Comprehensive Spending Review 2 - Ministerial Response - 13 December 2011

Findings

Comments

1

By  including  items  within  the Annual  Business  Plan  2012,  the Minister  for  Health  and  Social Services  is  attempting  to  bind future States Assemblies to accept major policy change.

This is factually incorrect. The Minister has no means to bind future States Assemblies to any major policy change.

2

The States has accepted a savings target  for  2012  from  Health  and Social Services which may not be capable of delivery until 2013.

Health  and  Social  Services  has  a  track record of delivering savings and balancing budgets.  Over  the  last  decade  the Department  has  never  exceeded  its  cash limits, and is set to over-achieve on its 2011 CSR  target.  Against  a  backdrop  of increasing  demand  and  costs,  savings  for 2012/13 will be challenging. However, the Minister  is  committed  to  supporting  their delivery  and,  where  the  original  CSR proposals are difficult to deliver, alternatives will be sought.

Findings

Comments

3

In  accepting  these  unscoped proposals  for  charges  within  the Annual  Business  Plan,  the Assembly may have accepted the principle  of  charging,  in  direct contradiction  of  a  previous decision (P.63/2003).

The  Panel  clearly  articulates  concern  that the Minister has been given a route to ignore P.63/2003  (States  approval  for  new  "user pays"  charges),  and  to  introduce  new charges  without  bringing  them  before  the States  Assembly  for  approval.  The  Panel and  the  Assembly  have  the  Minister's assurance that this will not be the case. The new  HSSD  charges  Law  is  due  to  come before  the  Assembly  next  year  and,  if approved,  will  allow  for  all  charges,  new and existing, to come before the Assembly. It  will  also  describe  a  mechanism  to introduce new charges which will include a States  approval  process.  The  States,  of course, have the right to reject this new Law and  in  due  course,  the  subordinate legislation, if it does not feel they are in the best interests of the Island.

This  key  finding  is  therefore  factually incorrect. The Minister has no mechanism to introduce  charges  without  first  bringing them  before  the  States  Assembly  or circumventing P.63/2003.

4

The Minister for Health and Social services  failed  to  put  in  place sufficient  resources  early  enough to produce scoped CSR proposals for  the  Annual  Business  Plan debate in September 2012.

The  Minister  acknowledges  that  placing resources  within  the  Programme Management  Office  (PMO)  was  delayed, and this was due to internal States processes. These delays have somewhat compromised the  timely  progress  of  developing  savings and user pays schemes. The staffing of the PMO  has  progressed  significantly  and  is almost  complete.  Internal  secondment  has provided a value-for-money solution, whilst allowing  home-grown  staff  valuable development  opportunities.  PMO  staff  are making  significant  inroads  with  regard  to scoping and planning key projects.

5

Savings  within  Occupational Therapy Service are likely to have a  direct  impact  on  frontline services.

This finding implies that any direct impact on  frontline  services  is  negative.  Driving efficiencies  through  all  service  areas, including Occupational Therapy, is part and parcel of the modernisation of Health and Social Services. Developing new models for frontline services is essential to ensure they remain fit for purpose.

Findings

Comments

6

The  CSR  timeframe  set  by  the Minister  for  Health  and  Social Services  is  contrary  to  Standing Orders  in  that  it  excludes  the possibility of proper scrutiny.

The  Minister  believes  this  to  be  factually incorrect.  The  development  of  a  3 year medium-term financial plan giving a clear view on resource availability will be very useful,  and  will  improve  the  Minister's ability  to  provide  the  Panel  with  the information  it  requires  for  the  scrutiny process.

7

The  3 year  timeframe  for  the delivery of the CSR savings within the  Health  and  Social  Services Department is unrealistic.

Service redesign is time-critical, and must not be delayed if we are to be prepared for the effects of the predicted increase in our elderly population. CSR therefore dovetails perfectly  with  the  HSSD  transition  plan being  developed  as  a  result  of  the  Green Paper  R.63/2011 –  "Health  and  Social Services Review May 2011: Caring for each other,  Caring  for  ourselves –  Consultation Paper". However, a funding stream for the future model remains to be identified.

8

There  has  been  a  severe  lack  of communication  between  the Minister  for  Health  and  Social Services and the Third Sector.

See recommendation 2 below.

9

It  is  unreasonable  for  States Members to be expected to vote on the  totals  presented  in  the  Draft Annual  Business  Plan  without being  fully  informed  of  the mechanisms by which those totals are to be delivered.

States members have the opportunity to vote against any elements of the Annual Business Plan that are not sufficiently detailed.

Recommendations

Comments

1

The  Minister  for  HSSD  must not  introduce  any  savings  in Occupational Therapy Services until they have been approved in principle by the States.

The Minister REJECTS recommendation 1 for the following reasons –

1. to  single  out  a  service  in  this  way  is illogical and inequitable;

2. it  abdicates  responsibility  from  the Minister to the States Assembly;

3. it will stifle innovation, modernisation and patient/client safety.

The Minister instead advocates working closely with the HSSH Scrutiny Panel in examining all proposals as they further develop.

2

In order to allow organisations to  have  confidence  in funding into  the  medium  future,  the Minister for Health and Social Services  must  create  a  greater flow  of  information  from  the department to the Third Sector with  more  robust  lines  of communication.  This  must  be reflected  in  the  Annual Business Plan 2013 process, to include  open  negotiation relating to SLAs and financial planning for a 3 year period.

The Minister REJECTS recommendation 2.

The Panel has been made aware that earlier this year a well-attended meeting took place with a large group of Third sector representatives to specifically discuss the CSR targets. It has also been informed that a senior member of one of HSSD's major grant-aided bodies attends the Department's CSR project management forum.

In  the  report,  the  Panel  describes  Brook's perceived poor treatment by HSSD in relation to  receipt  of  their  2011  grant.  It  failed  to comment,  however,  on  the  high  levels  of support  given  to  this  organisation  by  HSSD staff  in  terms  of  budget  analysis  and management and development of an SLA.

The Minister would also like to mention that the  consultation  on  the  Health  and  Social Services  Green  Paper  has  resulted  in unprecedented  consultation  and  engagement and that, at manager level, a provider network exists  for  many  independent  services  where business strategy is discussed.

Flow of information between organisations can always be improved, and as a matter of course we will endeavour to keep channels between the Department and the Third Sector as fluid as possible.

3

The Privileges and Procedures Committee  must  bring  an amendment  to  the  Public Finances (Jersey) Law 2005, to require  a  sufficient  level  of detail to explain the breakdown of the total amounts presented within the summary of the Draft Annual Business Plan and that this should be in place for the 2014 Plan.

This is a matter for the States Assembly.

The  Minister's  view  is  that  the  law  change proposed  would  serve  no  purpose,  as  it  is incumbent upon States members to vote against proposals that do not inspire their confidence or indeed that give them cause for concern.