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4.7 Deputy R.G. Le Hérissier of the Minister for Health and Social Security regarding the evaluation of new management positions:
How are new management positions such as those in the new Commissioning Unit evaluated in order to ensure, for example, that the annual expenditure of £269,450 for this unit is fully justified?
Deputy A.E. Pryke of Trinity (The Minister for Health and Social Services):
My department will be delivering on an ambitious £34 million project to improve health and social care in Jersey. This comes at a time when we also need to find £7 million in savings through the C.S.R. (Comprehensive Spending Review) programme. The Commissioners are fundamental in achieving this. Their responsibilities include supporting delivery of the White Paper initiatives worth a total of £11 million, negotiating and managing overseas contracts for hospital services worth a further £11 million, negotiating and managing placements for children and adults in the U.K. worth a total of £4 million, negotiating and managing a further £8 million on-Island contracts. The Commissioners are also crucial to building key relationships and improving partnership working as well as contributing to our C.S.R. My department expects the Commissioners to deliver these initiatives and as such, I consider the cost to be fully justified.
- Deputy R.G. Le Hérissier:
Firstly, would the Minister acknowledge then that all the savings that are anticipated were not being sought by previous management structures and the department was, in fact, wasting an awful lot of money? Secondly, would she not acknowledge that a commissioning system is very much a system oriented to creating competition within health delivery and is it not a total over- structured system to apply to a small Island where the possibilities of encouraging competition often lead to wasteful fragmentation, both of effort and of money?
The Deputy of Trinity :
No, I would not agree with the Deputy . Part of it over here is partnership, working especially with the voluntary and community sector. Up to now, it has been a bit of a one-way expectation on the contracts but now it is very much 2-way. It is not only what we expect from the voluntary sector but importantly, what the voluntary and community sector expect from the States of Jersey and our department and that is a key change. As I say, building up relationships is vital.
- Deputy G.P. Southern :
When can the States expect to hear what progress has been made in achieving those very ambitious targets set out for the Commissioning Unit? When will we hear what progress has been made?
The Deputy of Trinity :
The Commissioners have only been in post for 5 months and have undertaken a lot of work in that short time. The work is of some benefit too if you talk to the voluntary and community sector of improved partnerships but it is also about raising standards right across not only contracts and service level agreements that we have in Jersey but also overseas.
- Deputy G.P. Southern :
Can the Minister point to local improvements in the relationship between voluntary bodies and the hospital which are already in place?
The Deputy of Trinity :
Yes, most of the service level agreements have been in the process of being updated and renegotiated and, as I said, for the first time, the voluntary sector are expecting some feedback, some understanding of what is expected from the States of Jersey for them. The feedback so far has been very excellent. They say for the first time, and Deputy Southern is very happy to talk to anyone within the voluntary and community sector, that they feel valued and appreciated and welcomed the opportunity to contribute actively to the developments.
- Deputy J.H. Young:
Would the Minister inform the Assembly that the responsibilities of these new management positions that have been created that she has explained, whether these are new responsibilities and if they are not, could she tell us how those functions were being discharged before we invented this new structure?
The Deputy of Trinity :
The Commissioners are new within Health and Social Services. Before, the department, as I said, negotiated with 80 different hospitals, for example in the U.K. regarding the medical treatment, children and adult placements and mental health. At that time, the agreements were managed through the hospital as an add-on for people who were doing other important jobs. From now on, we will be able to benefit from further and more detailed negotiations of service to ensure best value for money, consistently high standards, both off-Island and on-Island, which will benefit patient care.
- Deputy J.G. Reed of St. Ouen :
The Minister was asked: how are the new management positions evaluated? Perhaps she could answer the question.
The Deputy of Trinity :
How are they evaluated? Well, we did wonder which side the Deputy Le Hérissier wanted. The posts were Hay evaluated.
- The Deputy of St. Ouen :
I think if the Minister reviews the question that was asked by Deputy Le Hérissier, she will see it was regarding value for money and the fact that they were going to deliver as per their engagement so perhaps, again, the Minister could answer the question.
The Deputy of Trinity :
As I have said, they have only been there in the job for 5 months. They have delivered service contracts, some off-Island and some on-Island, and how they are evaluated is the data that will come back informing service deliveries going forward.
- Deputy R.G. Bryans of St. Helier :
Contrary to what the Minister just stated, is the Minister aware of a growing dissent among doctors and the third sector with a feeling of dislocation in relation to the commissioning structure?
The Deputy of Trinity :
The commissioning structure is regarding the on-Island contracts. Regarding primary care, this is a separate issue that we are dealing with sustainable primary care going forward and we are in firm negotiations with primary care which includes G.P.s (General Practitioners), dentists, opticians and pharmacists.
Deputy R.G. Bryans:
Could she just answer the second part of the question which is in relation to the third sector? The Deputy of Trinity :
Could he repeat that on the third sector?
Deputy R.G. Bryans:
Yes, I could.
The Deputy of Trinity :
Is he talking about voluntary and community services? Deputy R.G. Bryans:
Yes, I am.
The Deputy of Trinity :
Sorry, I forgot that bit of the question.
Deputy R.G. Bryans:
Sorry, it is just again we have got this situation where the third sector is feeling that the commissioning structure is not resolving the situation that they find themselves in and there is a growing dissent.
The Deputy of Trinity :
I disagree with Deputy Bryans. The voluntary and community sector - known as the third sector - have really appreciated the commissioners because they have taken the time to understand their services and negotiating a way forward. As I said at the very beginning, up to now it has been a one-way traffic what the States of Jersey expect but this time now the voluntary sector is very much what the voluntary and community sector expects from the States of Jersey.
- Senator S.C. Ferguson:
To return to the original question, how does the Minister justify the annual expenditure of £269,450? Can she say that that money has been saved within the first 5 months or that it will be saved in the future?
The Deputy of Trinity :
It is very difficult to put an amount on the salaries. Part of it is negotiating better contracts with service providers to endorse patient care and it is very difficult to put a sum of money on patient care because we need to endorse especially with all the 80 different hospitals that we negotiate with the U.K., we need to ensure that we have the right data back from them and that we understand what their services are and what our Islanders need and be much sharper in achieving that.
- Senator S.C. Ferguson:
That was not my question. My question was: we did a service last year; we did a service this year - how much have we saved?
The Deputy of Trinity :
I have not got as I said, it is very difficult to come up with exactly you cannot do so because how can you put a cost to improving patient care?
- Deputy R.G. Le Hérissier:
Given that the whole justification was based on money to be saved, I am afraid that is a bit of a cop-out. I wonder could the Minister again inform us why, for internal Jersey-based partnerships why were not the strengths of line managers why were they not given new skills and why was their role not strengthened rather than insert yet another layer of bureaucracy in the health system of people who have to speak to people who then have to speak to further people. Secondly, will they be moving to payment by results?
[10:30]
The Deputy of Trinity :
People think there is a lot of management in the health service. Let me say that there is not and we have had various reports saying that there is not. As I said, we are talking about an awful lot of money and we need to make sure that we get value for money at the end of it of all negotiations whether it is here on-Island or off-Island.
Deputy R.G. Le Hérissier:
But will they be moving to payment by results? The Deputy of Trinity :
No, we will not.