Proposed Government Plan 2022-2025 (P.90/2021): ninth amendment. Mental Health Services

STATES OF JERSEY

PROPOSED GOVERNMENT PLAN (P.90/2021): NINTH AMENDMENT

MENTAL HEALTH SERVICES

Lodged au Greffe on 29th November 2021 by the Health and Social Security Scrutiny Panel

STATES GREFFE

2021  P.90 Amd.(9)

PROPOSED GOVERNMENT PLAN (P.90/2021): NINTH AMENDMENT

____________

1  PAGE 2, PARAGRAPH (f)

After the words "Appendix 2 - Summary Tables 5(i) and (ii) of the Report" insert the words–

",  except  that,  in  Summary  Table  5(i)  -  2022  Revenue  Heads  of Expenditure, the General Reserve Head of Expenditure shall be decreased by £500,000 with the Head of Expenditure for Health and Community Services increased by the same amount in order to increase the 2022 allocation for Mental Health"

HEALTH AND SOCIAL SECURITY SRUTINY PANEL

Note:  After this amendment, the proposition would read as follows –

THE STATES are asked to decide whether they are of opinion

to receive the Government Plan 2022 – 2025 specified in Article 9(1) of the Public Finances (Jersey) Law 2019 ("the Law") and specifically –

1. to approve the estimate of total States income to be paid into the Consolidated Fund in 2022 as set out in Appendix 2 – Summary Table 1 to the Report, which is inclusive of the proposed taxation and impôts duties changes outlined in the Government Plan, in line with Article 9(2)(a) of the Law;
2. to approve the Changes to Approval for financing/borrowing for 2022, as shown in Appendix 2 – Summary Table 3 to the Report, which may be obtained by the Minister for Treasury and Resources, as and when required, in line with Article 9
   2. of the Law, of up to those revised approvals;
3. to approve the transfers from one States fund to another for 2022 of up to and including the amounts set in Appendix 2 – Summary table 2 to the Report, noting that the transfer from the Consolidated Fund to the Technology Fund is subject to the Assembly's approval of a proposition to create such a Fund in 2022, in line with Article 9(2)(b) of the Law;
4. to approve each major project that is to be started or continued in  2022  and  the  total  cost  of  each  such  project  and  any amendments to the proposed total cost of a major project under a previously approved Government Plan, in line with Article

9(2)(d), (e) and (f) of the Law and as set out in Appendix 2 - Summary Table 4 to the Report;

5. to endorse the efficiencies and other re-balancing measures for 2022 contained in the Government Plan as set out in Appendix 2 Summary Table 6 and reflected within each gross head of expenditure in Appendix 2 – Summary Table 5(i):
6. to approve the proposed amount to be appropriated from the Consolidated Fund for 2022, for each head of expenditure, being gross expenditure less estimated income (if any), in line with Articles 9(2)(g), 10(1) and 10(2) of the Law, and set out in Appendix 2 – Summary Tables 5(i) and (ii) of the Report except that, in Summary Table 5(i) - 2022 Revenue Heads ofExpenditure, the General Reserve Head of Expenditure shall be decreased  by  £500,000  with  the  Head  of  Expenditure  forHealth and Community Services increased by the same amountin order to increase the 2022 allocation for Mental Health;
7. to approve up to £480 million to be appropriated from the Consolidated Fund for the Past Service Pension Liabilities Refinancing head of expenditure, subject to the availability of funding, which may include, in full or in part, use of the borrowing/financing referred in paragraph (b);
8. to approve the estimated income, being estimated gross income less expenditure, that each States trading operation will pay into its trading fund in 2022 in line with Article 9(2)(h) of the Law and set out in Appendix 2 – Summary Table 7 to the Report;
9. to approve the proposed amount to be appropriated from each States trading operation's trading fund for 2022 for each head of expenditure in line with Article 9(2)(i) of the Law and set out in Appendix 2 – Summary Table 8 to the Report;
10. to approve the estimated income and expenditure proposals for the Climate Emergency Fund for 2022 as set out in Appendix 2 – Summary Table 9 to the Report;
11. to approve an amendment to the policy of the Strategic Reserve Fund to enable that Fund to be used as a holding Fund for any or all monies related to the repayment of debt raised through external  financing,  with  the  monies  used  to  offset  the repayment of debt, as and when required; and l. to approve, in accordance with Article 9(1) of the Law, the Government Plan 2022-2025, as set out at Appendix 3 to the Report.
12. to approve, in accordance with Article 9(1) of the Law, the Government Plan 2022-2025, as set out at Appendix 3 to the Report.

REPORT

The Health and Social Security Scrutiny Panel has lodged an amendment to increase the funding for Mental Health Services by £500,000 in 2022, in order to assist the services which are experiencing pressure as a result of the Covid-19 pandemic. The Panel believes that this should be funded from the Covid-19 Reserve (set out as £30 million on table 9 of Appendix 3 to P.90/2021).

The Panel notes that the Government's mid-year review highlighted that there has been £1.6 million of additional investment in Mental Health services (between 2020 and 2021) and that this has been used to:

drive improvements in mental health services with new facilities and new services such as crisis prevention and intervention' teams'.1

However, the Panel highlights that this additional investment to adult mental health services in (GP20-CSP2-2-02) has been planned since the approval of the Government Plan for 2020-2023 (P.71/2019) in 2019. This highlighted addition was a planned increase pre-pandemic, and the amount of funding has not been changed despite the changed context of mental health services in 2021/22.

The Panel understands that the Covid-19 pandemic has created significant pressures on mental  health  services  and  for  Islanders.  The  wording  of  the  Government  Plan acknowledges the adverse impact that Covid-19 has had on mental wellbeing. There is a partial address of this issue with the new proposals for establishment of a Health and Social Recovery Fund and the Children's Health Recovery Plan, however, (other than support for perinatal mental health and the child to adult transition pathway), the initial proposed projects do not include any additional funding for adult mental health services. There has also been separate funding for capital expenditure on the mental health estate. However, the Panel is conscious of worthy initiatives supported by the funding in GP20- CSP2-2-02  that  have  faced  increased  pressures  from  the  effects  of  the  Covid-19 pandemic, which are still present in Islanders lives.

In a submission from Focus on Mental Illness to the Government Plan Review, the Panel was advised that:

The impact of Covid in terms of increase demand for mental illness services does not feature in the Government Plan. As a charity we are already seeing the devastating impact on some families affected by severe mental illness and the impact of Covid on family life.'2

The Proposed Government Plan (P.90/2021) itself states that:

The impact of Covid-19 on Islanders' mental health cannot be overlooked. We continue to commit to delivering services that will most effectively meet the needs of people with mental health conditions as well as those whose mental wellbeing has been adversely affected during the pandemic. Our Mental Health improvement plan is progressing well and will continue in 2022 with the aim to embed improvements to mental health services, ensuring we deliver the best care and support.'3

1 R Government Plan Mid-Year Review 2021.pdf

2 Written Submission, Focus on Mental Illness

3 R Government Plan 2022 to 2025.pdf, page 42 (accessed on 26/11/2021)

For its review of the 2022-2025 Government Plan, the Panel sent a letter to the Minister for Health and Social Services (the Minister') on 3rd November 2021, with a number of queries requesting a response by 12th November 2021. The Panel received responses to some of the queries on 22nd, 23rd and 25th of November, but there were still a number of responses outstanding.

The Panel had queried:

Mental Health and Mental Health Legislation

• How much of the £4.8 million funding for 2021 has been spent? Please can you provide a breakdown of this.

• Please can you provide a breakdown of the proposed £4.1 million budget for 2022?

• Please can you provide a breakdown of the £629,000 funding for Mental Health Legislation' in 2022.

• What is the focus of the mental health team for the priority of services in 2022?

A partial response was received by email from the Minister's officers on 26th November 2021. The Panel is disappointed that a response was not provided in the requested timescale, as this has impacted its ability to bring a more detailed and impactful amendment to P.90/2021.

On 26th November 2021, the Panel was provided with the following breakdown of the Mental Health funding for 2021 and the proposed funding for 2022:

4

The Panel notes that the proportion of funding for crisis resolution has increased since its review of the Government Plan in 2020 but, highlights from the table above, that the estimated budget for 2022 is £291,667 lower than the budget for 2021 (and is £144,597 lower than the forecast spend for 2021). The Panel queries if this is a realistic budget based on the increased pressures on mental health services due to the pandemic. Furthermore, the 2021 forecast annual spend on complex trauma (as per the table above), is more than £700,000 below budget. The Panel was not provided with this information in time to submit further questions about this.

From its review of the Government Plan last year, the Panel is aware that Covid-19 accelerated the crisis response / resolution work through the introduction of community triage,  intensive  outreach  through  the  Home  Treatment  Team  (HTT),  and  the strengthening of a focused liaison function. Per the breakdown of the budget provided above, this item forms the majority of the spend and the Panel is concerned that the original budget and plans for the funding have been de-prioritised. Additional pressures caused by the Covid-19 pandemic deserve additional funding and not the spread of funding that was initially intended for other matters.

4 Provided by email to the Panel on 26th November 2021

In a public hearing on 17th November 2021 the Group Managing Director of Health and Community Services stated:

We have to be clear that we have invested, so we have had an additional £4 million into these services. The Listening Lounge alone, when we established this  service  it  was  quite  a  definitive  expectation  between  £150,000  and £300,000. The cost of the service is significantly much more than that and we are funding that additional activity and we continue to fund that. We work with that provider every day around their activity requirement. They have gone up to around 26 staff, which we have supported in terms of them needing to recruit and that is taking a lot of activity. In relation to the wider services, there is definitely a need for us to ensure we have more capacity in crisis prevention and in the home treatment function, so that is the area that we are focusing on. There is funding within that, within the Government Plan.'5

From the information provided, the Panel is unable to identify the sums allocated in 2021 and 2022 for the Listening Lounge. From its previous review of the Government Plan, the Panel is aware that the total funding for the Listening Lounge service was estimated to £428,000 at the end of 2020 (the budget was £300,000). The Panel has been unable to revert with further questions due to the deadline for this amendment to be lodged. However, we did receive confirmation that the Listening Lounge would continue to be funded.6

In a submission to the Government Plan Review from the Service Lead at the Listening Lounge, the Panel was advised:

We continue to see an upward trend in demand that is mirrored by referral rates  to  JTT/PATS,  as  outlined  in  the  most  recent  HCS  Quality  and Performance Report (September 2021). This also identifies pressure points across several mental health services, manifesting as increased bed occupancy and unacceptable waiting times that are falling short of service standards.

The prior allocation of additional funding towards mental health provision was very much welcomed but, whilst there has been some progress in driving change, mental health support remains far from where it needs to be. A second Listening Lounge in the West of the island has been discussed previously, and certainly investment in additional community spaces that are shaped by the voice of service users would bolster the current network of accessible support by creating more front doors for islanders, across all ages and stages of life. It is essential that funding allocated to mental health services in the Government Plan is proportionate to the current context and level of need, and provides scope  for  a  considered  and  proactive  approach  to  service  development. Islanders' wellbeing needs to be prioritised as part of the island's ongoing recovery from the pandemic.'7

5 Transcript, Public Hearing with the Minister for Health and Social Services, 17th November 2021, page 16

6 Transcript, Public Hearing with the Minister for Health and Social Services, 28th October 2021, page 33

7 Written Submission, The Listening Lounge

The Panel has noted (in previous hearings and in the HCS Quality and Performance Reports) the backlog of referrals for certain services such as Jersey Talking Therapies. The Panel was keen to understand how this would be addressed by the funding provided in the Government Plan and queried the issue in a public hearing on 28th October:

Deputy K.G. Pamplin:

is there enough money in the Government Plan 2022 to meet the demand of, as predicted, the tsunami of people coming forward who need that mental health support for all those reasons? Is this enough?

Associate Managing Director, Mental Health and Adult Social Care: There might not be. Because there is a huge demand.'[8]

Conclusion

The Panel proposes that £500,000 of the sum held in the General Reserve for Covid-19 should be purposed to address the impacts of the pandemic on adult mental health services as part of GP20-CSP2-2-02, in order to address the identified backlogs and target the particular areas of need including support of its partnerships with the third sector, such as the Listening Lounge.

The Government has acknowledged the impact of the Covid-19 pandemic on mental health and wellbeing, and a key strategic priority is:

We will improve Islanders' wellbeing and mental and physical health by supporting Islanders to live healthier, active, longer lives, improving the quality of and access to mental health services, and by putting patients, families and carers at the heart of Jersey's health and care system'[9]

The Panel suggests that if the Government wishes to stand by this strategic priority, it should acknowledge the need for adult mental health services and match this with an increase commitment in funding to support service delivery through the remainder of the pandemic and beyond.

The Panel has maintained an interest in mental health services since its review of that matter (published as S.R.4/2019) and notes that it intends to undertake a follow up review into mental health services, starting in December 2021. The Panel hopes that the follow up review will be able to address some wider concerns relating to the delivery of mental health services in Jersey.

Financial and manpower implications

This amendment does not specifically relate to staff costs for the Government of Jersey; however, the intention is for the funds to be targeted for use in areas of need in mental health services, therefore, the manpower implications will be for the Department to determine in due course.