Electronic Patient Records (R.21/2024): executive response

STATES OF JERSEY

ELECTRONIC PATIENT RECORDS (R.21/2024): EXECUTIVE RESPONSE

Presented to the States on 7th May 2024 by the Public Accounts Committee

STATES GREFFE

2024  R.21 Res.

REPORT

In accordance with paragraphs 69-71 of the Code of Practice for engagement between Scrutiny Panels and the Public Accounts Committee' and the Executive', the Public Accounts Committee (PAC) presents the Executive Response to the Comptroller and Auditor General's (C&AG) Report entitled: Electronic Patient Records (R.21/2024, presented to the States Assembly on 8th February 2024).

Deputy I. Gardiner

Chair, Public Accounts Committee

COMMENTS

The Committee has reviewed the Executive Response to the report Electronic Patients Records' and has the following comments to make in respect of it.

It is noted that this is the first report to be responded to with a new format for Executive Responses. These changes have been agreed by the PAC and provide additional detail in relation to priority areas arising from the recommendations, as well as providing further narrative around the risk of non-implementation which has not been routinely identified within previous responses. These changes are welcomed by the PAC.

The PAC notes that the timelines identified at the start of the response are mostly set to the end of March 2025, with one priority area being set at the end of June 2024.

The PAC notes that the target date for action one within the Executive Response appears to amalgamate two actions to achieve implementation by the end of March 2025. The first part of action one is intended to map out major and strategic Digital Change projects with a significant M&D delivery component (across government) to establish a roadmap for the duration of the government plan that can be rolled over into future planning periods. This includes total cost plans.

The PAC is of the opinion that this deadline is particularly long when considering the overall spend that is being committed by the Government of Jersey in the Information Technology space. It appears to the PAC that the work that will be undertaken in time for March 2025 relates more to the building blocks' for the success of future projects rather than the delivery of a project itself. As a result, the PAC would expect to see further information on the key milestones that Government intends to achieve in this time ahead of the implementation date of March 2025 and whether these can be brought forward at all for the first part of this action- mapping exercise.

The Government must ensure that the total costs attributable to projects are reported in the Annual Report and Accounts alongside details of expenditure in the relevant year of account. It must also refine the approaches to project reporting to ensure easy visibility of total costs incurred to date and budgeted expenditure that is forecast for future years. It should be noted that any implementation within 2025 will need to be budgeted for in the Government Plan 2025 – 2028, which will be debated earlier in 2024 than previous years due to it being planned to be lodged on 9th July 2024. As a result, the PAC would question whether this timescale is appropriate in relation to clearly identifying the budget required for 2025.

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Furthermore, when considered in the overall context of Modernisation and Digital's (M&D) workplan, the PAC would also raise questions over the capability and capacity of the team to implement this programme alongside the myriad of other programmes. This is noted especially in relation to the spend on consultants that has been attributed to projects within M&D's remit. It would expect to see further information about the constraints and risks for the project (as well as the overall M&D workplan) and a clearer understanding of the potential risk of non-implementation of recommendations that may not be achievable in current timeframes.

In relation to the response to benefits management, the PAC also has the following comments to make. Benefits realisation is an important aspect in any project, and it would expect the programme to fully document the intended benefits and whether these have been achieved or not. In response to the recommendations made in the C&AG report, the Government provided the following information around benefits management:

As detailed in the response to the Major, Strategic and Other Projects Report, the embedding of frameworks to support effective benefits management will be a focus of the CPMO 3-year strategy which will be published by mid-2024.[1]

The PAC notes that it is intended for the Corporate Portfolio Management Office (CPMO) 3-year strategy to be implemented by the end of June 2024, which contain the frameworks to support effective benefits management. This is a positive development and is welcomed by the PAC. However, the PAC has noted that a number of programmes within the capital programme (as noted within the response to the Major and Strategic, including Capital Projects C&AG report) currently do not observe fully the frameworks of the CPMO. Whilst this is purely an IT related project, the PAC would expect to see further evidence of how the project is following the framework and meeting the standards as set out by the CPMO already.

The PAC would also draw attention to its view in relation to end user engagement during the implementation of this project. There does not appear to be, in the response, any mention of how the end user (whether this be the Health and Community Services Department itself or Members of the Public utilising the services) have been consulted in the development of this project. The PAC would expect to see evidence of this when considering the benefits realisation of the project and will look at this further in its future planned review of procurement across the Government of Jersey.

Conclusion

In conclusion, the PAC is pleased to see updates to the Executive Response template which better understand the risk narrative around non-implementation of recommendations. However, in respect of the response provided, the PAC will be examining further the need for the lengthy timeline and seeking clarity over the milestones that will be achieved in this time. Furthermore, the PAC would highlight the concerns around ensuring any budget for implementation in 2025 is clearly set out within the Government Plan 2025 – 2028.

Clarity is also required around the overall capability and capacity of M&D and the PAC will be examining this further. Also, it is important that the work in relation to benefits management of programmes, through the CPMO, is implemented as a matter of priority. Furthermore, consideration must be given to how end users of systems are consulted as part of the implementation and planning of these programmes.

Finally, the PAC notes that a number of pieces of C&AG work, including this particular programme, fall within the overall procurement space of the Government of Jersey. It has agreed that it will be undertaking a deep dive review into the overall procurement processes within Government, and this will focus on the recommendations made by the C&AG across a number of reports, including this one.

Chief Executive and Chief Officer for Health and Community Services response to C&AG Report: Electronic Patient Record - Executive Response to PAC by Friday 22nd March 2024 please.

Summary of response:

The Chief Executive and Chief Officer for Health and Community Services welcome the C&AG's report. All recommendations are accepted. Officers have discussed with the C&AG and Chair of the PAC a slightly revised approach to the presentation of responses, which is believed will drive a greater proportion of implemented improvements. The information below is presented in this revised format, which focusses on a prioritised improvement plan. Government will monitor delivery of this improvement plan and anticipates being challenged on its delivery by the C&AG and PAC. The responses to individual recommendations are then linked to the improvement plan.

Reports such as this should drive positive change. The Chief Executive considers that the revised format makes much clearer the improvement that will result from reports of the C&AG, but feedback from the C&AG and PAC is welcomed to promote continuous improvement.

This improvement plan will ensure that overall programme and project management, with a particular focus on Digital Change projects, is strengthened and that benefits management will be improved.

The C&AG's comments on planned work that should be prioritised and areas for consideration are also noted and welcomed. Work is ongoing on a technology strategy; consideration will be given to increasing the capacity of technical experts; and recruitment is underway for a dedicated Chief Information Officer role for health and community services within Government.

Prioritised improvement plan to address recommendations:

Risk Assessment and decision rationale