Report - Government Plan 2020-2023 - Health and Social Security - 11 November 2019

Review 2020

Health  and  Social  Security Scrutiny Panel

11th November 2019

This Report forms Section 5 of the Government Plan Review Panel's report on the Government Plan - S.R.13/2019

Contents

1. HEALTH AND SOCIAL SECURITY PANEL MEMBERSHIP .................................................... 3
2. CHAIR'S FOREWORD .............................................................................................................. 4
3. METHODOLOGY ...................................................................................................................... 5
4. FINDINGS AND RECOMMENDATIONS .................................................................................... 6 KEY FINDINGS ............................................................................................................................. 6

RECOMMENDATIONS .................................................................................................................. 10

5. DEPARTMENTAL BUDGETS AND EFFICIENCIES ................................................................ 11
6. SOCIAL SECURITY FUND AND SOCIAL SECURITY (RESERVE) FUND ............................. 17
7. LONG-TERM CARE FUND ...................................................................................................... 21
8. ACTIONS, PROGRAMS AND CAPITAL PROJECTS REVIEWED .......................................... 24
9. REPORTS ON SPECIFIC ACTIONS AND BUSINESS CASES ............................................... 26 ACTIONS NOT LINKED TO A BUSINESS CASE ................................................................................. 26

BUSINESS CASES FOR ADDITIONAL REVENUE EXPENDITURE......................................................... 27 BUSINESS CASES FOR CAPITAL EXPENDITURE ............................................................................. 57 PRE-FEASIBILITY VOTE ............................................................................................................... 63 5.10  FINAL PANEL COMMENTS .................................................................................................... 67 5.11  WITNESSES AND EVIDENCE GATHERED ............................................................................ 69 APPENDIX 1 - TERMS OF REFERENCE ......................................................................................... 70

1. Health and Social Security Panel membership

The Panel comprised of the following States Members:

Deputy Mary Le Hegarat (Chairman)

Deputy Kevin Pamplin (Vice-Chairman)

Deputy Carina Alves

Deputy Trevor Pointon

2. Chair's Foreword

The 2020-23 Programme makes explicit Government commitment to support islanders to live healthier lives and improve access to mental health services.

The inequalities of life experiences regarding economic opportunity, education and housing are known to provide a backdrop to our general health, and the objective of integrating health improvements to these wider issues through the Health and Wellbeing Policy Framework is welcomed.

The mental health agenda has lacked equal status with other health service elements and, following publication of the Panel's review "Assessment of Mental Health Services" in the spring of 2019, it is encouraging that all core recommendations have been adopted and are being taken forward in the 2020-23 Government Plan. The Panel will continue to support and monitor the Government action in this respect.  

M. Le Hegarat Chair

Health and Social Security Scrutiny Panel

3. Methodology

The Proposed Government Plan[1] is presented as a series of Actions aimed at meeting the Government's five Common Strategic Policy priorities, as well as a new sixth priority of Modernising Government.  

A supplementary document[2] has also been lodged to accompany the Plan, detailing planned expenditure over and above that budgeted in previous years for additional measures and capital projects.  

This document provides the most detail of proposed Government expenditure for 2020, even though it only represents around 18% of the total budget, while the actions in the Plan have limited, or no, information on expenditure.  

The Scrutiny review of the Government Plan has taken a thorough approach, looking at each Action, Business Case for Additional Revenue Expenditure, and Business Case for Capital Expenditure in as much detail as possible with the information provided by Government.

A summary of all Actions and Business Cases reviewed by this Panel is provided in Section 5.8 below. Only those Actions that do not correspond to a Business Case are listed in the summary table.

All Scrutiny Panels have agreed to use a common system to report on the status of each project, as follows:

This status means that the Panel has reviewed the background information on the project and is satisfied with it.

This status means that the Panel has  reviewed this and either has concerns or considers that it needs more work, or further detail should be provided. It might also mean that the Panel considers it too early to make an informed decision. This may or may not lead to recommendations and/or amendments.

This status means that the Panel has reviewed this and is not satisfied or does not agree with the proposal. This may or may not lead to an amendment.

4. Findings and Recommendations

Key Findings

Key Finding 5.1: 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.

Key Finding 5.2:  The total Heads of Expenditure for the Customer and Local Services Department is £90.6 million. In respect of Ministerial allocations, the Minister for the Social Security receives the second highest allocation of funding (£184 million) for her remit out of all the Council of Ministers.

Key Finding 5.3:  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.

Key Finding 5.4: The Efficiency Plan 2020 states that £1.77m worth of efficiencies will be made through commercial operations' and £3.67m through operational excellence'. It also indicates that £750,000 worth of cross-cutting operations are attributed to the Health and Community Services Department.

Key Finding 5.5: The Health and Community Services Department is due to make £9m worth of efficiencies in 2020. However, only £6.1m worth of efficiencies in respect of HCS are described within the Efficiencies Plan 2020-23. It is unclear to the Panel how the remaining £2.8m worth of efficiencies will be achieved.  

Key Finding 5.6: 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.

Key Finding 5.7: The Customer and Local Services Department is committed to making, in total, £2.2 million worth of efficiencies in 2020, £1m 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.  

Key Finding 5.8: The Government Plan proposes to reinstate the States Grant to its full value by 2023, rather than reinstating it in full in 2020.

Key Finding 5.9: The States Assembly will be asked to agree amendments to the Social 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.

Key Finding 5.10: 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.

Key Finding 5.11: 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.

Key Finding 5.12: 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.

Key Finding 5.13: The action "Develop a Health and Wellbeing Framework" will be delivered within existing departmental budgets.

Key Finding 5.14: 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.

Key Finding 5.15: 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.

Key Finding 5.16: 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.

Key Finding 5.17: The £102,000 funding requested for the Adult Safeguarding Improvement Plan in 2020 would provide funding for two additional FTEs who are needed to co-produce and implement the Plan.

Key Finding 5.18: 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.

Key Finding 5.19: At the start of 2019, £22.5 million was already invested in services which are delivering mental health activity.

Key Finding 5.20: 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.

Key Finding 5.21: The listening lounge will initially be a 2-year pilot project and the requested funds within the Government Plan (£0.3m in 2020) are required to support its implementation, to appoint a project team and to staff the facility.

Key Finding 5.22:  The Adult Mental Health Service is currently under significant strain because of staff shortages.

Key Finding 5.23: 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.

Key Finding 5.24: There is a lack of clarity within the Government Plan as to how the Digital Health and Care Strategy will be delivered.

Key Finding 5.25: 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.

Key Finding 5.26: It is the intention of the Health and Community Services Department to be digital in two years and to have the electronic patient records system in place in three years.

Key Finding 5.27: The Government Plan is seeking £3.6 million to be restored to the Health and Community Services 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'.

Key Finding 5.28: 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.

Key Finding 5.29:  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.

Key Finding 5.30: A full business case was not produced for the "Regulation of Care" project as 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.

Key Finding 5.31: 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.

Key Finding 5.32: 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.

Key Finding 5.33: The £150,000 funding requested for 2020 would pay for expert advice to 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.

Key Finding 5.34: 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.  

Key Finding 5.35: 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.

Key Finding 5.36: 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.

Key Finding 5.37: 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.

Key Finding 5.38: 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.

Key Finding 5.39: The funds will cover a range of domestic costs associated with caring for a family member in the home, it will not represent a payment to the carer or a specific amount for every claimant.  

Key Finding 5.40: 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.

Key Finding 5.41: 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.  

Key Finding 5.42: 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.

Key Finding 5.43: 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.

Key Finding 5.44: 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.

Key Finding 5.45:  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.

Key Finding 5.46: 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 (£5million per annum) is insufficient to deliver these priorities.

Key Finding 5.47: 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.

Key Finding 5.48: The Health and Community Services Department is currently working with a number of provider organisations to seek alternative accommodation for the Aviemore residents.

Key Finding 5.49: 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.

Key Finding 5.50: The money allocated to the hospital project in the Government Plan (£5m in 2020 and £1.6m 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.

Recommendations

Recommendation 5.1: 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.

Recommendation 5.2: 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.  

Recommendation 5.3: In advance of any changes 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

Recommendation 5.4: 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.

Recommendation 5.5: 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.

Recommendation 5.6: The Minister for Health 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.

Recommendation 5.7: 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.

Recommendation 5.8: 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.

Recommendation 5.9: 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 apportioned between maintenance work to the current hospital and primary work on the digital patient records system.

5. Departmental Budgets and Efficiencies

Departmental Budgets

The Health and Social Security Panel scrutinises the work of two Ministers; the Minister for Health and Social Services and the Minister for Social Security. Therefore, the project policy work contained in the various actions, programs and capital projects assigned to the Panel predominantly sit under these two Ministers.

In the Government Plan, the States Assembly has been asked to approve the proposed amount to be appropriated from the Consolidated Fund for 2020, for each head of expenditure, the summary of which was included in the summary tables 3(i) and 3(i)(i)[3] within P.71/2019. With regard to the departments that fall under the Panel's remit, the following information was provided:

The Panel was disappointed to find that, unlike the Medium-Term Financial Plan (MTFP) where the information was provided in an annex, the Government Plan lacked any detail regarding  the  breakdown  of  departmental  budgets  e.g.  staff  costs,  premises  costs  etc. Accordingly, the Panel requested a further breakdown of how the above figures are allocated across the wide remit of the two departments, as well as the expenditure for 2019. The following information was provided[5]:

Health and Community Services

Customer and Local Services

These figures were provided to each Panel and correspond with the figures in the Government Plan. However, the draft business plans for each department were published on 23rd October. The draft business plans detail the net revenue expenditure figures above but also include the 2020 efficiency programme, resulting in the overall next revenue expenditure being less than the  figures  States  Members  are  being  asked  to  approve  within  the  Government  Plan. Furthermore, the service areas noted above for the Health and Community Services have now been condensed into three main areas; Hospital and Community Services, Chief Nurse and Medical Director.

The Government Plan states that as expenditure is approved based on  departments, it therefore does not directly align with areas of Ministerial responsibility. However, an indicative mapping of departmental allocations to Ministers' portfolios is included on page 138 of the Plan. The 2020 resources allocated to the Ministers within this Panel's remit are as follows:

During a Public Hearing with the Minister for Social Security in September, the Panel queried how the allocated £184 million was made up. The Director General advised us that that figure included the £65.3 million States Grant to the Social Security Fund and the Government contributions to the Long-Term Care Fund, which equated to roughly £30 million.[7]

Key Findings

FINDING 5.1

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.

FINDING 5.2

The total Heads of Expenditure for the Customer and Local Services Department is £90.6 million. In respect of Ministerial allocations, the Minister for the Social Security receives the second highest allocation of funding (£184 million) for her remit out of all the Council of Ministers.

FINDING 5.3

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.

Efficiencies

The Government Plan proposes £40m of efficiency savings in 2020. Of this total, £7m is increased tax revenues arising from more efficient tax collection. The remaining £33m is included at the bottom of Summary Table 3(i) Proposed 2020 Revenue Heads of Expenditure in Appendix 2 of P.71/2019.

Health and Community Services

Further information provided in the Efficiencies Plan 2020-23 informs us that the Health and Community Department (HCS) is due to make £9 million worth of efficiencies in 2020. As a result, HCS' 2020 budget has reduced from £211,387,000 to £202,387,000. It is anticipated that the savings will be made through commercial operations and operational excellence.

The Plan states that £1.77 million worth of efficiencies will be made through Commercial Operations'. Commercial Operations are described as schemes within HCS that are focused on ensuring that the Department gets the best value for money on its procured purchases and consumables whilst also maximising any contracts it holds with service providers. Three schemes have been identified in the Efficiencies Plan 2020:

• Pharmacy and drugs: ensuring best value for money on medicines purchases and redesigning our pharmacy operating model

• Consumable purchases: reducing variation and rationalising suppliers to maximise HCS buying power and reducing cost

• Income generation: capitalising on HCS opportunities to drive income generation through application of policy, inflation increase and provide patient income recovery.

According to the summary provided in the plan, the £1.77 million of savings identified does not include £750,000 worth of cross-cutting commercial operations that are attributed to HCS.

Key milestones and actions are noted to be detailed with the project plan, however, this had not been disclosed at the time of drafting our report.

Operational Excellence' is expected to achieve £3.67 million of efficiencies within the Health and Community Services Department. Operational Excellence describes nine schemes within HCS's efficiency programme. As stated in the Efficiency Plan, "Operational Excellence is focused on ensuring that services are meeting the current demand from patients and transformation in line with the HCS strategy and Jersey Care Model'. Schemes cover the entirety of the patient pathway, from the development of the acute floor to on and off-island placements and mental health facilities."[8]  This programme combines both established schemes form the 2019 efficiency programme and new schemes to be introduced in 2020. The nine schemes stated in the Plan are:

• Social Care – on and off-island placements

• Mental Health – off-island review/repatriation of acute services currently developed off-island

• Support Services – soft facilities maintenance contracts

• Intermediate care – bed model contract

• Community and voluntary sector – review and alignment with new care models

• Off-island repatriation – repatriation of acute services currently delivered off-island

• Theatres – a full programme of work to improve theatre efficiency

• Acute floor – delivery of the clinical model to support planned/unplanned care pathways

• Outpatients – transforming outpatient pathways to be delivered in the right place.

Key milestones and actions are noted to be detailed with the project plans within the Project Initiation Document'. This information had not been disclosed at the time of drafting our report.

These two efficiency programmes only add up to £5.44 million, even though it is stated within the summary 2020 efficiencies table that HCS is due to make £9 million savings in 2020. We understand, as highlighted above, that another £750,000 has been identified within the cross- cutting commercial operations programme that is attributed to Health. However, it is unclear within the Plan how the remaining £2.8 million worth of efficiencies is going to be achieved.

On 23rd October the draft operational business plans for each States Department were published. The document states that the remaining £2.8 million of efficiencies, which is not clearly identified within the Efficiencies Plan 2020-23, will be made through a "modern and efficient workforce". The business plan contains no further description of how exactly this would be achieved.

During our Public Hearing with the Minister for Health and Social Services and his Officers in September, we were advised by the Director General that "there is no headcount reduction"[9] in HCS's efficiency programme. Whilst the Panel is pleased to hear that the HCS's 2020 efficiencies programme will not impact on the current staffing level, we are concerned that efficiencies may be made by not replacing current vacant positions within the hospital. Due to a recent written question that was asked of the Health and Social Services Minister during a States Sitting, we are aware that as of August 2019 there were 194 vacant posts (that were still being funded) within the hospital (see table below)[10].

The Panel followed up its concern with the Minister and was advised:

"HCS is continuing to appoint to key vacancies as highlighted. Our intention is to appoint to our vacancies with substantive staff rather than continue reliance on agency and locum staff."[11]

Key Findings

FINDING 5.4

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

FINDING 5.5

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

FINDING 5.6

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.

Recommendations

RECOMMENDATION 5.1

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.

RECOMMENDATION 5.2

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.

Customer and Local Services

Further information provided in the Efficiencies Plan 2020-23 informs us that the Customer and Local Services Department (CLS) is due to make £2.2 million worth of efficiencies in 2020. The Efficiencies Plan 2020-23 states that £1 million with will be made through the development of the Target Operating Model (£0.7m) and "reductions in non-staff budgets" (£0.3m). A further £0.94 million will be saved by reducing tax funded benefit payments and £0.04 million by bringing some of their services into one location.[12]

The Target Operating Model is aimed at achieving the re-organisation of staffing and it is anticipated phase 1 and phase 2 of the re-organisation will achieve savings of approximately £0.7 million. However, it is stressed in the Efficiencies Plan that the realisation of the savings from phase 2 will only be confirmed once budgets are transferred to CLS from the Chief Operating Office and the Treasury and Exchequer. In regard to reductions in non-staff spend, the Plan states that reductions have been made possible through the continuous improvement programme  in  the  Department  and  changes  to  the  delivery  of  training  for  unemployed candidates and staff.

When the Panel queried what impact the proposed efficiencies would have on the current workforce within CLS it was advised:

"Through the 2 target operating model changes, I think both of which we have discussed in  previous  scrutiny  panel  meetings,  there  is  an  overall  staff  reduction  of  the  2

combinedphase 1 about 9.4 FTEs (Full time Equivalents) and the second phase is under consultation at the moment but that will result in a net reduction of about 3 FTEs."[13]

It was not clear within the Efficiencies Plan how the remaining £0.2 million would be made, since the central efficiency programmes did not contain a breakdown as to the exact amount each department was expected to save. It was not until the Draft Departmental Operational Business Plans was published on 23rd October that the Panel had sight of this information. Within this document it was confirmed that the remaining £0.2 million of efficiencies (from the total £2.2m) would come from various central programmes; £0.1m from Modern & Efficient Workforce, £0.02 from efficient organisational structures and £0.1m from contract efficiencies.

As a result of only first having sight of the Efficiencies Plan 2020-23 on 17th October and the Draft Departmental Operational Business Plans on 31st October, the Panel was unable to undertake appropriate and sufficient scrutiny of the proposed efficiencies programme. For this reason, the Panel fully supports the amendment brought forward by the Government Plan Review Panel to delay the approval of the efficiencies programme to allow for further scrutiny to be undertaken.

Key Findings

FINDING 5.7

The Customer and Local Services Department is committed to making, in total, £2.2 million worth of efficiencies in 2020, £1m 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.

6. Social Security Fund and Social Security (Reserve) Fund

Social Security Fund

The main purpose of the Social Security Fund (SSF) is to provide old age pensions. It also pays maternity, incapacity and other benefits.

At the time of publication of the Medium-Term Financial Plan (MTFP) in 2015 the ratio of working age people to pensioners was 4-1 and was predicted to fall to 3-1 by 2032. The actual number of pensioners was predicted to double from 14,000 to 28,000 by 2035.

The SSF receives contributions from employers, employees and general tax revenues and historically surpluses have been transferred to the Social Security Reserve Fund. As a result of reducing levels of surpluses, in 2012 the UK Government Actuary identified the Fund would "break  even"  in  2016  with  expenditure  outstripping  income  and  the  reserves  would  be exhausted by 2046. However, two subsequent actuarial reviews have been undertaken since then, one in 2015 and one in 2017. The 2017 review indicated a significantly higher projected Fund balance than at the 2015 review. It also concluded that, whilst the Fund was in surplus,

it was estimated to reduce to just three months' worth of Fund expenditure by 2023 and become negative by 2027.[14]

The Government Plan asks the States Assembly to approve the estimated income and expenditure of the Social Security Fund for 2020 as set out in Appendix 2 – Summary Table 8(i) (below)

The Government Plan seeks to reinstate the States Grant to the Social Security Fund to its full value of £93,100 by 2023 (an increase of £28 million). It also proposes further ring-fenced revenue-raising proposals, where the revenue raised is paid directly into the Long-Term Care Fund and Social Security Fund, rather than into general tax revenues. In respect of the Social Security Fund, the Plan proposes an increase of 0.5% in the employer and Class 2 Social Security contributions paid in respect of those earnings in excess of £53,304 up to the new income cap of £250,000. It is suggested that the changes  to the employer and class 2 contributions would bring in additional contributions of £3.35 million per annum and would help fund a range of family-friendly benefits from the SSF.[15]

With regard to the proposal to reinstate the States Grant over the years 2020 to 2022, the Panel is aware that in March this year, the Chief Minister expressed his preference to re- instate the grant in full in 2020. At a Quarterly Hearing with the Corporate Services Panel on 25th March, he stated:

"In the current M.T.F.P. (Medium Term Financial Plan), the grant that is paid into the Social Security Fund was frozen for the period of this plan. That will be unfrozen at the end of this year and therefore the liability on that will go up by £15 million a year to approximately £80 million. There is always one solution, which is to kick the can further down the road and freeze it again. That is not my preferred option because I do not think it is a long-term solution and that would therefore mean you would just have a look and see what can be done to resolve that."[16]

When we queried this matter with the Minister for Social Security she told us that, whilst the Council of Ministers had different opinions, in the end it was agreed that restoring it to its full

value over the next three years had the best outcome. It was explained that the staged reinstatement of the States Grant would release a total of £50million to invest in the agreed priorities set out in the Government Plan to fund some of the services that are significantly underfunded, whilst still ensuring the sustainability of the fund in the long-term.[17]

Furthermore, an Officer from SPPP assured the Panel that the Minister would be proposing changes to the Social Security (Jersey) Law 1974 for the States Assembly to  approve alongside the Government Plan which would introduce a legal requirement to reinstate the States Grant in full by 2023:

"What will be passed in the Government Plan this year is a number of law changes. You talked about long-term care, so there will be a law change that will put the rate up in law and at the same time there will also be law changes around the grant. The grant will be written into law that is a fixed amount of money for next year and the year after, then it will go up by a few million, which is halfway to where it should be and then in the last year of this term it will hit its full formula rate, so that is in the law. The can has kicked down the road only for one or 2 years and there is a very specific legal requirement that it will be the full amount of money in 2023. It is not saying we have just got the money, we are also going to agree the law changes to put it back to where it should have been. There has been a small number of years where it has been a bit lower than it was normally, but it will go back in this year, legally back to where it should be. That maintains its sustainability going forward."[18]

The Draft Social Security (Amendment of Law No.11) (Jersey) Regulations 201- was lodged by the Minister for Social Security on 14th October 2019. The Draft Regulations will facilitate the proposed changes to the Social Security Fund and the Long-Term Care Fund contained within  the  Government  Plan.  The  Panel  received  a  briefing  from  the  Strategic  Policy, Performance and Population Department on the draft Regulations on Monday 21st October.

Key Findings

FINDING 5.8

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

FINDING 5.9

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

Social Security (Reserve) Fund

The Social Security (Reserve) Fund holds the balances built up in the Social Security Fund and is a key to the Government managing the impact of an ageing population on future pension costs. The Government Plan states that consideration is being given to changing the

investment strategy of the Reserve Fund "to allow it to invest in local infrastructure, providing greater benefit to the Island while still providing a good return to the fund."[19]

The  Panel  raised  a  number  of  questions  with  the  Social  Security  Minister  about  the consideration of changing the investment strategy of the fund. The Minister advised that, whilst she does not have control of the investment strategy of the reserve fund, she sought advice from Treasury colleagues (as the investment strategy of the Reserve Fund is the responsibility of the Treasury and Resources Minister) in order to facilitate answers to the Panel's questions. The Panel received the following responses:

• What is the rationale for the proposed change to the investment strategy of the Reserve Fund?

Investment in local infrastructure could complement the existing asset classes held in the Fund's portfolio, increasing diversification and offering an appropriate risk adjusted return. Any investment would need to be considered on its own merits and in line with the long-term strategic objectives of the Fund. As well as providing opportunities for the  Fund,  local  infrastructure  investment  may  offer  additional  benefits  through supporting the delivery of improved facilities for the public of the island.

• Can you inform us how much is proposed to be invested and in precisely what form the investment would take?

This has yet to be determined, but as stated above any investment amount would need to be considered on merit and with reference to the long-term strategic objective of the fund.

• What assurances can you give that this is a sound investment and will not cause a problem in the future?

All investments are assessed by the independent Treasury Advisory Panel, both in terms of the absolute level of risk and return but also its contribution to the overall portfolio. Any investment would be expected to contribute to the long-term strategic objectives of the Fund.[20]

Key Findings

FINDING 5.10

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.

Recommendations

RECOMMENDATION 5.3

In advance of any changes 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.  

7. Long-Term Care Fund

The Long-Term Care Fund (LTCF) was established in 2013 to fund a long-term care scheme from tax payers. The Scheme provides that claimants having assets of £419,000 (including cash of over £25,000) or more will pay the first £56,130 (for an individual) or £84,195 (for a couple) of the care costs. Any person over 18 years of age can claim.

As with the Social Security Fund, it was identified in the 2017-2019 MTFP that the ageing population would increase demand upon the Scheme. The contribution rate of 0.5% in 2015 increased to 1% in 2016 and was predicted to rise to 3% by the 2040s.

An Actuarial review completed at the end of 2017 found that the LTCF would reduce to provide just 3 months' worth of expenditure by 2023 and become negative by 2027. It also predicted that the contributions would require "break even" contributions of 1.5% by 2028 and up to 2.5% by end of 2043. The projections are noted to be uncertain.

The Government Plan seeks to increase the balance of the LTCF from the current 2019 balance of £24m to £94m by 2023 (See below)[21].

To achieve this, the Government Plan has proposed a 1% increase (to 2%) in the headline rate of Long-Term Care contributions from 2020, together with an increase in the income cap from £176,232 to £250,000. It is claimed that these changes will increase the income into the fund by approximately £22 million a year and will place the LTCF on a sustainable basis for the next 25 years.[22] The Panel has previously received a briefing on the proposed changes to the long-term care fund so was not surprised to see them appear in the Government Plan.

The Government Plan asks the States Assembly to approve the estimated income and expenditure of the Long-Term Care Funds for 2020 as set out in Appendix 2 – Summary Table 8(iii) (below)

The Panel acknowledges that in March 2019, the Fiscal Policy Panel (FPP) released their report on the Government Plan 2020-2023, in which they recommended:

"that the early part of the forthcoming Government Plan period is an appropriate time to plan an increase in the long-term care contribution, while the economy is running above trend.  Consideration  should  also  be  given  to  whether  a  larger  increase  could  be appropriate to provide additional flexibility regarding future increases in the rate."[23]

In a Public Hearing in September, the Panel queried what evidence the Social Security Minister had, apart from the FPP's recommendation to "consider" a larger increase, which supported increasing the contribution rate by 1% rather than the original 0.5 per cent. The Minister advised the Panel that the Council of Ministers had a good discussion "around the table" and agreed that by increasing the contribution by 1% would mean that the fund would remain secure for many years into the future. The Assistant Minister also added:

"one of the things that long-term care was about, we were determined to make sure that we were not going to push this off trying to make sure that it was a sustainable fund to the next Council of Ministers. We wanted to deal with that now and make the decision now. The reason to bring it early was also that the people that are paying into it now, the people that are going to take it early now, so the people that are going to need it the soonest, will have contributed into the fund as well."[24]

The Minister also explained to the Panel that, despite concerns that an 1% increase will have a considerable impact on individuals, most people will pay less than this as a percentage of their total income. According to the Government Plan, most people currently pay far less than 1% of their income into the Long-Term Care Fund each year, due to the availability of allowances and reliefs. The impacts of the proposals on a range of tax payers is shown in the below table[25]

The Panel also asked the Minister in the Public Hearing whether any consideration had been given to staggering the increase of the contribution rate over the 4 years of the Government Plan. We were told that consideration had been given to this, but that the Council of Ministers had decided that it was best to introduce the total increase in 2020. We were further advised that if the headline rate and income cap were increased in 2020, then the fund would not have to be looked at again for another 20-odd years.[26]

Regulation 5 of the Draft Social Security (Amendment of Law No.11) (Jersey) Regulations 201- raises the contribution percentage rate for the Long-Term Care contributions to 2% from 1st January 2020.  

Key Findings

FINDING 5.11

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.

FINDING 5.12

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.

8. Actions, Programs and Capital Projects Reviewed

9. Reports on Specific Actions and Business Cases

Actions not linked to a business Case

Develop a Health and Wellbeing Framework

Summary Report

• The Government Plan explains that the aim of the Framework is to connect and coordinate actions across the Government and its partners that will support all islanders to live healthier, fulfilling, longer lives - from the Active Jersey schemes and active travel, to accessing arts, culture, heritage and education, to developing early help and preventative health services, and embedding sustainable wellbeing in what we do as the Government of Jersey.

• The Panel was advised that the reason this action is not linked to a project seeking additional revenue expenditure is because it can be delivered by the existing departmental budget.

• During a Public Hearing with the Minister for Health and Services in September, when discussing the "preventable diseases" project, the Panel was advised that the health and wellbeing policy framework was currently under development. We were also told that the Framework would link together policies such as; smoking cessation, alcohol policy and the food and nutrition strategy.

Key Findings

FINDING 5.13

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

Provide Appropriate Accommodation

Summary Report

• The  action  contained  within  the  Government  Plan  is  to  provide  appropriate accommodation for people within Learning Disability Services, in order that individuals avoid significant risk of harm.

• The Panel was advised that the reason this action is not linked to a project seeking additional revenue expenditure (i.e. a business case) is because it is instead linked to a capital project.

Key Findings

FINDING 5.14

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.

Business Cases for Additional Revenue Expenditure

Preventable Diseases

Summary Report

The Minister for Health and Social Services has requested the following funds in respect of preventable diseases:

Additional Investment Required (£000)

According to the summary business case contained in R.91, the aim of Reducing Preventable Disease (RPD) portfolio is to reduce the burden of preventable disease and, avoidable early death in Jersey's population. In doing so, HCS will be aiming to achieve the Government of Jersey's Common Strategic Priority to Improve Islanders wellbeing and mental and physical health.' The RPD portfolio sets out an array of funded programmes which will complement a wider piece of work that is being undertaken by the Public Health Team. The business case also explains that there is a need to shift away from reliance on public messaging campaigns and health promotion, because of little impact on behaviour, to an approach addressing wider detriments  of health. The Panel was told that this shift would be reflected in the work undertaken under this project.

During a Public Hearing with the Minster for Health and Social Services, the Panel asked whether it was the intention of the Department to amend any existing policies to ensure the aspirations of RPD could be achieved, we were advised:

"We are currently progressing a health and wellbeing policy framework that will link all those policies: smoking cessation, alcohol policy, food and nutrition strategy. All of those need to be linked in an overall strategy that links them altogether."[27]

The Assistant Minister for HSS advised the Panel that he was due to consider a first draft of this framework later in the day and the hope was to have it finalised and published by Christmas.

In a written question to the Minister, the Panel queried the substantial increase of requested investment for this project from £300,000 in 2020 to £1,200,000 in 2021 and again to £2,500,000 in 2022. We were advised that in 2020, £0.1m would be spent on health promotion and £0.2m on meals for primary schools. A two-year pilot scheme in two schools is planned to be rolled out more widely with £200,000 beginning the roll-out. In 2021, primary school meals will be rolled out further and new programmes in Strategic, Policy, Performance and Population (SPPP) will be introduced. For example, Healthy Start and Food Dudes, which will provide access to fruit and vegetables for low income groups, and a whole school Cooking and Growing programme. In 2022, the SPPP programmes will be rolled out further, breakfast clubs and family weight management will begin, and the smoking cessation work will increase. In 2023, the family weight management would get a broader roll out.

The Assistant Minister for HSS also explained that it would take time to build some of these programmes and rather than throwing money at it on day one, the Department had to be clever with what they spent and wise with how they spend it. HCS felt that the wise thing to do in this instance was to get the programmes into place and then funding would follow – hence why the budget in years 2,3 and 4 increase quite considerably.

During the Public Hearing, the Panel asked for further information regarding smoking cessation and how the Department intends to spend the requested £579,000 in 2021, 2022 and 2023. The Director General of Health and Community Services told the Panel:

"Part of the work that we are doing is we are working collaboratively alongside other government departments, particularly CYPES (Children, Young People, Education and Skills), around how we can get smoking cessation and smoking prevention message into schools. We are also looking as part of the work we are doing with the Jersey Care Model at harnessing community efforts that we have across the parishes so that we start to get a more educative process happening out within groups that are touching people every day and are able to speak to them quite informally."[28]

The Group Medical Director also added:

"It is not just schools. It is smoking avoidance. Smoking cessation is also directed at adult smoking, those adults who are unfortunately addicted to cigarettes and nicotine. We have a new care prevention for families and primary care, which we need to give our primary care colleagues, both paramedics and G.P.s, funding for the outcome of the measures so they can convince and assist their patients to stop smoking. A lot of funding

will go into the community where it is best served rather than being used to pay for colleagues in the hospital, secondary care, to deal with the complications."[29]

Key Findings

FINDING 5.15

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.

FINDING 5.16

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.

Adult Safeguarding Improvement Plan

Summary Report

The Chief Minister has requested the following funds in respect of the Adult Safeguarding Improvement Plan:

Additional Investment Required (£000)

The Safeguarding Adults Partnership Board is responsible for co-ordinating work locally, safeguarding and promoting the welfare of adults in Jersey and monitoring and challenging the effectiveness of Jersey's safeguarding arrangements. The Board meets 6 days per month and is led by an independent Chair. The work is undertaken by 2 trainers and 1 policy staff, with a part time manager and administrators.

According to the business case, two reviews were undertaken in 2018 by independent advisers and in consultation with service providers and the Safeguarding Adults Partnership Board. The reviews identified some good practice but identified 40 recommendations relating

to delivery personalisation through an outcomes-based approach and improving inter-agency working, processes and culture.

The Board has stated that the extra work required to co-produce and implement the adult safeguarding  improvement  plan  (Making  Safeguarding  Personal'[30])  requires  additional resources, which was agreed by the Council of Ministers.

The business case therefore requests additional investment for 1 FTE Manager and 1 FTE Administrator for one year.

Key Findings

FINDING 5.17

The £102,000 funding requested for the Adult Safeguarding Improvement Plan in 2020 would provide funding for two additional FTEs who are needed to co- produce and implement the Plan.

Mental Health and Mental Health Legislation

Summary Report

The Minister for Health and Social Services has requested the following funds in respect of mental health:

Additional Investment Required (£000)

The Department is also requesting the following funds for mental health legislation:

The business case in R.91 states that the above requested funds are required to deliver HCS's plan to:

• Improve access to 24/7 mental health services, aid recovery, and provide safer and more effective care closer to home

• Improve the quality and therapeutic value of the care environment through work on the mental health estate

• Keep Islanders mentally healthy and physically well by co-producing and developing services, initiatives and educational and promotional activities that are recovery oriented and improve well-being

• Improve access to advocacy and upholding human rights

• Develop our workforce for the future in response to innovation and new models of care

• Optimise technology as an alternative option supporting the therapeutic process

• Work in partnership with a range of stakeholders to deliver value-based care and support.

In order to better understand how the Health and Community Services intended to spend the additional investment of £3.2m in 2020, the Panel requested a breakdown of the funds along with a timeline for each of the 6 initiatives identified within the business case. Below the Panel will summarise the information provided, however if you wish to view the full response from the Minister please click here:

1. CAMHS - £0.4m

HCS seeks to secure resources to facilitate the transfer of CAMHS services from health and community services to CYPES (Children, Young People, Education and Skills); clarify and improve operational accountability and reasonability for delivery of the CAMHS pathway and commence a programme of redesign work to shape a future service model for CAMHS and relevant pathways of care and support.

Phase 1 to commence Q4 2019:

1. Securing recruitment to vacant team manager post;
2. Undertaking a review of complex cases;
3. Completing a full analysis of the service;
4. An additional CAHMS Consultant post is needed to address the needs of 19-25-year olds.

Phase 2 to commence Jan 2020:

a) Completion of a business case to secure support to assist with service design. It is anticipated that this will be in the region of £50k.

2. Crisis Support - £1.1m in 2020

We were advised that, following confirmation of funding, immediate recruitment would begin of a consultant psychiatrist with expertise in crisis intervention and two full-time equivalent staff (FTEs) grade psychiatrists. Following those appointments, a multi-disciplinary team including alcohol and drugs and physical health care services will be appointed. It is anticipated that the crisis support services will be in place by Q3 2020.

3. Listening Lounge - £95k in 2019 & £0.3m in 2020

On 31st July 2019 the Mental Health Improvement Board decided to allocate existing funds to initiate a two-year pilot. This is due to begin in terms of venue refurbishment in November 2019.

4. Complex Trauma - £0.8m in 2020

The costs are for a forensic consultant, clinical psychologists, sexual health/domestic violence counsellors, assistant psychologists and non-pay (training). It is estimated the pathway as a whole will be operational by the end of Q3 in 2020.

5. Mental Health Legislation - £0.6m in 2020

The funds would be put towards an immediate team recruitment of 8 FTEs to ensure that the Department can meet the statutory obligations under the Mental Health (Jersey) Law and the Capacity and Self-Determination (Jersey) Law. The Department has envisaged that the recruitment process will take approximately 6 months so will be finalised in Q2 2020.

6. Mental Health Strategy - £0.6m in 2020

Further development of the Mental Health Strategy aligned to the New Jersey Care Model is required in 2020. This will include expanding upon the Community and Voluntary sector role and opportunity going forward so that Mental Health partners are clear as to future long-term strategic plans and can have certainty regarding their roles and functions within the future care model. This will commence in Q1 2020.

Investment in existing staff and recruitment of high-quality workforce

In March 2019, the Panel undertook a review of mental health services (S.R.4/2019 Assessment of Mental Health Services). One of the Panel's recommendations was for the Government to focus on investing in existing staff by giving them access to appropriate training. During a Public Hearing with the Minister, the Panel queried whether the request for additional funds in the Government Plan included any consideration of investment in existing staff. The Group Managing Director highlighted the crisis prevention service as one area where the extra investment was needed to train existing and new staff. Speaking about crisis prevention he told the Panel:

"It is a completely different specification to the current psychiatric liaison service. Those psychiatrists and psychiatric liaison nurses have to work in a different way and will need a lot of training, support, education and professional development to help them to do that, and they will need a revised on-call arrangement as well."[31]

It was also noted that investment in a new mental health leadership team under Dr Garcia (Medical Director of Mental Health) had already been made in 2019 and that this would not be funded within the Government Plan. The team included a dedicated improvement lead, a dedicated lead nurse, a dedicated lead social worker and a dedicated lead allied health professional.

The Panel raised concerns during the Public Hearing with the Minister for Health and Social Services about the importance of recruiting the right staff to be able to undertake all the initiatives that HCS intend to implement with the Government Plan funding. In a written submission we received from Adult Mental Health Services, we heard that the service was currently under significant strain because of staff shortages. Although, recent recruitment drives had been successful, and the service was working on developing collaboration with partners in the third and private sector. The Panel is very much in agreement with Adult Mental

Health Services when they say that  "sustainability and successful implementation is dependent on successful recruitment and retention of a high-quality workforce."[32]

Housing mental health professionals

The Panel also questioned the Minister as to whether any of the requested funds within the Government Plan would be used to assist in housing mental health professionals. The Panel was advised that this work was being led by Andium Homes, the Housing Department and Jersey Property Holdings and that a scheme, which included 45 properties (predominately one-bedroom apartments) was due to be completed by the end of this year.[33]

The Panel has previously raised concerns about ensuring that Jersey attracts the best people to work in mental health by, among other things, improving access to housing. In the Hearing, Deputy Pamplin raised this concern with the Minister:

Deputy K.G. Pamplin

"In that instance if you are fundamentally wanting somebody exceptional in mental health, they would be saying "we need this person, we want this person, they come with their family; one bedroom is not going to do it Minister." Therefore, as Minister would you then go to the Minister for Housing and Andium Homes and say "I have got a bit of money and we really want this person"?

The Minister and Health and Social Services

"We would do everything we can to find a way, because if this person is key to enhancing our services and fill a much a much-needed gap then we want to get them in and we will find a way".

Director General, Health and Community Services

We have a relocation package that we are able to flex if needs be, which is an upfront payment that we can give to people but also helping them to find accommodation that suits their needs. I am confident that we would be able to make that happen."

The Minister further advised that if this situation was to arise the Department would be able to fund it out of its existing budget.

Crisis Response Team

From further information we requested from the Department on mental health, we understand that £5.4m, of the total £16.3m requested for mental health (2020-2023), would be used to fund the crisis response team of 14 FTEs. In the Public Hearing, the Group Managing Director confirmed that all the FTEs are identified as new posts and will most likely be a blend of off- island and on-island professionals.

In the mental health business case it states that "it is anticipated that the implementation of the crisis response service will generate additional efficiency opportunities[34]." When the Panel queried what these efficiencies were, we were told:

"There are two expected real benefits in terms of efficiency. The first is around prevention of admissions into our in-patient unit, into Orchard House and what will be Clinique Pinel. The second is that if we start to manage crisis prevention and we are stopping getting to an escalated position then we would expect that to impact on our prevalence of off-island activity, which is really expensive."[35]

The Panel is extremely supportive of the use of funds to establish a crisis team and acknowledge the need to be able to swiftly respond to people who are at risk of admission to hospital for matters relating to their mental health. However, the Panel is concerned about recruiting the right people to the various posts to ensure the crisis intervention service is as effective as it can be. The Panel enquired about this issue at the Public Hearing and was advised by the Director General of Health and Community Services:

"I think what we are trying to offer here is a real wraparound mental health provision within Jersey. With the listening lounge, with the crisis support, particularly with the complex trauma, we are investing in staff that do provide that and not just for our patients that present with mental health illness but across the board for patients that come into our care that we are touching. We hope that that the mental health campus approach that we are taking will encourage staff to apply and come here to Jersey."[36]

The Assistant Minister (Senator Pallet) advised the Panel that he had absolute confidence that HCS will find the right people to staff the crisis team and that they will put the right packages of care together to support people in crisis in Jersey.

Talking Therapies and Listening Lounge

During the Panel's review of mental health services, we found that the majority of respondents who use mental health services had to wait to access those services, for what the majority of them considered an unacceptable time. Accordingly, the Panel was keen to find out whether any of the requested funds in the Government Plan would be used to address the important issue of waiting times. During the Public Hearing, it was acknowledged by the Minister and his Officers that the current waiting lists for Jersey Talking Therapies (JTT) were too long. The Panel was told that Dr Garcia, Medical Director of Mental Health, was due to undertake a review of JTT to find out the reasons for the long waiting lists and to understand how resources could be moved around to deliver the service differently. The Assistant Minister, Senator Pallet, confirmed that there was funding within the Government Plan to undertake that work[37].

The Minister also spoke of the listening lounge as a service that will be available to people to receive help when they need it as opposed to just sitting on a waiting list. The listening lounge will form part of an overall model of service to improve 24/7 access to mental health support. It will be a designated place where people can make a call to or drop in' or be referred to talk to someone about issues impacting on their mental health and wellbeing. HCS has requested £1.6m over the 4-year period in respect of the listening lounge. In further information we

requested from the Department on this subject, we were told that the listening lounge would initially be a 2-year pilot project and the requested funds in the Government Plan were required to support its implementation, to appoint a project team and to staff the facility.

However, the Group Managing Director did advise the Panel that the plan was to review the listening lounge after 3 months of it being up and running:

"Our view of what the listening lounge is offering is an element of some of the pathway that you would expect to go into Jersey Talking Therapies. So we need to see what that impact is and that is why we are at the moment going to do a 3 month review on the activity for the listening lounge because it could be quite big and if it is then we would have to repurpose how we would support that initiative."[38]

At the time of Public Hearing, a location for the listening lounge had been identified but the Department was not willing to share the information, as the contract had yet to be signed. However, we were told that the lounge would be situated in a town centre location and that the announcement as to the exact premises would be made very shortly.

Following the Hearing, the Panel learnt that the listening lounge would be based at Charles House in Charles Street in St Helier town centre. Furthermore, L.I.N.C, a specialist mental health and wellbeing provider in Jersey has signed a contract with Health and Community Services to launch the facility which will provide Islanders with free help. The facility will be staffed by clinicians who will oversee the day-to-day running of the service, while peer support staff will bring additional insights through their lived experience of mental health difficulties.[39]

The Panel notes that the venue refurbishment is due to begin in November 2019. Third sector – involvement and funding

In discussing mental health more generally, the Assistant Minister also spoke about his hope for better collaboration between the Government and third sector organisations and the support that such organisations may be providing in terms of staffing mental health-based facilities going forward. The Assistant Minister did acknowledge however that, whilst closer relationships were being built with third sector partners, such as Mind, Samaritans, Recovery College, the Department needed to find a better way to fund them and support them if they were going to provide the assistance that was needed.