Questions to Minister without notice Health and Social Services

3.  Questions to Ministers Without Notice - The Minister for Health and Social Services The Deputy Bailiff :

Very well, we come on then to Questions to Ministers Without Notice, and the first period is to the Minister for Health and Social Services. Are there any questions of the Minister?

1. Deputy R.G. Le Hérissier:

Traditionally, the health budget has been very much orientated towards the hospital and its various services. Would the Minister tell us in a concrete sense what he is doing about diverting more resources into both adult and children's social services?

Senator B.E. Shenton (The Minister for Health and Social Services):

I thank the Deputy for the question. Obviously I have not been that long in the job, but the attention paid to Social Services and Children's Services since myself and Senator Perchard took office has been quite intense. It has unearthed quite a number of areas where we have found deficiencies and the need for more funding. The Children's Service or Social Services budget is currently around £21 million and there is an awful lot of work to be done. The more I get into the job, the more surprised I am at the amount of work that needs to be done. Part of it is because of a lack of investment in the past, but also part of it is because of the changing way that we look after people and we look after the needs of people with regard to more facilities for carers, more investment into the disabled, more investment into the Children's Service. With regard to the Children's Service, it would be wrong of me to pre-empt the Andrew Williamson report which is due out in a number of weeks, but certainly we will be looking at Social Services and we will be looking at adult respite and adult care with great detail because they are areas which are high priority for both myself and for Senator Perchard.

3.1.1 Deputy R.G. Le Hérissier:

Would the Minister acknowledge that while not driven by the same sense perhaps of crisis and urgency that it would be advisable if he were to set up a group or an individual with immense credibility to look at services like adult mental health services which are staffed by excellent people but are, benchmarked against other services, very poorly resourced?

Senator B.E. Shenton:

Yes, I think it is fair to say that the services we do provide, we do provide to a very high standard, but it is an area that can be expanded upon. I am all for working with the resources within the States Assembly. For example, Deputy Scott Warr en still works with the Health Department on Safer Routes to School and so on. I have spoken to Senator Le Main about input into the ageing population with his connections with Age Concern and his interests in that area. Certainly, the idea of setting up a sort of sub-branch to look at adult mental health services is a very good idea and I will take it further.

2. Deputy J.A. Hilton of St. Helier :

Can the Minister explain why he believes his department's decision to switch from full-time day care to sessional part-time service provision benefits the carers and parents of adults with learning difficulties?

Senator B.E. Shenton:

Again, this is an area that I have inherited rather than put in place myself. Perhaps if the Deputy could have a more comprehensive chat with me after this debate, we could try and find out exactly where she is coming from with regard to this question. It is obvious that the service must have some failings for her to ask the question in the manner that she has asked the question, and I would be delighted to talk to her and find out what they are.

3.2.1 Deputy J.A. Hilton:

The point I was trying to make was that Le Geyt Centre offered day-care provision to adults with learning difficulties and it is only in the recent past that they have changed to sessional part-time service. Obviously that has a knock-on effect for those parents and carers of adults with learning difficulties in that they then have to cater for the time that care is now not provided for their offspring.

Senator B.E. Shenton:

I was aware that we had changed the sessional part-time, but I was unaware that it was causing problems so I will be delighted to speak to the Deputy on that.

3. Deputy G.P. Southern :

Can the Minister examine his budget and find a better use for £15 million proposed to be raised towards a building and infrastructure of a national art gallery?

Senator B.E. Shenton:

Personally, I am not a big fan of the idea of an art gallery. One thing, with my Health and Social Services hat on, I will say that the provision of a town park is of vital importance to the residents of that area of the town. Under the New Directions Strategy we are looking at people undertaking a healthier lifestyle and I think it is very important that they have the facilities available on their doorstop to partake in more healthy activities. I believe that a millennium town park - and this is my personal opinion - is far more important than a national gallery.

4. Deputy S.C. Ferguson:

When the Minister took office, I gave him and his Assistant Minister a copy of the complete organisational structure of the hospital and some of the out-departments, from whence comes the legendary 9 levels of management structure. Will the Minister tell us what action he has taken with this and what he intends to do?

Senator B.E. Shenton:

We have reviewed the management structure of the hospital and it is an ongoing process. I believe when I looked at Deputy Ferguson's charts that they were, in my opinion, slightly flawed because of the way it worked down management levels. Because you have different grades does not mean you have different management structures. I think probably the best bet, because we have done work on this, is if I invite Deputy Ferguson for a meeting with both myself, Senator Perchard and our Chief Officer and we sit down and go through and show how we have made some changes and show the way that we are moving forward. But from a personal point of view, I am fairly content ... well, I am content that from a management structure viewpoint the hospital and Health and Social Services is not overburdened with middle management or top management staff.

3.4.1 Deputy S.C. Ferguson:

Perhaps the Minister is not aware - maybe he will tell us if he was aware - that, in fact, most of the charts in those 14 pages of organisational structure were, in fact, checked with the heads of department before I finalised them.

Senator B.E. Shenton:

I think the problem lies in what you have described as layers of management. I think within a banking organisation you would have perhaps the board at the top and then the senior management and then you would have the staff and you could show that as 3 layers, but then similarly you could show it as the chairman, the board members, the management in order and then go down the staff, the supervisor, who is above who, all the way down. So it depends how you look at management structures. The management structure is fairly flat and I think if the Deputy does pay a visit to Health and go through the structure she will find that there are not too many layers. I very much doubt there is anyone that has to go through 9 different departments to get to the top.

5. Deputy J.J. Huet:

This relates very much to what Deputy Ferguson was saying. I was in hospital just before Christmas and I have to say the care was excellent, but the common complaint seemed to be that there seemed to be as many managers as there were nurses. I would be very interested to know - maybe we could put this to lie one way or the other - what the nurses to management are on the figures. One other thing I would like to say is - it is not quite the same thing - while I was there the common complaint on the wards was the standard of the food. I would ask him if he could kindly look into it. It was not that good. Thank you very much.

Senator B.E. Shenton:

The comment on the food is news to me. In the time I have been Minister for Health and Social Services I have not had one complaint about the food.

Senator T.J. Le Main:

The Deputy is used to having steak. [Laughter]

Senator B.E. Shenton:

With regard to the number of managers and number of nurses, it depends how you look at it. If you look at the number of nurses and then the number of managers relevant to that nursing body, you get a different picture to the number of nurses and the number of managers within the whole of Health and Social Services as an organisation. I think you have to drill down and look at the number of nurses and the number of nurse managers. Certainly, I can let the Deputy have that information.

6. The Deputy of St. Martin :

The Minister will recall that Kathy Bull made a number of recommendations in respect of the Children's Service. Will the Minister inform the House whether all the recommendations have been implemented and, if not, what recommendations have not been implemented and why?

Senator B.E. Shenton:

All the recommendations of the Kathy Bull report were not implemented and some of the recommendations in hindsight would appear to have been flawed. The Andrew Williamson report will be looking at the Kathy Bull report, looking at where we are and how we implemented the recommendations. The Andrew Williamson report will be an opportunity for us to put everything in place in the correct manner. Some parts of the Kathy Bull report, although well meaning, when it came down to it did not work particularly well and these areas we need to address.

7. Deputy C.J. Scott Warr en:

On a question that has been well aired so far, I would like to say that it was always my understanding that Jersey has a lower percentage of management to staff than the N.H.S. (National Health Service) hospitals, and I really want to ask the Minister if he agrees with that statement and, if not, if he would come back to confirm that that is correct?

Senator B.E. Shenton:

I believe that is the case, but I am always a bit wary about statistics and using statistics because the N.H.S. is such a massive organisation that it can skew things one way or the other. But I can certainly let the Deputy have those statistics if she so wishes.

8. Deputy J.A. Martin:

I am sorry to hear that the Minister thinks that there were many flaws in the Kathy Bull report and the Williamson report will be the panacea for all our problems, because as far as I can understand it is going to be a report that is going to take about 6 months and gather evidence, where Kathy Bull came over to the Island and worked for a very, very long time, Sir. My question to the Minister is a basic question following on from the Deputy of St. Martin 's. On the children's homes issue, the Kathy Bull report said much more money must be put into professional foster carers and one of the homes should be shut down immediately. It was not naming one of the homes, Sir, as being bad; it was the way care was received and the age range between children of 6 and 15 being under the same roof. Now, is this one of the recommendations that the Minister is now telling us is wrong, or is it because, Sir, being Social Services' poor relation, new initiatives, the money has not been put into professional foster carers? The question directly is how many foster carers have we now recruited called professional foster carers, and how many children are still occupying both of our children's homes, that one already should have been shut down?

Senator B.E. Shenton:

We currently have 73 children under our care, of which 27 are in residential care and 46 are in foster care. We operate 9 homes. The largest home takes 9 residents. We are looking to close at least one of the homes over the next 6 months. The way to care for children these days is much more towards a family environment rather than an institutionalised care home. The other aspect should be the fact that the smaller the care home, the more personal the service and the attention. So the days of the large care home are long gone and this is a recommendation that we are implementing and it is a recommendation that will be implemented over the next few months.

9. Deputy D.W. Mezbourian :

There is evidence that children almost regularly go missing from one of these care homes. I wonder whether the Minister will explain how that is being addressed.

Senator B.E. Shenton:

This is an area that is of deep concern for both myself and for Senator Perchard. In fact, Senator Perchard had a chat with the Attorney General about it yesterday. When you have a child in your care, if they are not under a remand order they are at liberty to move wherever they should wish to move. If they are 15 or 16, they may prefer to go back to a family friend - a friend, a parent, a girlfriend or boyfriend - for the night, rather than stay in the residential home. We can put them into a secure unit if they abscond on a regular basis and we believe them to be in a dangerous situation to themselves. Senator Perchard and myself both feel that if a child is in your care, they are in your care and you should be aware of where they are at all times. It is a very important issue and it is something that is giving us a lot of concern and it is something that needs to be addressed. One of the advantages of moving people towards foster care is that their tendency to abscond is greatly reduced. The problem tends to lie more with children in residential care than it does with those children that have been moved into a family environment. This is why again the acceleration towards foster care and away from residential and institutional care is very, very important. To be honest with you, the political guidance to achieve this has not been there in the past, but it is something that needs to be accelerated and we have to make up for the fact that there seems to be no political ... no endeavour, but it did not seem to be high on the priority list to achieve this. In fact, from a political level, we do feel that Social Services perhaps was a little bit neglected in the past. [Approbation] This is something that we intend to put right and we intend to put right very quickly.

The Deputy Bailiff :

I am afraid that that means that time has now expired for questions to the Minister.