Ministerial Response - Scrutiny Review of the Government Plan: 2020–2023 (S.R.13/2019) –joint response of the Ministers for Health and Social Services and Social Security - 30 December 2019

Findings

Minister

Comments

1

The total Heads of Expenditure for the Health and Community Services Department is £211 million. In respect of Ministerial allocations, the Minister for the Health and Social Services receives the highest allocation of funding (£211 million) for his remit out of all the Council of Ministers.

MHSS

Agreed, but excluding the impact of efficiencies, pay award and other transfers.

2

Unlike the Medium-Term Financial Plans, where the information was provided in an annex, the Government Plan lacked any details regarding the breakdown of departmental budgets.

MHSS & MSS

The HCS budget is presented in the agreed corporate style for the Government Plan as for all other Departments.

3

The Efficiency Plan 2020 states that £1.77 million worth of efficiencies will be made through commercial operations' and £3.67 million through operational excellence'. It also indicates that £750,000 worth of cross- cutting operations are attributed to the Health and Community Services Department.

MHSS

Agreed

Findings

Minister

Comments

4

The Health and Community Services Department is due to make £9 million worth of efficiencies in 2020. However, only £6.1 million worth of efficiencies in respect of HCS are described within the Efficiencies Plan 2020-23. It is unclear to the Panel how the remaining £2.8 million worth of efficiencies will be achieved.

MHSS

The £2.8 million forms part of the total Modern Workforce efficiencies total.

5

The Panel has been advised by the Minister for Health and Social Services that there will be no headcount reductions as result of Health and Community Services' efficiency programme. However, the Panel still has concerns that efficiencies may result from not replacing current vacant posts within the hospital.

MHSS

The department will be drafting a Workforce Strategy and Plan. As part of the Strategy, the department needs to undertake a skills analysis as well as reviewing roles to enable delivery of the Jersey Care Model. The department requires an agile and flexible workforce that is fit-for-purpose and for the future. There are no plans to reduce headcount.

6

The action "Develop a Health and Wellbeing Framework" will be delivered within existing departmental budgets.

MHSS

Yes

7

The action "provide appropriate accommodation for people within Learning Disability Services" is not linked to a project seeking additional revenue expenditure because it is instead linked to a capital project.

MHSS

Yes. People with learning disability access Long-Term Care and other revenue funding as do other Jersey citizens.

8

A Health and Wellbeing Policy Framework is currently being drafted which will link and coordinate actions across Government to support islanders to live healthier and fuller lives, including those developed under the "preventable diseases" project. The Panel was advised that the intention was for the Framework to be completed by the end of 2019.

MHSS

Yes. The Health and Wellbeing Framework is currently being drafted. It is due to be completed and published by the end of Q1 2020.

9

The £300,000 funding requested for 2020 under the "preventable diseases" project would be spent on health promotion and introducing a two-year pilot scheme to provide healthy meals in primary schools.

MHSS

Yes

10

The £102,000 funding requested for

CM

Correct. The need for additional

Findings

Minister

Comments

the Adult Safeguarding Improvement Plan in 2020 would provide funding for two additional FTEs who are needed to co-produce and implement the Plan.

resources is supported by a business case, with the work programme based on the recommendations from independent reviews in 2018.

11

The project "Mental Health" includes a number of ambitious programmes and workstreams over the next 4 years. To ensure their delivery, the Government Plan has requested £3.2 million additional investment in 2020.

MHSS

Yes, the £3.2 million is correct.

12

At the start of 2019, £22.5 million was already invested in services which are delivering mental health activity.

MHSS

Yes

13

The Medical Director of Mental Health is due to undertake a review of Jersey Talking Therapies to determine the reasons for the current long waiting lists and to understand how resources could be moved around to deliver the service differently. It was confirmed that funds are within the Government Plan to undertake this work.

MHSS

Yes, this has been partially completed.

14

The listening lounge will initially be a 2-year pilot project and the requested funds within the Government Plan (£0.3 million in 2020) are required to support its implementation, to appoint a project team and to staff the facility.

MHSS

Yes. The Listening Lounge opened in November 2019.

15

The Adult Mental Health Service is currently under significant strain because of staff shortages.

MHSS

Yes, this is a national challenge. Ongoing recruitment exchange to seek to address the issue. MH management team now fully appointed and staff in situ.

16

The level of resources requested for mental health should be sufficient to enable the project to meet its stated aims. However, the sustainability and successful implementation of the programme is dependent on successful recruitment and retention of a high- quality workforce and improved collaboration with third and private sector partners.

MHSS

Yes

17

There is a lack of clarity within the Government Plan as to how the Digital

MHSS

Internally, HCS has appointed a Chief Clinical Information Officer (CCIO) to

Findings

Minister

Comments

Health and Care Strategy will be delivered.

clinically lead on the digital agenda. The portfolio sits under the Executive Director for Health Modernisation who commenced in post in November. The team has established a digital board to determine the strategy and rationalise the financial ask. A strategy document is being developed. There is collaborative work with the Modernisation and Digital team within the Chief Operating Office.

18

Within the Government Plan there is no clear line of funding for the development of a digital patient records system, which it has been estimated will cost in the region of £30 million.

MHSS

Funding will be discussed with the Chief Operating Officer Department.

19

It is the intention of the Health and Community Services Department to be digital in 2 years and to have the electronic patient records system in place in 3 years.

MHSS

HCS aspires to be fully digital in

2 years and to have an EPR (electronic patient record) in place when our current contract with intersystems' expires in 2022.

20

The Government Plan is seeking

£3.6 million to be restored to the Health and Community Services Health baseline budget to fund the delivery of a new Health Care Model, in line with the principles of P.82/2012

– A new way forward for Health and Social Care'.

MHSS

Yes

21

Additional funds of £4.1 million have been requested for 2020 under the "Maintaining Health and Community Standards" project to ensure that health and social care standards are maintained at a level comparable with the UK and other European jurisdictions.

MHSS

Yes

22

To assist the Government budget setting for 2020, the "maintaining community health and care standards" project will receive £1 million less in 2020 and manage any consequential pressures in year with the funds being remunerated in 2021.

MHSS

Yes. As part of the Government budget setting process, it was agreed that HCS would receive £1 million less than originally sought and that this would be replaced in 2021.

23

A full business case was not produced for the "Regulation of Care" project as

CM

As the expression of interest published says, the £200,000 built into the MTFP

Findings

Minister

Comments

the additional investment requested in 2020-2023 is intended to fund a shortfall from the non-receipt of income that was budgeted to be received through the regulation of care legislation in 2018.

(2017-19) from 2018 for user pays income under the Regulation of Care Law did not allow for the increased costs of regulation. As such, this change in the Government Plan is straightforward. A full business case was unnecessary.

24

The "Mental Health Improvements" capital project requests £3,930,000 in additional funding for; investment in works to "make safe" Orchard House and to prepare Clinique Pinel and Rosewood House to allow the delivery of high quality and safe mental health care.

MHSS

Yes

25

Whilst the Panel is satisfied that the amount of additional funds requested is adequate to undertake the necessary work on mental health facilities, it has concerns regarding the timeframe for the completion of Clinique Pinel and, specifically, the provision of a place of safety.

MHSS

Yes, but continuous attention is paid to maintaining the timetable, working collaboratively with colleagues in Jersey Property Holdings. The project is a standing agenda item on the weekly executive meeting.

26

The Minister for Health and Social Services has expressed his own frustration about the progress that had been made in delivering a place of safety.

MHSS

Yes. Options have been explored and a new place of safety suite will be part of the refurbishment at Clinique Pinel and, eventually, the new hospital.

27

The project "Health Service Improvements" seeks to deliver, not only essential maintenance work to the current hospital, but also initial work for the development of digital patient records. The Panel is concerned that the funding identified for 2020-2023 (£5 million per annum) is insufficient to deliver these priorities.

MHSS

There is significant backlog maintenance and significant investment in digital required. This will remain under review.

28

Immediate works to Aviemore, to ensure the building is legally compliant, will be funded under Capital Project "Discrimination Law, Safeguarding and Regulation of Care, in which £2 million has been allocated to HCS for the years 2020-23.

MHSS

Yes

29

The Health and Community Services Department is currently working with a number of provider organisations to

MHSS

Yes, alternative accommodation has been sourced for 2 of the residents, enabling a safer environment for the

Findings

Minister

Comments

seek alternative accommodation for the Aviemore residents.

remaining 2. We are seeking permanent accommodation for them, while continuing to engage with partners.

30

The Government Plan requests £250,000 to fund a feasibility assessment in order to determine a long-term solution for housing Aviemore residents in alternative accommodation.

MHSS

Yes; this also includes future scoping for provision of need in this area of HCS.

31

The money allocated to the hospital project in the Government Plan

(£5 million in 2020 and £1.6 million in 2021) is the continuation of funding requested by the project team to develop the Outline Business Case. The funding will be held by Treasury and Exchequer and drawn down as required.

MHSS

Yes

32

The total Heads of Expenditure for the Customer and Local Services Department is £90.6 million. In respect of Ministerial allocations, the Minister for Social Security receives the second highest allocation of funding

(£184 million) for her remit out of all the Council of Ministers.

MSS

Agreed

33

The Customer and Local Services Department is committed to making, in total, £2.2 million worth of efficiencies in 2020, £1 million of which is planned to come from a spend reduction in the Target Operating Model and a review of non-staff costs. It has been proposed that the remaining £1.2 million worth of efficiencies will be found through contract management, more efficient organisational structures and adopting Modern Workforce principles.

MSS

The £2.22 million can be broken down as follows:

£1.0 million Dept operating model savings

£944,000 Reduced benefit payments based on Q3 2019 forecast

£100,000 Contracts review

£136,000 Modern efficient workforce and efficient organisational structures

£40,000 One Customer Location.

34

The Government Plan proposes to reinstate the States Grant to its full value by 2023, rather than reinstating it in full in 2020.

MSS

Yes. This proposal ensures that the Social Security Fund remains financially sustainable and is able to support future generations, whilst allowing the government to invest more in public services over the next few years.

35

The States Assembly will be asked to agree amendments to the Social

MSS

This is correct.

Findings

Minister

Comments

Security (Jersey) Law 1974 alongside

the Government Plan. If approved, the Law will introduce a legal requirement to reinstate the States Grant to its full value of £93.1 million by 2023.

36

Consideration is being given to changing the investment strategy of the Social Security (Reserve) Fund to allow it to invest in local infrastructure. The Panel was told that investment in infrastructure could complement the existing asset classes held in the fund's portfolio, increase diversification and offer an appropriate risk adjusted return. The Panel is still unclear, however, as to the type of local infrastructure that might receive this investment.

MSS

Comment from Treasury: No specific individual projects have been identified at present, but examples of potential future projects might be a sports campus/complex or student accommodation as part of an enhanced higher education offering. Local infrastructure is not an area in which the Social Security (Reserve) Fund is currently invested but examples like those provided could produce revenue streams which are aligned to the Fund's investment objectives whilst at the same time supporting much-needed investment in the Island's infrastructure.

37

The Government Plan proposes a 1% increase to the headline rate of Long- Term Care contributions and an increase in the income cap from £176,232 to £250,000

MSS

This is correct. The 1% increase would have provided a sustainable and fairer long-term care scheme for younger people and future generations.

38

Due to availability of allowances and reliefs, most people would pay less than the proposed 2% in contributions towards the Long-Term Care Fund as a percentage of their total income.

MSS

This is correct.

39

Diffuse mesothelioma is a disease associated with historic exposure to asbestos fibre. As a result, it is not foreseen that there will be an increase in diagnosis of the condition following the establishment of the compensation scheme. Rather, it is expected that there will be a dwindling of cases over the next few years.

MSS

The number of cases will diminish over time, but a decrease will probably not start to be seen for another 10 years as the disease has a very long latency period.

40

The Panel is satisfied that the amount of money requested for the "diffuse mesothelioma scheme" in 2020 is sufficient and the reasons behind the request agreeable.

MSS

Acknowledged

41

The £150,000 funding requested for 2020 would pay for expert advice to

MSS

This is correct.

Findings

Minister

Comments

help identify options, an approach and actions to improving financial independence in old age. The funding allocation for 2021 would be dependent on the outcome of the work undertaken the previous year.

42

The Panel supports the request for additional funds in 2020 to undertake research on financial independence in old age. However, until the outcome of the investigation is known, and proposals of a way forward are brought to the States Assembly, we are unable to confirm whether we are content with the funding allocation for 2021-2023.

MSS

Acknowledged. Detailed plans will be developed during 2020.

43

The triennial regulations that are currently in place for the Food Costs Bonus expire at the end of 2019. The business case for this project simply proposes a further extension of the Bonus at its current value.

MSS

Agreed

44

The Government Plan is seeking £2.5 million of additional funds to in order to maintain the single-parent component of income support on a permanent basis.

MSS

Agreed

45

It has been estimated that 1,204 people would be accessing the single-parent component of income support by the end of 2020. This figure was used to determine the amount of additional investment required.

MSS

Agreed

46

Additional funds of £150,000 have been requested in 2020 under the "Support for Home Care and Carers' project to deliver a pilot scheme, which will provide additional financial support to a small number of lower income families. The scheme will be aimed at domiciliary care - care provided in a household by family members - and it is intended that the money will assist with extra domestic costs.

MSS

Agreed

47

The funds will cover a range of domestic costs associated with caring for a family member in the home, it

MSS

Agreed

Findings

Minister

Comments

will not represent a payment to the carer or a specific amount for every claimant.

48

Experience gained in 2020 from the pilot scheme will be used to inform a wider scheme available from 2021, hence the substantial increase in requested funding for the subsequent 3 years.

MSS

Agreed

49

Whilst the Panel is content with the proposals and satisfied with rational behind the request for additional funds, at this stage we are unable to conclude whether the resource allocation for the years 2021-2023 is appropriate until we understand the outcome of the pilot scheme.

MSS

Acknowledged; detailed plans will be developed during 2020.

50

The additional funding requested in the Government Plan for the "Disability and Community Strategy" project will support the roll out of a wide range of projects from 2020 onwards. However, at the time of producing the Government Plan, the identification of these projects was still under discussion. The Disability Strategy Delivery Group was due to consider a draft list at its meeting in October.

MSS

Attached at Appendix 1 is a provisional list of actions prioritised for the Disability Strategy in 2020; this includes permanent staffing resource. The 2020 projects are in the process of being discussed by the Disability Strategy Delivery Group (DSDG). The DSDG is a collaboration between Government officers, voluntary and community organisations and individual service users. The proposed projects are a combination of actions listed as medium-term' in the Strategy (which was published in 2017), and new' actions identified by the group over the past 2 years.

The recommendations of the DSDG will be considered by the Minister for Social Security who has political oversight of the Disability Strategy.

Recommendations

To

Accept/ Reject

Comments

Target date of action/ completion

1

The Minister for Health and Social Services should provide a detailed breakdown of how his department intends to make £9 million of efficiencies in 2020, before the debate on the Government Plan.

MHSS

Agree

A detailed breakdown is provided in the attached briefing at Appendix 2.

The £9 million of efficiencies are broken down across HCS in a number of schemes, these being –

1. Operational Excellence

• Continuing Care

• Mental Health

• Support Services

• Intermediate Care

• Community & Voluntary

• Off-island acute services

• Productive theatres

• Acute floor

• Outpatient services

2. Commercial and Customer

• Pharmacy and drugs

• Non-pay costs

• Income recovery

• Cross cutting commercial

3. Modern Workforce

• Nursing establishment and bed reconfiguration

• Medical staffing

• Modernisation of services and skill mix

Target Operating Model

2

The Minister for Health and Social Services should provide the Panel will an updated table every quarter noting the number of funded posts, actual staff in post and vacant posts within the hospital.

MHSS

Partially agree

This will be possible once the central HR system has been reconfigured to the new HCS care group structure. If there are any delays to this then there will be an impact on the ability to report to Scrutiny.

3

In advance of any changes

MTR

Response from Treasury: No

Recommendations

To

Accept/ Reject

Comments

Target date of action/ completion

being made to the investment strategy of the Social Scrutiny (Reserve) Fund, the Minister for Treasury and Resources should provide the States Assembly with documentation in respect of the proposed changes, including details of the local infrastructure to be invested in, any potential risks associated with that investment, and any risks to the future projections of the fund and its objectives

specific individual projects have been identified at present. Local infrastructure is not an area in which the Social Security (Reserve) Fund is currently invested but projects which produce revenue streams aligned to the Fund's investment objectives could be considered. At the same time, this would support much- needed investment in the Island's infrastructure.

Under the Public Finances (Jersey) Law 2019, the Minister for Treasury and Resources is required to publish Investment Strategies for Funds and cannot act in accordance with those Strategies until they have been presented to the States.

4

The Minister for Health and Social Services should provide the Health and Social Security Panel with quarterly updates, starting from January 2020, detailing successful recruitment of staff into the mental health service. The update should also provide evidence of improved collaboration with third and private sector partners.

MHSS

Agree

Yes, this can be provided.

5

The Minister for Health and Social Services should provide clarity ahead of the Government Plan debate as to how the digital and health care strategy, and specifically the digital patient records system, is to be funded.

MHSS

The Government Plan includes a

£5 million capital sum in 2020 for Health services improvements (including IT development). This is planned to be split between the digital and the estates infrastructure programmes. Thereafter, the strategy implementation will continue to be implemented each year, financed from both capital and revenue, with the funding source being aligned with each project and developed and refined over the Government Plan period.

6

The Minister for Health

MHSS

Partially

Response from Minister for Social

Recommendations

To

Accept/ Reject

Comments

Target date of action/ completion

Social Services should provide the States Assembly with a list of projects that will receive funding under the overarching "Disability Community Strategy" project ahead of the debate of the Government Plan.

agree

Security: A provisional list of actions prioritised for the Disability Strategy in 2020 is provided in parallel. These 2020 projects are in the process of being discussed by the Disability Strategy Delivery Group (DSDG). The DSDG is a collaboration between government officers, voluntary and community organisations and individual service users. The proposed projects are a combination of actions listed as medium-term' in the Strategy (which was published in 2017), and new' actions identified by the group over the past 2 years.

Their recommendations will then be considered by the Minister for Social Security who has political oversight of the Disability Strategy.

7

The Minister for Health and Social Services must continue to put pressure on those delivering and undertaking the work to Clinique Pinel to ensure that it is completed, and the place of safety is in place, by the end of 2020.

MHSS

Agree

The work to Clinique Pinel is a HCS priority and is regularly monitored.

8

The Minister for Health and Social Services should provide the Health and Social Security Panel will quarterly updates, starting from January 2020, detailing the timetable for the completion of work and highlighting any delays and the contributing reasons.

MHSS

Agree

As above

9

The Minister for Health and Social Services should provide clarity to the States Assembly before the debate of the Government Plan to as to how the £5 million requested for 2020 will be

MHSS

The split between maintenance work and the patient record is £4.1 million maintenance and £0.9 million on digital.

Recommendations

To

Accept/ Reject

Comments

Target date of action/ completion

apportioned between maintenance work to the current hospital and primary work on the digital patient records system.

Strategic Reference

Action

Narrative

Staffing resource

Disability officer

Specialist resource within Government of Jersey (GoJ) to provide expert advice and guidance and promote disability awareness in the Island.

Project manager

Dedicated resource to manage oversight and delivery of strategy actions.

Strategic Policy Performance and Population policy resource

Disability and diversity policy development.

Disability Sport officer

Dedicated disability officer post within Jersey Sport (through Jersey Sport funding).

Proposed projects to be delivered within existing budgets or through new dedicated resource

United Nations Convention Rights Persons Disability scoping work

Policy team to conduct initial scoping exercise to identify work required to extend United Kingdom ratification of the convention, including establishing an independent monitoring body.

1.2b

Customer service policies review and develop communication policy

Review GoJ customer service policies to ensure they are equitable and that accessibility requirements of disabled customers are met. Develop clear policy on communication with disabled customers.

1.3a

Communication support needs in healthcare settings

Explore options for an Accessible Information Standard in Jersey.

3.3c

Increase access to health and fitness groups

Co-ordinate development of offering for generic fitness groups – including walking groups, armchair yoga etc. to meet needs of younger and older disabled adults.

3.1c

Voluntary Community Sector (VCS) offering re under-supported conditions

Work with VCS umbrella and structural organisations to map current VCS support of disabled islanders and identify gaps.

3.3d

Meeting communication needs of customers

Work with trade and promotional bodies to communicate benefits of meeting disabled customer needs, including awareness of discrimination legislation.

5.1b

Working group – disability awareness

Establish working group to promote disability awareness Island-wide , including work with media outlets.

Proposed projects with additional resource required

1.2b

Accessible Government information

Develop Government policy on providing documents in an accessible format.

1.3b

Communication training in care settings

Improve communication support in community and care settings.

2.1c

Volunteer driver scheme

Introduce community-based post of volunteer driver co-ordinator to set-up and manage an island-wide volunteer driver scheme.

2.2c/2.3a

Accessibility reference group

Establish a reference group of disabled volunteers to advise on accessibility of buildings. Train group to provide advice and guidance and support an Island access audit.

3.2b

Develop respite offering

Develop the respite and short break services available to individuals and carers with a view to increasing the variety and flexibility of options available.

4.2b

Accessible discrimination information

Ensure that discrimination legislation is provided in accessible formats – including British Sign Language. Explore options for advocacy and support.

5.2a

Engagement event

Co-ordinate an annual event where disabled Islanders can share their experiences with elected members.

5.2b

The cost of living with a disability

Commission research to better understand the extra costs associated with disability and work with local businesses, VCS and service providers to develop positive action to mitigate against these costs.

Improve social inclusion and support diversity

Research and explore opportunities for supporting diversity within the Island.