Proposed Government Plan 2024-2027 (P.72/2023): thirtieth amendment. Freeze on Public Health staff appointments.

STATES OF JERSEY

PROPOSED GOVERNMENT PLAN 2024- 2027 (P.72/2023): THIRTIETH AMENDMENT

FREEZE ON PUBLIC HEALTH STAFF APPOINTMENTS

Lodged au Greffe on 28th November 2023

by Deputy A. Howell of St. John , St. Lawrence and Trinity

STATES GREFFE

2023  P.72 Amd.(30)

PROPOSED GOVERNMENT PLAN 2024-2027 (P.72/2023): THIRTIETH AMENDMENT

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1  PAGE 3, PARAGRAPH (l) –

After the words "as set out at Appendix 3 of the Report" insert the words –

", except that, on Page 10, after the words "£3m on an ongoing basis." there should be inserted the following, "The funding provided for the public health function is predicated upon a freeze on any recruitment within the service, whether due to increases in staff numbers or fulfilment of vacancies, until a full business case for the public health function has been produced, scrutinised, and approved."".

DEPUTY A HOWELL OF ST. JOHN, ST. LAWRENCE AND TRINITY

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 2024 – 2027 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 2024 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  refer  to  their  Act  dated  30th September  2016  and  to  approve  the application of existing resources for work on the development of user pays' charges  in  relation  to  all  aspects  of  waste,  including  commercial  and domestic liquid and solid waste;
3. to approve the proposed Changes to Approval for financing/borrowing for 2024, as shown in Appendix 2 – Summary Table 2 to the Report, which may be obtained by the Minister for Treasury and Resources, as and when required, in line with Article 9 (2)(c) of the Law, of up to those revised approvals;
4. to approve the extension of the use of the existing Revolving Credit Facility to include the provision of funds that would otherwise be implemented through bank overdraft or bank overdraft facilities under Article 26 (1)(a) of the Law, should they be needed, subject to the limits outlined in that article;
5. to approve the transfers from one States fund to another for 2024 of up to and including the amounts set in Appendix 2 – Summary Table 3 in line with Article 9(2)(b) of the Law;

6. to approve a transfer from the Consolidated Fund to the Stabilisation Fund in 2024 of up to £25 million, subject to a decision of the Minister for Treasury  and  Resources  based  on  the  availability  of  funds  in  the Consolidated Fund as at 31 December 2023 in excess of the estimates provided in this plan, or from budgeted underspends identified before 31 December 2024;
7. to approve each major project that is to be started or continued in 2024 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;
8. to approve the proposed amount to be appropriated from the Consolidated Fund for 2024, 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;
9. to  approve  the  estimated  income,  being  estimated  gross  income  less expenditure, that each States trading operation will pay into its trading fund in 2024 in line with Article 9(2)(h) of the Law and set out in Appendix 2 – Summary Table 6 to the Report;
10. to approve the proposed amount to be appropriated from each States trading operation's trading fund for 2024 for each head of expenditure in line with Article 9(2)(i) of the Law and set out in Appendix 2 – Summary Table 7 to the Report;
11. to approve the estimated income and expenditure proposals for the Climate Emergency Fund for 2024 as set out in Appendix 2 – Summary Table 8 to the Report; and
12. to approve, in accordance with Article 9(1) of the Law, the Government Plan 2024-2027, as set out at Appendix 3 to the Report, except that, on Page10, after the words "£3m on an ongoing basis." there should be inserted thefollowing,  "The  funding  provided  for  the  public  health  function  ispredicated upon a freeze on any recruitment within the service, whether due to increases in staff numbers or fulfilment of vacancies, until a full businesscase for the public health function has been produced, scrutinised, and approved.

REPORT

This amendment seeks a commitment from Government to pause any recruitment for the Public health team, either through filling vacant posts or through new roles, until such time as they have provided a business plan for full scrutiny and approval by the Assembly.

The reasoning behind this amendment lies in the confusion that there exists about the growth of the function and its fundings.

A simple example is that that within the Government plan is found the following –

And yet in a recent letter from the Minister for Health and Social Services to the HSS Scrutiny panel –

"There is no underlying growth in Public Health FTE proposed for 2024."

This could be explained away – perhaps this is the difference between a growth bid and underlying growth  –  but  for  Members,  and  indeed  the Public,  reading  these  two statements, they seem at odds.

There are further areas of disconnect that can be identified. The above referenced letter to Scrutiny goes on to state –

"Within the Public Health department currently there are 51.5 FTE posts (including some  vacancies),  these  posts  are  funded  through  core  Public  Health  funds, departmental transfers from HCS, Jersey Care Model (JCM), Building a Safer Society (BASS), and COVID-19 pandemic funding. The 2024 Government Plan is proposing that the JCM, BASS and Covid funds are replaced with ongoing core public health funding to maintain the Public Health functions that have developed between 2020- 2023.

The proposed 2024 FTE as described in the Annex of the Government Plan 2024-2027 is 61.

This is comprised of:

• 32 FTE for the core public health team;

• 11 FTE for reducing preventable diseases;

• 5 FTE for the Child Health team;

• 3.5 FTE for the Health Promotion team; and

• 9.5 FTE to support existing major incident recovery posts."

WQ.450/2023 provides further breakdown of the funding for the above sections for the last five years. However, there is a disconnect within the Reducing Preventable diseases team as there is a jump from four staff in 2023 to 11 in 2024. This discrepancy does not seem to be detailed anywhere. Despite multiple notes from Government in both the

written question and in the Minister's letter to Scrutiny, explaining over discrepancies in staff numbers, this one is not touched on.

It does not seem to be clear in any of the public documentation, where the additional 7 roles have come from.

In broader terms, there is a lack of clarity about what the funding will be used for, the specifics of how and why this is being applied.

The Government Plan provides little information about the funding of the Public Health function –

 Covid-19 has shown the need for greater resilience and support for the public health function; therefore this plan provides £3m on an ongoing basis.

The Annex to the Government Plan does go further and on page 17 details –

-SPP-GP24-004  Maintaining  the  Public  Health  and  Health  Protection Function

 Public health services are critical for keeping the island safe, preventing disease, reducing health inequalities, and improving the population's health, through for example, managing outbreaks of infectious disease, developing alcohol policy, or delivering child nutrition programmes. Short term funding has  been  invested  since  2020  to build  the health protection function  and commission  or  deliver  some  health  improvement  services,  ensuring  that islanders are kept safe and ill health such as diabetes and hypertension is prevented  and  reduced.  The  Government  Plan  provides  the  salary  costs associated with the existing public health staff, enabling the development of joint strategic needs assessments (JSNA), public health law, delivery of some health improvement services and public health campaigns.

What this text does not explain is how the function has swelled from 7 FTE in 2019 to 51.5 FTE in 2023 – and then to 61 FTE in 2024.

What can be seen from the information provided within Written Questions 404/2023 and 450/2023, is that posts have been transferred into the function from multiple areas. Funding has been provided from multiple, unsustainable areas. And overall, there is a lack of cohesive whole.

This amendment does not seek to take funding from the Public Health function. It merely seeks some clarity about the business case for the function as a whole – and transparency and scrutiny of both the aims of the function and the number of FTE required.

Financial and staffing implications

There will be costs and staff time associated with preparing a business plan, should one not already exist. However, this is considered an essential part of business as usual.