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STATES OF JERSEY
Health, Social Services and Housing Panel
Quarterly Meeting with the Minister for Health and Social Services
FRIDAY, 30th NOVEMBER 2012
Panel:
Deputy K.L. Moore of St. Peter (Chairman) Deputy J.A. Hilton of St. Helier (Vice-Chairman) Deputy J.G. Reed of St. Ouen
Witnesses:
The Minister for Health and Social Services Managing Director, Community and Social Services Chief Executive Officer
Assistant Minister for Health and Social Services Assistant Director, Performance and Operations Director of Finance and Information
Also Present:
Ms. K. Boydens (Scrutiny Officer)
[12:02]
Deputy K.L. Moore of St. Peter (Chairman):
Good morning. Welcome to another hearing with the Health, Social Security and Housing Scrutiny Panel. Thank you all very much for your attendance. I will refer our member of the public to the code of behaviour, which I know he is very familiar with, and I am sure he will observe very diligently, as he always does. We will kick off I think today, obviously the focus is mostly on Social Services. I am sorry, we do need to introduce ourselves. I am the Chairman of the panel, Deputy Kristina Moore .
Deputy J.A. Hilton of St. Helier (Vice-Chairman): I am Deputy Jackie Hilton, Vice-Chairman.
Deputy J.G. Reed of St. Ouen : Deputy James Reed, panel member.
Director of Finance and Information:
Jason Turner, Finance Director for Health and Social Services.
Chief Executive Officer:
Julie Garbutt, Chief Executive for Health and Social Services.
Assistant Director, Performance and Operations:
Ruth Johnson , Assistant Director, Ministerial Support, Health and Social Services.
The Minister for Health and Social Services:
Deputy Anne Pryke, Minister for Health and Social Services.
Managing Director, Community and Social Services:
Richard Jouault, Managing Director of Community and Social Services.
Assistant Minister for Health and Social Services:
John Refault, Assistant Minister, Health and Social Services.
Ms. K. Boydens (Scrutiny Officer): Kellie Boydens , Scrutiny Officer.
The Deputy of St. Peter :
Thank you. We would like to start by thanking you, Minister, for your work programme, which we received only yesterday unfortunately. We are not quite sure where it got to between 16th November, when you wrote the letter to us, but it was not received into our department until the 27th, so we have had a brief look and it has been very useful. If we talk first about the respite report that we conducted earlier in the year. When you responded to that you mentioned the input of Mr. Richard Mills and we were wondering if there was any update that we could have on that ongoing piece of work.
The Minister for Health and Social Services:
I am pleased to say that Richard Mills is still definitely involved and still working very hard with the service and I am sure Richard can give you a bit more update on what is happening on the day-to-day.
Managing Director, Community and Social Services:
I think we fall into 3 areas broadly: Richard Mills, who is the Director of the National Autistic Society, is assisting us and working closely with Autism Jersey also, in looking at both the estate issues that we have, so developing appropriate services in terms of residential and respite services for particularly adolescents with Autistic Spectrum Disorder. Then also looking at, and coming to some of the points you made in your previous report, assessment of demand, gap analysis of where those gaps might be, and thirdly, looking at areas of transition. So Richard is helping us with aspects of transition around autism but more broadly there is quite a lot of work going on at the moment around looking at transition for all young people to adults, whether they have autism, whether they have complex needs or whether they are just looked after children or whatever. He has been gauging all those areas really.
The Deputy of St. Peter :
When do you expect those pieces of work to be complete?
Managing Director, Community and Social Services:
It is iterative really; it is a continuous piece of work so there are different timescales for different pieces of work. For example - we are looking at the estates aspects - we will be looking at the work around Heathfields to commence in earnest in 2013. Similarly the work we have around other respite facilities, they will be in earnest in 2013. We need to look at our decant facilities and when they are available for us. So it is important there is quite a tight time schedule for some of the works that are going on.
The Deputy of St. Peter :
You mentioned other respite facilities; can you just explain a little bit more in detail what you mean by that?
Managing Director, Community and Social Services:
I was referring to Oakwell actually. The works in Oakwell, there is quite an extensive amount of work that needs to go on at Oakwell. We have already engaged with another provider to provide us with decant for the shoulder months. So we would be looking to decant service users in October 2013. The works will definitely take 6 months, so it will be for the entire winter and January to March 2014 that we will probably be using decant facilities.
The Deputy of St. Peter :
For the families who use the service at Oakwell, will they still have the same level of service when they move from Oakwell to wherever you intend to provide that service?
Managing Director, Community and Social Services:
Yes, and on completion of the works we will have increased capacity. It is not just a like for like upgrade of facilities. We are increasing the capacity. The users of the service, I believe, have seen the latest plans - I believe that to be the case - and they have been involved in working up those plans. So, yes, there will be no reduction in service.
The Deputy of St. Ouen :
You mentioned a number of workstreams that Mr. Mills and others are undertaking. Will it be possible to provide the panel with an indication of when those particular pieces of work, including the assessment of demand, will be completed, so that we will be able to see and, perhaps the public may be able to see, the progress that you are making in the different areas?
Managing Director, Community and Social Services:
Certainly. I mean we would tend to track that information within the Service Improvement Plan, so perhaps that might be a good mechanism for you to track that work also.
The Deputy of St. Ouen :
That would be useful. Presumably the Service Improvement Plan would have an end date or completion date?
Managing Director, Community and Social Services:
Yes, that is right. That work is captured in the Service Improvement Plan so you might be able to track it through that.
The Deputy of St. Ouen : Thank you.
Deputy J.A. Hilton:
We have been told that Eden House was closed for a period of time; would you be able to comment on that as to why that happened?
Managing Director, Community and Social Services:
We have had some issues at Eden House, we have not had it closed. What you might be referring to is the fact that we have a unit attached to the side of it, which has been used continuously for one individual as a placement, and therefore that would be blocking that place, which is the issue that we have referred to in the past. We have also had some staffing issues in that our lead for that area unfortunately broke her leg in a parachuting accident so that resulted in some reductions in staff, but I am not aware of us closing the facility.
Deputy J.A. Hilton:
How has that impacted on the service for the users of Eden House?
Managing Director, Community and Social Services:
I am not aware that it should have impacted on the service.
The Deputy of St. Peter :
Speaking anecdotally to families who use the service, the feeling was that they had suffered a change in their access to services due to those staffing issues.
Managing Director, Community and Social Services:
Anecdotally I would have expected the latter because we have put in significant additional resource into providing non-residentially based respite over the last couple of quarters so I am surprised to hear that, so I will go back and check that.
The Deputy of St. Peter :
Again, anecdotally, the evidence we gathered was that there has been no improvement in terms of access according to groups of parents. So perhaps it would be helpful if you have some evidence that we could perhaps see that would display that increase in access that you feel you are achieving.
Managing Director, Community and Social Services:
I am absolutely sure that certain cases who were having less access are having more access now. I know that as a fact. To provide you that information, there are very specific cases so obviously I would have to anonymise that but certainly could provide that evidence for you.
Deputy J.A. Hilton:
Is that non-residential respite instead of residential?
Managing Director, Community and Social Services:
No, it is both. Non-residential and residential respite in a number of cases has been increased. I will provide you with that evidence.
The Deputy of St. Peter :
That is existing cases that we saw at the beginning of the year and new cases as well who have been brought into the system who are currently receiving respite?
Managing Director, Community and Social Services:
It is existing cases. We have had more respite, both residential and non-residential, and new cases who have had respite when they have had none before.
The Minister for Health and Social Services:
I do not know whether it is appropriate or not, but perhaps having the evidence that you think so we can look to make sure that we are talking about the same thing, because I think that would help too.
The Deputy of St. Ouen :
One of the recommendations we did make in our report on respite for children and young adults was that you needed to improve communication with your users. Certainly our experience to date and following the discussion, we say, it is clear that maybe greater efforts need to be made in that area; would you agree?
Managing Director, Community and Social Services:
I think we have made amazing efforts in the last 6 months to improve communication with all users of both respite services and to improve communication with all stakeholders with regard to Children's Services as a whole. So if we started the latter bit first, we have made quite a lot of effort in speaking to States Members and other stakeholders about the services that we provide, Ministers; only this week speaking to lawyers and the Jersey Family Law Society about the kind of work we do. Within the respite services I have met personally with families to become involved directly with their respite arrangements to ensure that they are meeting the needs of the individual. We have had many politicians do the same. We have involved families of respite care, as I say, into the design of the new facilities. I think we have done enormous amounts. You can certainly see the policies and procedures that we put in place around internal and external communications for Children's Services.
The Deputy of St. Ouen :
How are you monitoring that improvement because, as I said, anecdotally we are not getting the information that you seem to be suggesting you are?
The Minister for Health and Social Services:
Are you saying that we have not been more engaged or not engaged at all?
The Deputy of St. Ouen :
I think the question is: what evidence do you have to support the fact that the users are seeing improvements in communication and in the services that you are providing to them?
Managing Director, Community and Social Services:
It is anecdotal, it is the feedback that I receive when I have met with people. But I mean, as I say, it will be very useful if the panel do have any individuals who feel that their communication is not satisfactory and my door is absolutely open to any service user to come and meet with me and to discuss those issues personally. I have no problem with that whatsoever.
The Minister for Health and Social Services: As I have done as well.
The Deputy of St. Peter :
Another of our recommendations was for extra provision within Adult Services for a social worker, particularly looking at transition, which we were discussing just earlier. Has that been actioned yet?
Managing Director, Community and Social Services:
Yes, as I said earlier, there is quite a lot of work going on around transition. I think we have spoken in a report about should there be a service for transition and we discussed the fact that if you have a service transition you end up with 2 transition points going from children to transition, transition to adults, so we are not doing that. Because if we restructure the services so that the services that are provided for these
children now operate all together ... you will recall in the past that C.A.M.H.S. (Child and Adolescent Mental Health Service), for example, is a Private Mental Health Directorate and the Child Development Centre was under the auspices of the Acute Service. Now all of these areas, Childhood Development Centre, C.A.M.H.S., complex needs, social work, all operate within one element of Children's Services, under one line of management. That means there is a real wraparound of services around these children. That is a great advantage. The second advantage is then you can plan very clearly about transition, so we are working. An officer is currently developing these transition policies and we have had a workshop with about 40 stakeholders from different agencies in September coming together to talk about transition across agencies so we understand how that works.
[12:15]
In terms of additional resource, in the White Paper Transition Plan, there is an additional social worker for transition but it is not until quarter 2 in 2016. So that is when there is additional resource but there is certainly a lot of restructuring of the current organisation to deliver better transition.
The Minister for Health and Social Services:
Also on top of this, I think it is important, with that transition is the voice of the young person and a lot of work has been done with that group and the feedback, and I know that some of you have been party to the feedback, and that work is continuing and will continue and that has been a big task and it has been very successful. Those young people have been very engaged and also thinking of the Board of Visitors too. We have got increased numbers on the board and that has gone well and they are now into ... still continue and probably going to widen their remit as well.
The Deputy of St. Ouen :
We do acknowledge that there have been significant improvements in the support to looked after children, but this goes a bit wider than that, Minister.
The Minister for Health and Social Services: But they are too important, that group.
The Deputy of St. Ouen :
We just wondered how you are catering, you are providing for, the many other disabled individuals other than special needs that would not fall into a looked after category in the manner that you have just spoken.
Managing Director, Community and Social Services:
That is what the work of Richard Mills has been supporting us, particularly if you look at adolescents with Autistic Spectrum Disorder, there are some real challenges for those young people as they move through transition. Some of those young people are extremely high functioning and will be looking to go to university, to go away to college and how we support them in that transition as well. Childhood to adulthood is a challenging time for all young people, but for those with complex needs or, as the Minister says, those who are looked after children, there are specific areas that we need to support them in, so that is what the work is being done.
Deputy J.A. Hilton:
I believe you just told us that you would not have that additional member of staff until 2016. It is a very important role, can you explain to us why we are having to wait 4 years for that additional member of staff?
Managing Director, Community and Social Services:
Three years. In terms of the plans that we have, that is where it falls within the transition plan in terms of where the money sits. There may be possibilities to move things forward or backwards but broadly speaking that is where it is. What we have done in the meantime is to restructure existing resources and reorganise services so that they run more efficiently. So there should be more opportunity for better planning and better delivery of transition for children.
Deputy J.A. Hilton:
But you have recognised yourself that there is a gap there in the service, obviously that is why you have put in place somebody to be employed in 3 to 4 years' time, and I am just concerned that we are all aware that transition was a big issue with families with children with special needs. Three years just seems an awful long time to have to wait to get that additional resource in.
Managing Director, Community and Social Services: It is just an issue of competing priorities.
Chief Executive Officer:
I think that is the problem. I mean ideally, as I know the Scrutiny Panel are aware, it would be lovely to be able to do everything immediately. There are gaps across all services, very important gaps, and we have had to try and take a few on what we can do when. We are always reiterating that and we always look at it, and if there is a way of bringing this forward we will, but in bringing that forward we may well be pushing something else back. It is just getting a sense of what can go back a bit in order to bring that forward.
Deputy J.A. Hilton:
Who makes the decision around these matters? Is it yourself, Richard, as head of Social Services?
Chief Executive Officer:
No, they are corporate decisions that are also discussed within the steering group that is part of the governance of the implementation of the White Paper proposals. So there is a lot of clinical input and stakeholder input to those choices.
The Deputy of St. Ouen :
In your response to our respite care review, you said that you were awaiting the report from Action for Children, which will comment on the provisions of services in this area. As you know, we are all getting a bit frustrated that we still have yet to see this Action for Children report and my question is, with regard to that, if they support, as we propose, the introduction of at least one additional full-time social worker post, will you advance the funding for that prior to 2016?
The Minister for Health and Social Services:
I think that is one of the things that we will look at. But as the Chief Executive said, if we did bring that forward something else has to give with the priorities. But, as Richard said, there is an awful lot of work that is being done in the meanwhile. It does not mean to say that work is put on hold until 2016. Work is going to be done in different stages. But regarding the Action for Children report, I think you will get a copy of it by the end of next week because, as we said, the recommendations have been put into the Service Improvement Plan so you will get them both by the end of next week.
The Deputy of St. Ouen :
Would you accept then that the decision as to whether an additional full-time social worker post is assigned and is specific to children with special needs is ultimately down to your decision on whether it is a priority or not, within the overall funding allocated to you by the States?
The Minister for Health and Social Services:
Yes, probably at the end of the day but it is on advice. As I said, if I did press that then something else might have to fall out according to the list of priorities. But what I am certain and heard from the Director is that work is still continuing. It does not mean to say that you have got that worker up until 2016. It may be that we can, we will have to see on that, but work with Autism Jersey as well as the National Society with Richard Mills is continuing, as well as looking at respite for those children with special needs.
Managing Director, Community and Social Services:
Can I just pick up on that, Minister? A few points about social work numbers. Having an additional individual in this area may not be the answer. We have to look at, and we are looking at, numbers of social workers across the board and particularly across Children's Services. We are currently restructuring. We have restructured the Children's Service significantly to improve the way in which services wrap around children, and I have just alluded to that with regard to complex needs. I believe you have got a copy of our organisational structure for Children's Services I think. We can certainly send it to you if you have not, but you will see that, how that is changed so there is that service. We are also next year doing significant changes, working with other agencies about safeguarding, so we have a multiagency safeguarding hub in 2013, which will again radically rearrange the way in which social workers work with other agencies to protect children. In doing that reorganisation, we will look at where the resources are allocated to meet the needs. For example, a number of the children who are in the special needs/complex needs area are also looked after children. They have complex needs and they are looked after children. The question is which team manages them. For example, there are about 6 cases who currently sit in complex needs who are looked after children. They could move to be looked after by that team and therefore make more resources. It is not just about having additional numbers there, it is about where caseloads are managed and making sure that they are ... because there are pressures across the board.
The Deputy of St. Peter :
Thank you. If we could move on and talk about another of our recommendations, which was regarding funding for more holiday club provision. That required some discussions with Education, Sport and Culture and we would like to know whether those discussions are underway and whether any changes might be made to holiday club provision.
The Minister for Health and Social Services:
I think holiday club provision is, as I said, done by Education and how far they have looked at it I do not know. I think that is something you have to ask the Minister for Education because that is not one of our core services.
The Deputy of St. Peter :
Have you not had any discussions with them?
The Minister for Health and Social Services: Not personally, no.
Managing Director, Community and Social Services:
We are working obviously with the Education Department very closely about the individual packages of care that go around children and we are currently being extremely flexible working in partnership with them to provide both respite provision and educational packages, which are absolutely bespoke for some of these individuals that we are referring to. In that we look at the individual provision but, as the Minister says, when it comes to the quantum of monies put to holiday club provision, that is the gift of the Minister for Education, Sport and Culture, not the Minister for Health.
The Deputy of St. Ouen :
In your 2012 Business Plan, one of the actions was to contribute to the implementation of agreed actions within the Children and Young People's plan and you suggest that that is on target. Can you just elaborate on exactly what you have been doing and what actions have been currently or are being implemented?
Assistant Director, Performance and Operations:
The Children and Young People's strategic framework, there are a number of activities happening and going on at the moment. We have set up under all the outcomes, with the exception of one, working groups. They are currently developing
implementation plans, which are specific and bespoke to each of the particular outcomes, so we had outcomes such as Be Healthy, Have a Voice and Be Heard, Be Responsible and Respected. The development of those plans is underway at the moment and the lead officers for each of those areas are talking to key stakeholders within their own area. We also had a third sector consultation meeting, I think it was about 6 weeks ago - it was relatively recently - to look at the draft of those implementation plans, which are now currently being revised in light of the feedback that we have had back. We are hoping that certainly by the end of quarter one next year the C.P.G. (Children's Policy Group) will be in a position to sign off those implementation plans. In the meantime, that does not mean to say that some of the activities within those plans is it is not just sitting there and waiting for those plans to be finalised. There is work already underway, which is about developing a set of key indicators across all aspects of children and young people's lives. So it could be about who is relating to housing, education, as well as their health issues as well. That work is underway. We have been doing a review of all legislation impacts on children and young people and that is currently underway at the moment. That is a very, very, very extensive piece of work. It is about looking at some of the gaps and about developing proposals for what legislation needs updating and a timeframe in order for that to happen. So that is underway. We are also progressing work with the U.N.C.R.C. (United Nations Convention for the Rights of the Child) and have been in conversation with both the Ministry of Justice and the Department of Education in the U.K. (United Kingdom) and have agreed a process for taking forward that ratification.
The Deputy of St. Peter : Have you got a timescale yet?
Assistant Director, Performance and Operations:
The intended timescale is that pending a decision that will need to be taken by the Council of Ministers, in probably around February next year. It is our intention to formally write to the United Kingdom requesting the extension of ratification in time for the next U.K. periodic report to the United Nations Committee, and that periodic report is due by January 2014. So at some point between the Council of Ministers agreeing that we move forward with ratification and the U.K. compiling that report, they will extend ratification. In terms of the process, it is relatively simple. We have to write to the Ministry of Justice, the diplomatic wheels churn and then they come back and either say yay or nay, ratification is extended. Then that information, in terms of added degree of compliance, is included within the U.K. report to the U.N. (United Nations).
The Deputy of St. Ouen :
When do you propose the extensive review you have just described on legislation will be completed?
Assistant Director, Performance and Operations:
The bulk of the review is currently underway and I suspect that we are going to be at a stage where we have to release the information on a staggered basis or release the findings of the review on a staggered basis because there has to be some ongoing conversations with law officers about some aspects of potential review. There are also certain issues which may slow down the process.
[12:30]
For example, as you know, we are looking at setting up a Vulnerable Adults Protection Committee, the equivalent of the J.C.P.C. (Jersey Child Protection Committee), one of the ongoing questions we have had is should the J.C.P.C. be set up on a legal basis, should it be defined in statute? I think the thinking is, yes, it should be but if we are going to place children's safeguarding on a legal basis we should do adult safeguarding on a legal basis at the same time. We need to think through some of those issues, so there are issues coming at us from the side, which we need to consider. What we do not want to do is we do not want to delay the release of the information and the legal review process until everything is done because we are never going to get to a point where we have done all of it. But we certainly, by mid next year, will be able to be putting forward recommendations about required changes in children's legislation or legislation that impacts children.
The Deputy of St. Ouen :
So you will reach the first stage of a process that ultimately ...
Assistant Director, Performance and Operations: We will reach the first stage of a process ...
The Deputy of St. Ouen :
... will reflect in new legislation recommended remedies.
Assistant Director, Performance and Operations:
Absolutely. Obviously then political decisions need to be made about what legislation will and will not be changed in the timeframe associated with that. Some of that will be driven by the U.N.'s response to us, assuming that ratification is extended on where they feel that the particular priorities of change are as well. So there is quite a number of different issues and stakeholders that we will need to consider in the prioritisation.
The Deputy of St. Ouen :
While we are on the subject of legislation, I would just like to ask why there has been a delay in the legislation that you propose to implement and deliver this year to do with the food, health and safety? There is a whole range of legislation, I cannot remember the list now, I do not have it in front of me, that was included in your business plan to be delivered in 2012. From your updated ...
The Minister for Health and Social Services:
I have not got that information with me. Is there any particular one? I know the food one was very ... because I think we are working with Guernsey on that one and it became very complicated with the law officers.
The Deputy of St. Ouen :
Rather than waste time what we will do is we will send you a list of the legislation ...
The Minister for Health and Social Services:
And we can give you an update of where we are with it.
The Deputy of St. Ouen :
... you described in your business plan and maybe just ask you to give us an update on exactly what is happening and why there has been a delay. Thank you.
Deputy J.A. Hilton:
Before we move away from the Children's Service, can you just confirm for me the number of beds you currently have for looked after children?
Managing Director, Community and Social Services: Number of beds occupied or number of beds capacity?
Deputy J.A. Hilton:
No, number of beds available. Yes, your capacity.
Managing Director, Community and Social Services:
Off the top of my head ... can I send you that later rather than me guess it because the numbers have just changed?
Deputy J.A. Hilton:
I know there has been a lot of change within your organisation so I was interested to know what beds you had available, what the occupancy is like and also where they are.
Managing Director, Community and Social Services:
Just as a global bit of information about that, we are looking back from 2004, 2005 to today, the numbers of looked after children who are currently in residential settings has dropped incredibly, which is fantastic news because that means that the number of looked after children are in alternative placement, but I will provide you with that data.
Deputy J.A. Hilton:
I agree with you, that is fantastic news, as long as those children who need to be removed from their dysfunctional families are actually being removed.
Managing Director, Community and Social Services:
Absolutely. We can provide you with that information about children on the At Risk Register as well, if you wish.
Deputy J.A. Hilton:
It is an area that the panel is very interested in and we have had concerns in the past, so if you can send us that information, that would be very useful.
Managing Director, Community and Social Services: Certainly.
The Minister for Health and Social Services:
75 per cent of children under 12 are placed in foster parents, so I think that is very good, rather than being placed in residential care.
Deputy J.A. Hilton:
I think our concern was around more ... I know there is great difficulty in finding foster carers. I do not know whether the situation has been alleviated at all, but it has been a big problem and I assume it continues to be a bit of a problem, and so the concern was around children maybe being left with families simply because you did not have the beds for them or you did not have the foster carers for them.
Managing Director, Community and Social Services:
I am just looking at all the data here, perhaps it might be best if I provide you with what I have in front of me here.
Deputy J.A. Hilton:
Thank you for that. We just wanted to move on and ask a question around adult respite care, particularly at Highlands. The panel did visit Highlands earlier in the year and we did have a number of concerns around the configuration of the rooms and everything else and we have had communication recently that there are still concerns from some parents about the care there. I wanted to specifically ask you a question, and I have asked this before, about criminal record checks for care staff. My understanding is under the new Regulation of Care Law it does state in the law that staff will undergo a criminal record check. Can I just ask for confirmation from you that that will apply to individuals who may come from countries where their criminal record checks are not of the same standard as the U.K.? That there will not be any exemptions to that rule.
The Minister for Health and Social Services:
Yes, I think I have answered a question in the States.
Deputy J.A. Hilton: Yes, from me.
The Minister for Health and Social Services:
From you. If I remember rightly, yes, it will apply but for those whose countries do not have an equivalent of a criminal record check it is very difficult because they do not have it therefore, if I remember rightly, the risk ... I think you still need 2 references. The risk that we have taken, do they work with frontline staff, and if they have not got that then the answer is no.
Deputy J.A. Hilton:
I believe your previous answer to me in the States was that those staff would have to undergo a criminal record check and I think it is very important that this is going to be established sooner rather than later because I think as a department if you are going to carry this through, in the way that I believe you should, it is important that care homes in the private sector are aware that these checks are going to be required when the legislation comes in. What work is the department going to do to get this message out to those care homes where they are employing staff who do not come with a criminal record check?
Managing Director, Community and Social Services:
Internally speaking, in terms of getting our own house in order, can I just say that Community and Social Services are now embarking on a rolling programme of enhanced C.R.B. (Criminal Records Bureau) checking for all of our employees who work with vulnerable adults and vulnerable children on a 3-year basis. That means that I will be checked every 3 years irrespective of when I joined the organisation, and that will be the case for all of our employees going forward. We have started that process now. As I say, that is for all of our employees so all of our people working in our homes and all of our provisions. In terms of our vicarious liability and working with other providers, obviously we work closely with them to ensure that they have very high standards but that work really comes out of a different area. It comes out of the registration and inspection area. It would be best to have those questions answered by Christine Blackwood about the extensive checking they do currently and the changes to those checks that will occur over the coming years with regard to the Regulation of Care Law.
Deputy J.A. Hilton:
I know when the Regulations are lodged. I know this is going to come up and I know that in the private sector, in particular, where maybe a high number of foreign workers are employed, they are going to turn around and say: "Well, I cannot get a criminal record check" because they do not operate the system in the country where the person has come from.
Managing Director, Community and Social Services:
It is a massive issue and it is not just in care homes. At the Child Policy Group we have spoken about language schools and you think about the homes that provide placements for foreign students and how vulnerable those young people are in an island they do not know, with families they do not know and about C.R.B. checking those families. This is a massive issue.
Deputy J.A. Hilton:
Getting back to Highlands, have you had any concerns expressed to you by users of the service or potential users of the service?
Managing Director, Community and Social Services:
There have been some issues recently at Highlands, which have not involved our clients but involved clients from Highlands. Obviously we do not commission all the placements at Highlands. What I am saying is there have been some issues in relation to residents at Highlands who have been not our clients. We are aware of that and we have been working with the management team to ensure that what is done has been appropriately done, so our current ... we do not currently have concerns about Highlands residential facility. I think it is under very good management and we are working very closely with them.
Deputy J.A. Hilton:
Even though issues have arisen recently, not with your clients?
Managing Director, Community and Social Services:
On the contrary, the issues that have arisen recently have given me a great deal of confidence in their whistle-blower policies, in the way in which they run their services. I am much happier about services that raise incidents, tell you about their problems than those that do not.
Deputy J.A. Hilton:
But currently you have not had any complaints from users of the service, your clients?
Managing Director, Community and Social Services:
Not personally to me. I can go back and check with the Director of Adult Services, but not to me.
The Deputy of St. Ouen :
Just very quickly, will the next Social Survey gather comprehensive information about individuals with special needs?
Managing Director, Community and Social Services:
We have had to seek some advice from people who know what they are talking about when it comes to statistics here because it is not really my area this, but we have been reliably informed that the Social Survey is not the mechanism to collate data about specific conditions because the respondents in the sample size is quite small. It might be worthwhile speaking to Duncan Gibaut about the statistical reasons for this because, as I say, I am not potentially qualified to give this answer but I will give it my best shot. The Social Survey is useful for looking at very broad brush issues like asking people whether they have had an enduring or long-term disability. But when you are looking for numbers like how many people have got special needs, the catchment number of 2,400 respondents is not statistically significant to enable you to look at small cohorts. I believe that is the right answer.
The Deputy of St. Ouen :
Are you suggesting that 5 or 6 parents are not aware of whether their child has a special need or not?
Managing Director, Community and Social Services:
It depends whether they are part of the 2,400 respondents or not. In other words, if there is only 60 children on a caseload you may get them all within that survey or you may get none of them, so it is difficult to be statistically significant when you have a small cohort.
The Deputy of St. Ouen :
Have you considered other ways of gathering that information?
Managing Director, Community and Social Services:
Yes. Possibly the more appropriate way of looking at identifying disability is making sure that the agencies that work with them are coalesced around them, which is what we have done in terms of making sure that the Child Development Centre, Complex Needs Service and C.A.M.H.S. are all in the same part of the organisation, so they are all talking to each other and sharing information. Sources for special educational needs and identification are spread across agencies, so you have educational statement of need, is one place, C.A.M.H.S. will give you another group. The Child Development Centre will give you another group. The child health system we have, which is the McKesson system, will be another piece of information, all of which when you pull it together will probably give you a pretty darn good view of what the issues are.
The Deputy of St. Ouen :
Will you be publishing that information? General information, not specific.
Managing Director, Community and Social Services: I do not have any plans to publish that information.
The Deputy of St. Ouen :
But otherwise how will people know how many individuals we are required to provide for? If you do not publish the information how will the public or States Members or anybody else understand what the issues are?
Managing Director, Community and Social Services:
I think in terms of the public, we just have to be very careful when you are publishing information in Jersey when there are such small numbers. You have some disease issues which are related to one or 2 children, so you just have to be a bit careful about that. We are talking about very small numbers. But nevertheless, in terms of their performance data that we are gathering with a variety of different agencies, we will be collating that information and that will be provided by various reports in the future.
The Minister for Health and Social Services:
It will be part of a general report, rather than say: "Right, there are so many children who have problems with deafness." I mean a number is a number. It is how they fit in the overall system to make sure that the services are there, whatever they need.
The Deputy of St. Peter :
If we could move on to discuss the full business cases now following the States agreements for your health reform. Obviously this is well under way now and you have got a wide range of stakeholders, particularly from the community and voluntary sector taking part in your workshops, et cetera. What monitoring is underway of attendance figures in those workshops?
[12:45]
Chief Executive Officer:
I can advise you that at the present time we have 29 different third sector organisations engaged in the various or business case workshops and task and finish groups that I know you are aware of. Obviously certain groups are more interested in certain business cases than others. We have invitations to a further 15 who so far have not participated but the invitation is there for them to, should they have that interest. I do not propose to read out the list but we can make a list available to you if you would be interested and we do regularly obviously with each of those meetings, each of those workshops, we take a record of who is there, and if we were to see that there seemed to have been a falling off from a particular organisation we would obviously check with them what the reason for that was, if there was any problem. We have got individual conversations ongoing. I am aware of a number of third sector organisations who specifically engaged with the Director of Service Redesign recently to talk through particular issues.
The Deputy of St. Peter :
That work is ongoing. I can see you cannot really elaborate at this time.
The Minister for Health and Social Services:
On top of that the quarterly meetings are still continuing as well as the ... I know that the Director of Service Redesign is also in close discussions with the new Director of ... whatever his title is.
Chief Executive Officer:
Community and Voluntary Sector Forum.
The Minister for Health and Social Services: So there is a lot of work being done.
Chief Executive Officer:
Our next quarterly meeting is next week and we have specifically on the agenda a slot where we are going to split into 2 groups so that those third sector organisations who are particularly interested in children and those that are more interested in the adults and young people's agendas, will be taking a stocktake of how the full business case work is going and the task and finish groups can talk through any issues that are emerging from that.
The Deputy of St. Ouen :
When do you plan to complete the service specifications?
Chief Executive Officer:
We envisage having them all completed by the end of January.
The Deputy of St. Ouen :
When will you decide who will be providing services?
Chief Executive Officer:
We will then be working through with various organisations and testing through with a steering group, a ministerial oversight group, the split between those services that may need to go through some sort of procurement process and those services where it will be clearly identified who the preferred provider should be. That will be part of that debate and then the recommendations will be put forward.
The Deputy of St. Ouen : That will likely take how long?
Chief Executive Officer:
I would not expect that to take more than a month or 2, because obviously the sooner we can get into the process, whatever it is, whether it is advertising for staff to start filling new roles or whether it is about going through a procurement process so that a third sector organisation is employed to do that for us that will take several months. The sooner we can go through those processes that we have services starting to be delivered from the end of the year the better really. But it will vary depending on what the service area is.
The Deputy of St. Ouen :
You say those specifications completed by end of January 2013.
Chief Executive Officer: Yes.
The Deputy of St. Ouen :
And 2 months' later you would hope to know who I ... have identified, should I say, who will be providing ...
Chief Executive Officer:
No, we will have identified which course of action we would be taking to secure the provider. For some it may be absolutely obvious there is only one obvious legitimate provider and there is no other choice. For other services it may be that there are several who would all be interested, who all feel that they can provide that specification and you would have to have some sort of process in order to be fair and transparent about who is being selected for what.
The Deputy of St. Peter :
You are currently advertising for a number of positions within your services, particularly for midwives and health care assistants. Are those related to your workstreams?
Chief Executive Officer:
No, they are largely related to business as usual pressures. I know the panel is aware of a significant rise in the birth rate in the Island, so those are day-to-day pressures where we know we need more midwives and other workers.
The Deputy of St. Ouen :
It would be extremely useful, and I know you have provided us with quite detailed information about the process and how business cases have been developed, but currently, if my memory serves me correctly, we only have a timetable up to the end of January and it would be useful if we could see the bigger picture and how the different actions following agreement of the full business cases will be delivered and when.
Chief Executive Officer:
Part of the process of completing the full business cases, partly it is to identify the service specification of the underpinning data that would be used to monitor the delivery of new services. The third element of it is also to identify the timeline. So we should, at that point, be able to say, across all of that work, we would hope that if we take the improving access to psychological therapies, for example, just as an example, that may be an area where we could say at the end of January there is the
service specification. The view from the working group, which has been accepted by the steering group and the ministerial oversight group, is that we should proceed to do X in order to acquire those services, whether it is to have some sort of agreement with G.P.s (General Practitioners) or it is to have a different set of agreements with a third sector organisation but that should be part of what we can tell you, and then we can say: "So it will take 3 or 4 months or 6 months" or whatever and we would be able to have a service on the ground that Islanders could use by this point in time. So we should have all of that information that we can share with you at that point.
The Deputy of St. Ouen :
That would apply to Acute Services as well?
Chief Executive Officer:
The Acute Services is on a slightly different timescale because obviously the complexity of looking at every single speciality within the hospital is part of the work that we have been doing. What I would suggest is perhaps at a future meeting we share with you that emerging Acute Services workstream so you can start to get a better feel of what is in there and when that might start to feed through.
Deputy J.A. Hilton:
Can I just ask you a question around early intervention, which I support wholeheartedly. I just wanted to say that. Can you explain to me, in your outline business cases, and I assume it is just transferred to your full business case, the idea of using M.E.S.H., which is Maternal Early Screening ...
Chief Executive Officer:
That has not transferred into the full business case. What has transferred into the full business case is the strong support from all agencies for that type of early intervention. We are not wedded to any particular form of that. The whole piece of work we are doing in the full business case working with the specification is to identify what we mean by an early intervention stream and it will be for anyone who is interested in providing that service to say: "We would do that this way." It may well be that a group of individuals from one organisation would say: "We think M.E.S.H. is a great idea. We are going to propose we offer that." Somebody else might say: "We think something else is a better way of doing that" and that is why you have a process where you look at the different offerings, what is your outcome, what does that provide for vulnerable children and their families and what does it cost you to provide that? That is why we have that process, but we are not wedded. In the full business case you will not see anywhere in it M.E.S.H. as the preferred outcome because that is not our preferred outcome.
Deputy J.A. Hilton:
So basically you are going to wait for the third sector to come to you with their proposals, which will be ...
Chief Executive Officer:
The specification will set it out clearly.
Deputy J.A. Hilton: ... evidence back.
Chief Executive Officer: Yes.
Deputy J.A. Hilton:
The reason I raise that is I am sure that I have read in some of the paperwork that you have provided for us under M.E.S.H. about early intervention, but talking about midwives being involved on a visiting basis from the age of 20 weeks, which struck me as a little bit strange because I thought why would you want to leave it 5 months until a baby was ...
Chief Executive Officer:
No, you would not. The reassurance I can give you is we are not wedded to M.E.S.H. So you will not see that in the full business case. But no, the intervention start before birth and they go all the way through from there.
Deputy J.A. Hilton:
That is why I was puzzled about that and I thought that to me seems crazy to have intensive input into a family from 5 months onward; what about ... but that is what was in the papers.
Chief Executive Officer:
I think the way it works is obviously there are levels of support to the family, preconception, conception, birth, onwards, that any family will get, so health visiting services, whatever. It is about having a mechanism whereby we assess very early, possibly even preconception, this is going to be a family where this will be challenging for them. They are going to need those additional levels of support and accessing and signposting them into that earlier than we do currently. But, no, it really would not be doing what it says on the tin if we were not doing that until 5 months in.
Deputy J.A. Hilton: Thanks for that clarification.
The Minister for Health and Social Services: It would not be early intervention then.
Deputy J.A. Hilton: Precisely.
The Deputy of St. Peter :
Thank you. You should receive from us shortly our terms of reference as we have highlighted, I think, in the past to look closely at your full business case process and so you should receive that from us within the next ...
The Minister for Health and Social Services:
Sorry, what do you mean by the full business case process?
The Deputy of St. Peter :
We would like to review the process that you are undergoing.
The Deputy of St. Ouen :
You will be having our terms of reference shortly.
The Minister for Health and Social Services:
I was just thinking because we have not finished the process yet so it is very difficult to see where you wish to come in.
The Deputy of St. Peter :
It will be something that we will examine. We would like to be able to observe your process as it is under way, if that is at all possible, which I think we have voiced to you previously, with a view to obviously waiting until you get to an end point and then looking back over the process and giving our view. But it should in no way impinge on the process.
The Minister for Health and Social Services:
So you would wait until we have finished the process and then look back? Sorry, just for a bit of clarity and understanding where you wish to come from.
The Deputy of St. Peter :
In understanding the process and how it has achieved its end point we would like to be able to observe elements of the process underway, which is why we want to begin our review while the process was still underway. Does that make sense?
The Deputy of St. Ouen :
I think when you see our terms of reference it will become clear.
The Deputy of St. Peter :
It is not designed in any way to delay your progress as well, which is another reason for beginning our work as early as possible.
The Minister for Health and Social Services:
Sorry, it is still not clear. The process will continue and it has got to go into the right stages. So I just wonder where you wish because by the time your review has come out we have already ... we are done, so to speak.
The Deputy of St. Ouen :
I think, bearing in mind the time, a lot of the questions the Minister will have will probably be answered with the terms of reference when we submit to her. I would like to pick up ...
The Minister for Health and Social Services:
So would you be open to us to comment back on the terms of reference?
The Deputy of St. Peter :
Absolutely. Of course we would, and we in no way want to delay your programme. We know that you have a lot of work to do in the next 12 months. It is for that reason that we want to start our work so that we feed in at the relevant moments because we can see that you have a very tight schedule.
The Minister for Health and Social Services:
What I am very positive about, all the staff are doing a lot of work, everyone is really engaged, including the voluntary and community section and full praise to everyone because we have had an awful lot of meetings that will continue because it needs to be focused, because now with the money we need to make sure that we deliver for Islanders the services that they wish and need but also to make sure that ... and also because we have got the money as well, so we need to deliver that too. We do not want to be sitting here and you kind of in 6 months, 9 months' time say: "Well, what have you spent the money on, Minister? Where are the better new services?" We need to deliver and I want that progress to continue because it has been approved by the States and we need now to get on with it.
The Deputy of St. Ouen :
We absolutely agree and I think our view is that we want to make sure that the money that is agreed by the States is directed towards the areas that have been equally acknowledged by the States that need improving. I think that is the simple view. Moving on, following recent comments I would like to ask the Minister what discussions have taken place regarding the proposal to have a Minister for Children.
The Minister for Health and Social Services:
The comments from the Chief Minister, I think this was brought up 3 or 4 months ago, if not longer, I know recent discussions have taken place fairly recently.
The Deputy of St. Ouen :
With who? Who has been involved?
The Minister for Health and Social Services:
I think we have had some discussions around the ministerial table as well as I have had some off the cuff discussions with the Chief Minister.
The Deputy of St. Ouen :
But you can say, was it Council of Ministers or ...?
The Minister for Health and Social Services:
No, it was the Chief Minister.
The Deputy of St. Ouen :
It is just you and the Chief Minister?
The Minister for Health and Social Services: I think so, a little while ago. Not formal ones.
The Deputy of St. Ouen :
Is this proposal going to be developed further?
The Minister for Health and Social Services:
It is difficult because if we need a Minister for Children we have to think what that means. Are we going to include all children, where would Education fit into that? Where would a service like C.A.M.H.S. fit into that? Where would our Children's Services fit into that? What will be the role of that person? Should we be looking at other things that perhaps ... there was a proposition from Deputy Le Claire on a Commissioner for Children; would that be a better way forward with Guernsey, Isle of Man or whatever? But also you have got to think that in this present Government it is 10 Ministers, so therefore if we have a Minister for Children where does that fit in?
The Deputy of St. Ouen :
So you are not supportive of introducing a Minister for Children?
The Minister for Health and Social Services:
I have not said that, but more work needs to be done. As I said, that might not be the best model. It could be looking at a Commissioner. I do not know.
The Deputy of St. Ouen :
Who will be undertaking that work?
The Minister for Health and Social Services:
It is probably something we could do within the C.P.G.
The Deputy of St. Ouen :
And that will be undertaken soon or ...?
The Minister for Health and Social Services: It is not on our present working list.
The Deputy of St. Ouen : Thank you.
The Deputy of St. Peter :
With an eye on the time, we have now slightly overrun the 12.55 p.m. deadline we set ourselves so I apologise for that, but I close the meeting and thank you very much for your attendance.
[13:00]