Management of the Healthcare Response to the Covid-19 Pandemic (R.70/2021): Executive Response

Recommendations

Action

Target date

Responsible Officer

R1 In light of the COVID-19 experience, review the expansion of the public health function proposed as part of the Jersey Care Model to ensure that it is properly equipped  to  address  future  health protection emergencies.  

Undertake review of public health function, to ensure it is equipped to support delivery of the JCM and future health protection emergencies. Includes a requirement to revisit the public health resources provided via the Jersey Care Model (JCM) to ensure they are sufficient to deliver the prevention agenda that is central to the success of the JCM  

Jan 2022

Director of Public Health

R2  Introduce  formal  procedures  to improve the documentation of specialist public  health  advice  to  make  it  clear what advice was given, and why that advice  was  given,  as  opposed  to alternative advice that was not given.

The new Public Health Law, subject to approval from the Assembly, will include a statutory duty to publish arrangements and procedures for public health decision making, including standards associated with reporting and recording advice given.

Dec 2022

Director of Public Health

R3 Ensure that all future material pieces of public health advice that are provided to  Government  contain  appropriate impact  assessments,  that  take  into account  the  impact  of that  advice  on vulnerable communities.

The new public health law will bring forward mandatory requirement for impact assessments including, where appropriate, in emergency response scenarios.

Dec 2022

Director of Public Health

R4 Develop and implement a Code of Practice for future STACs to encompass principles and procedures to be followed in determining membership, relationship with  the  sponsor  department  within Government,  independence  and objectivity,  working  practices  and communication and transparency.

Code  of  Practice  for  STAC  to  be  developed  and published.

End Q3 2022

Director General, SPPP

R5 Improve the records and minutes of future STAC meetings to provide a more complete audit trail as to:

• how advice given has been determined

• the  action  plans  arising  from  the meetings  (including  timescales  and responsibilities for actions); and

• the follow through of matters arising and actions taken.

Record keeping requirements to be included in the Code of Practice for STAC (as referenced in R4 above).

End Q3 2022

Director General, SPPP

R6  Ensure  risk  assessments  are documented to support decisions made on guidance issued to staff.

Partially accepted

Findings in the report refer to decisions being made on closure  of  services  in  the  first  weeks  of  the  Covid outbreak, decisions on testing and PPE for patients and staff. Lessons learned from these early days have been incorporated into operational decision-making during the year and risk assessments have taken place and better communicated to all staff. For example, action cards' have been produced as part of our operational plan which  set  out  clear  guidance  on  procedures  to  be followed and have been a great support to staff during the second wave.

However,  sometimes,  decisions  needed  to  be  made based on public health advice and legal requirements which had to be implemented.

This  recommendation  is  partially  accepted  because relative to decisions taken in the emergency command and  control  structure  and  considering  the  limited availability of staff to support the documentation and administration, a fully documented risk assessment may not be reasonable for every decision made at this time. However,  HCS  will  endeavour  to  acknowledge  and document any associated risks as part of the decision- making process and a risk log will be maintained.

Arrangements  in place

Group  Managing Director, HCS

R7  Undertake  a  formal  reflective evaluation  of  the  lessons  learnt  on business  continuity  planning  during 2020.

Partially Accepted

This recommendation is partially accepted as a

corporate review of Business Continuity was already planned in 2020 and an internal review of Business Continuity arrangements was started in Q2 in 2021.

Furthermore, the outcome of the review and actions required relative to lessons learnt to support business continuity planning will be agreed with the Department as well as corporately.

Recommendations arising from internal reviews, such as the last internal review of Business Continuity arrangements in 2017 are tracked and monitored, and a summary report is considered by the Risk and Audit Committee (which is attended by the C&AG, External Audit as well as the Chief Executive, Chief of Staff and the Treasurer of the States).

Dec 2021

Director of Risk and Audit.

R8  Introduce  formal  arrangements  to review  the  effectiveness  of  Business Continuity Plans on an annual basis and report the findings of these reviews to the Risk and Audit Committee.

Partially Accepted

At Departmental level, the departmental Risk Register, is discussed  at  least  quarterly  by  the  HCS  executive includes  a  consideration  of  Business  Continuity. Additional arrangements will be created to review the effectiveness of HCS Business Continuity Plans annually and to present back for assurance to the HCS Finance and  Performance  Committee  and  Quality  and  Risk Committee. (see appendix 1. Governance structure).

It  is  the  responsibility  of  departments  for  their  own Business  Continuity  effectiveness,  arrangements  for which  are  confirmed  as  part  of  departments'  annual

Mar 2022

Group Managing Director, HCS

Governance  Statements.  Issues  arising  from  these Governance Statements are reviewed by the Risk and Audit Committee.

At an organisational level, regular corporate oversight is achieved thought the enterprise risk management system and a formal risk review is undertaken monthly by People and Corporate Services. The outputs of these regular reviews inform departmental and Government risk registers and improvement opportunities will be considered by the Executive Leadership Team.

The Risk and Audit Committee is also due to consider the output of the internal review described in R7 above. However,  this  recommendation  is  only  partially accepted as it is unlikely that a formal internal review will be  conducted  and  presented  to  the  Risk  and  Audit Committee annually due to the existing controls and reviews that are in place.

Head  of  Corporate Services

R9  Review  the  COVID-19  experience and  develop  future  emergency pandemic preparedness to deal with the risk from high consequence infectious diseases  such  as  flu  and  COVID-19. There should be a formal public report produced to summarise the outcome of this review.

Partially accepted

HCS sees emergency planning as very important and lessons learnt from COVID-19 are incorporated into operational plans on a regular basis. Therefore, this recommendation is partially accepted with HCS focus: HCS Emergency Planning Team will produce an influenza response plan & ensure the COVID-19 response plan is current.

Reviewing the experience of Covid-19 has been or is still being undertaken at various levels in HCS and across other Government departments, for example,

Dec 2021

Group Managing Director, HCS

General Manager for Medicine, HCS

the HCS Community Bronze Cell review, internally at HCS across the affected hospital wards, and throughout the Government in the various teams. The findings feed into the above business continuity planning and the flu and Covid-19 response plans.

R10 Ensure that the Operational Plan for 2021  prioritises  reducing  waiting  lists and catching up on the cancer screening backlog.

HCS Operational Recovery Plans to be developed as part of the Operational Business Plans for 2021 and 2022.

Detailed  review  and  planning  to  take  place  across specialities and cancer screening programmes to define the requirements and costings to reduce the backlog.

Alongside this, clinical triage to be in place to minimise risk  &  productivity  review  to  ensure  maximal  use  of current capacity across breast & cervical services and development  and  implementation  of  pilot  bowel screening model which could further mitigate the impact of Covid on this screening programme.

Sep 2021

Group Managing Director, HCS

R11 Ensure future business cases for new  facilities  include  an  explicit assessment  of  the  staffing  risks  and planned mitigations.

Future development of business cases for new facilities will capture robust staffing data to mitigate operational risk. This element of work ties in with forecasting new revenue budgets/costs.

Dec 2022

Head of Estates, HCS

R12  Complete  the  final,  independent internal audit review of the GP surgery contract  payments  and  ensure  the outstanding  income  due  is  recovered promptly.

13 GP surgeries were contracted by GoJ to deliver this element of the response. Over the course of the 4-month contract term, GP salaries were paid by GoJ, and 90% of an estimated reasonable surgery expenses amount was paid in monthly tranches.

Subsequent reconciliation of surgery expenses over the contract  period  has  resulted  in  balancing  payments being  made  to  9  of  the  13  practices.  4  remain outstanding. In terms of recovery of GP surgery income, invoices totalling £2.548m were raised to surgeries in December 2020 on the basis of CLS appointment data.

Jul 2021

Finance Business Partner HCS

As at 14/05/21, £0.715m of the invoiced amount remains unpaid, and is to be followed up with individual surgeries before the end of May.

R13  Undertake  a  review,  led  by  the Jersey Care Commission, of business continuity  and  resilience  planning  in primary and community care services.

Partially accepted

This recommendation is partially accepted because such a review would be outside of the scope of the Jersey Care Commission.

However, the Government of Jersey recognises that a review of business continuity and resilience planning across primary and community care services to ensure joined up collaborative working would be beneficial. In support of this a Bronze Community Cell Review has taken place and is informing the development of the group to ensure future resilience across the community and primary care sector.

Dec 2022

Group Managing Director, HCS

R14  Introduce  systems  to  ensure comprehensive records are maintained of  completion  of  mandatory  training requirements.

HCS to develop further its use of Virtual College as the system to record mandatory training. Comprehensive records  such  as  training  details  for  PPE  may  need additional  systems  and  resources  and  are  therefore dependent on additional funds.

Dec 2022

Associate Director of People, HCS

R15  Review  the  States  wide Occupational Health service and ensure that any new tender meets the future needs of all HCS staff including access to confidential external counselling and support.

AXA is the current Occupational Health (OH) provider with a three year+ contract that expired 31 March 2021. The  latest  OH  tender  exercise  is  currently  being finalised and yielded a limited response in terms of level of interest and ability to provide the required services from the market. This is in part attributable to timings of the tender exercise coinciding with the height of the pandemic and its associated demands. This included the limited capacity and appetite that providers had for completing tender exercises.  

Dec 2021

Associate Director & Head of Organisational Development

Following  detailed  scrutiny  of  the tender  bid  by  the evaluation panel, AXA have been awarded preferred bidder status. Negotiations are ongoing to finalise the detail of the new contract. and an agreement reached whereby AXA will continue providing services under the existing terms until the new contract is signed.

R16  Undertake  a  lessons  learnt' exercise from COVID-19 to understand staff health and well-being needs (both physical and emotional) and build these lessons  learnt  into  future  training programmes and service designs.

For HCS, a lessons learnt exercise to be undertaken through the implementation of SCHWARTZ Rounds.

Further detail is provided about a corporate response in R17 below.

Jun 2022

Associate Chief for Allied Health Professions and Wellbeing

R17 Maintain comprehensive health and well-being  assessments  for  all  staff including any identified risks and how these are being managed.

Completed

Following the second wave of COVID-19, HCS have continued to offer a range of timely and accessible

wellbeing support to HCS staff. A full-time counsellor and psychological wellbeing practitioner are offering targeted therapy through self-referral for individuals where the need is identified. All HCS staff who are tested COVID-19 positive are offered a telephone wellbeing check and further support. Targeted group reflective sessions have been implemented in service areas that have found responding to COVID-19 challenging. A weekly drop-in wellbeing session has commenced offering group mindfulness and stress management strategies. A comprehensive self help guide about how to support your wellbeing is available for all HCS staff including access to digital apps. Recognising that improving wellbeing is most effective through peer support, managers and supervisors of HCS staff are being trained in having psychological

Completed

Associate Chief Nurse for Allied Health Professions and Wellbeing

savvy conversations' and signposting for support when needed. An HCS Wellbeing Committee has been set up for the purpose of co-ordinating and endorsing the development of a staff wellbeing programme for HCS.

On a corporate level, health and safety risk assessments are completed for individuals where there is a specific need. During the 2020 period, more specific need than during the Government's normal operational environment was recorded. Some reasons for risks assessments during 2020 were that more colleagues were experiencing stressful situations, some were highly vulnerable to Covid-19 and many were working from home. The Government provides training courses for line managers that cover how to carry out risk assessments as part of its commitment to ensuring staff have the necessary training to perform their roles effectively.

R18 Undertake a retrospective reflection and  learning  exercise  with  key stakeholders during the Spring of 2021. This  exercise  should  seek  to  identify lessons from the COVID-19 pandemic for future whole system working.

Completed:

Two reflections and learning exercises have taken place:

The  Covid-19  Hospital  Bronze  group  undertook  a reflective session on 4 August 2020. The output with lessons learnt from this session were presented to the HCS Senior Leadership Team in September 2020.

The Covid-19 Community Bronze Cell also undertook a session with their members and stakeholders as to their reflections in August 2020.

In addition, as part of COVID-19 planning for a second surge,  a  tabletop  exercise  was  undertaken  on  2 December 2020 with operational and clinical managers

Completed

Group Managing Director, HCS

within HCS to test our resilience and performance in the management of a Covid-19 surge. A reflective report was produced in December 2020 which included learning. This  was  presented  to  the  HCS  Emergency Preparedness and Resilience Group on 15 February 2021.

On a wider level, there is commitment to completing the revised Channel Islands Pandemic Strategy as soon as practicable  possible.  However,  this  requires  each jurisdiction (Jersey and Guernsey) in the coming months to consider their response to the pandemic, recognising the different strategies of suppress and elimination that were  adopted.  This  will  include  lessons  learnt,  the management  of  risk  and  solutions  implemented  to identify good practice which will inform strategic planning in the future. This will include what learning is available in both the local and wider contexts.

Director General, Justice and Home Affairs

R19  Provide  greater  clarity  as  to  the roles  and  responsibilities  of  the  HCS Accountable  Officer  and  the  Chief Nurse/HCS  Director  of  Nursing  when HCS step in to support services provided by third party organisations.

Report  with  greater  clarification  on  roles  and responsibilities to be created.

Jan 2022

Chief Nurse, HCS