and informing Members whether she was aware that it was available albeit via the Consultant route. Also had she contacted Chemists she could have informed Members that the cost of Sativex in Jersey would be around £3000 and not the 4/5k as quoted in the Comments.

It is estimated that possibly one person in a thousand may have Multiple Sclerosis (MS). As there are around 100,000 residents in Jersey there could be around 100 people with MS who have various stages of the disease. Sativex is primarily to relieve spasticity which can be a problem for some people with MS. Although the number of people who would benefit from Sativex is unknown it is likely to be only a small percentage of 100. The reason why not exact figure can be given is because Sativex has only been available to those who can afford to purchase it.

Sadly it is evident that Senator Cameron did not pick up on the contradictions in the former Ministers Comments and the current Ministers speech. She had an opportunity of informing Members of how the current system is not working but failed to do so. Her short uninspiring speech added nothing to the debate, it was hardly the stuff of a potential Minister and she was one of the 29 Members who voted against the proposition.

The debate lasted less than 20 minutes and Deputy Tadier’s proposition received 16 votes which were around the same number he received for his other propositions. He might not have won the vote but he shook some branches in relation to the issue of Sativex because not withstanding the previous Minister’s Comments the current Minister says that Sativex can be freely prescribed if supported by a GP and Consultant. 

I have written to Senator Green asking what steps he is taking to ensure that MS patients and their GP’s are informed of his policy.

Readers might find this blog posted by Tony the Prof to be of interest---Please click here

Sativex Proposition P127/2014

Details of the Vote for P127

Bedrocan Proposition P126/2014

Cannabis; Possession of cannabis for treatment purposes P128/2014