HSS Government Plan 2022 - 2025 Review

Government Plan 2022-25 Review

Health and Social Security Scrutiny Panel

10th December 2021 S.R.19/2021

1  CHAIR'S FOREWORD  4

2. INTRODUCTION / METHODOLOGY  5
3. FINDINGS AND RECOMMENDATIONS  6

Findings  6 Recommendations  11

4. DEPARTMENTAL BUDGETS  13

Departmental Budgets  13 Departmental Heads of Expenditure  14

SPECIAL FUNDS  18

Social Security Fund  18 Social Security (Reserve) Fund  21 Health Insurance Fund  23 Long-Term Care Fund  28

5  EFFICIENCIES  30

Rebalancing and Efficiencies  30 Minister for Health and Social Services  31 Minister for Social Security  32

6  SUMMARY TABLES OF SCRUTINY RAG' RATINGS  32

Previously reviewed programmes and capital projects (GP 2020-23 / GP 2021-24)  33 New capital expenditure (GP 2022-25)  37

7  PREVIOUSLY REVIEWED PROGRAMMES AND CAPITAL PROJECTS: UPDATE REPORTS  37

Programmes  37 GP20-CSP2-2-02 --- Preventable Diseases  37 GP21-CSP2-1-05 --- Jersey Care Model  41 GP20-CSP2-2-02 --- Mental Health  43 GP20-CSP2-2-03 --- Mental Health Legislation  49 GP20-CSP2-3-01 --- Digital Health and Care Strategy  50 GP20-CSP2-3-02 --- Health P82 reinstate 2019 new and recurring  52 GP20-CSP2-3-03 --- Maintaining Health and Community Care standards  53 GP20-CSP2-3-04 --- Regulation of Care – income deferred  55 GP20-CSP4-1-01 --- Compensation for Mesothelioma  57

GP20-CSP1-1-02 --- Financial Independence in Old Age  58 GP20-CSP4-1-04 --- Food Costs Bonus  60 GP20-CSP4-1-04 --- Single Parent Component P.113/2017  62 GP20-CSP4-3-01 --- Care Needs at Home  63 GP20-CSP4-3-02 --- Disability Social Inclusion  65 GP21-CSP4-C-02 --- Covid-19 Income Support Costs  66

Capital Projects  68 Health Service Improvements  68 Learning Difficulties – Specialist Accommodation  70 Jersey Care Model – Digital Systems  73 Digital Care Strategy  76 In-Patient / Support Services Refurbishments  80 Benefits and Payments – System  82

8  NEW PROGRAMMES AND CAPITAL PROJECTS IN GP 2022-25: REPORTS  84

Programmes  84

Obstetric and Gynaecological (O&G) Services  84 Covid-19 Vaccine  87 Covid-19 Health Service Recovery  91 PPE Provision and Supply  94 PPE Warehousing  96 Health and Social Recovery  98 Children's Health Recovery Plan  102

Fund as required programmes  107 Fund as required - Covid-19 Helpline  107 Fund as required: Covid-19 Test and Trace Programme and Technology  108

Capital projects  111 Replacement Assets (Various)  111 Crematorium  114

9 CONCLUSION  116 10 WITNESSES AND EVIDENCE GATHERED  118 APPENDIX 1  119

Terms of Reference  119 Panel membership  120

1  Chair's Foreword

The Panel has reviewed the Proposed Government Plan 2022-2025 thoroughly. We have gathered evidence and had two public hearings, and so wish to thank those who have contributed.

We continued to review the Jersey Care Model throughout 2021. Progress has not occurred as quickly as we would have liked, in particular the implementation of the independent oversight board. The funding model moving forward is still awaited.

High demand for Mental Health Services has significantly increased as a result of the pandemic and the Panel is of the opinion that sufficient funding is critical moving into 2022. We have therefore brought an amendment for this to be increased.

I would like to thank the Panel's scrutiny officers for their hard work and commitment to putting this report together and the significant support they have given the Panel in 2021 and of course, as always, the members of the Panel.

Deputy Mary Le Hegarat

Chair,

Health and Social Security Panel Scrutiny Panel

2  Introduction / Methodology

The proposed Government Plan 2022 sets out the approach the Government of Jersey has taken in responding to COVID-19 whilst continuing to invest in the Common Strategic Policy priorities:

1. Put children first
2. Improve Islander's wellbeing and mental and physical health
3. Create a sustainable, vibrant economy
4. Reduce income inequality and improve the standard of living
5. Protect and value our environment.

The Plan outlines the investment proposed in each of these five strategic priority areas and also includes a number of proposed efficiencies within the Government.

The Government Plan Financial Annex has also been lodged which contains supporting information for the Government Plan 2022-2025.  

The Scrutiny review of the Government Plan has taken a thorough approach, looking at the projects identified for additional revenue expenditure and capital expenditure last year, as well as new projects requiring additional revenue expenditure and capital expenditure in 2022. The Panel has undertaken this review in as much detail as possible with the information provided by Government.

A summary table of all business cases is provided in Chapter 6, along with the Panel's RAG rating.

In line with the methodology used during previous reviews, all Scrutiny Panels have agreed to use a common system to report on the status of each business case, as follows:

The Panel has reviewed the background information and is satisfied with the business case.

The Panel has reviewed the business case 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.

The Panel has reviewed the business case and is not satisfied or does not agree with the proposal. This may or may not lead to an amendment.

3  Findings and Recommendations

Findings

FINDING 1

No review of the Social Security Fund, or social security schemes, has been undertaken in 2021. This had been a commitment from the previous Government Plan. An actuarial review of the Social Security Fund will be undertaken in 2022.

FINDING 2

It has been proposed that the States Grant from the Consolidated Fund is not paid to the Social Security Fund in 2022 and 2023. It is proposed that the Social Security (Reserve) Fund will transfer £81,255 million in 2022 to support ongoing payment of pensions and benefits.

FINDING 3

If the Government Plan is adopted as proposed, and the draft Regulations are subsequently approved by the States Assembly, the estimated balance of both the Social Security Fund and the Social Security (Reserve) Fund at the end of 2024 would total £2.497 million.

FINDING 4

Based on the latest fund valuations and changes to the States Grant, an actuarial estimate has shown that the Social Security (Reserve) would have the equivalent of 4 years' worth of expenditure in 50 years' time. Estimates have been based on population assumptions and it is anticipated that future decisions about Jersey's population will affect the balance of the fund.

FINDING 5

The value of the Health Insurance Fund is estimated to reduce to £47.590 million by  the  end  of  2025.  This  represents  approximately  one  years'  worth  of expenditure.

FINDING 6

In 2020, Ministers committed to undertake the review of sustainable funding for the Jersey Care Model before the next Government Plan debate in 2022. This has not been undertaken.

FINDING 7

Estimates of the Long-Term Care fund balances have improved since the previous Government Plan. This is because income receipts have been higher than expected.

FINDING 8

The Minister for Health and Social Services has been asked to make a total of £6.25 million of efficiencies in 2022.

FINDING 9

The Minister for Social Security has been asked to make a total of £575,000 worth of efficiency savings in 2022.

FINDING 10

All aspects of the Preventable Diseases' project budget – which is split between HCS, CYPES and SPPP - are underspent in 2021. Activity was expected to increase towards the end of the year and into 2022.

FINDING 11

There have been delays to the establishment of the Jersey Care Model (JCM) Independent Oversight Board, however, appointments are expected to complete in November 2021 with the first meeting anticipated in December 2021.

FINDING 12

The budget for Mental Health Services programmes under GP20-CSP2-2-02 in 2022 is £4.1 million. This budget was allocated to the programme in 2019, pre the Covid-19 pandemic.

FINDING 13

Clarification is required from the Department about the inclusion of the Mental Health Legislation' budget in the breakdown of spend for GP20-CSP2-2-02.

FINDING 14

The Mental Health Legislation' has forecast an underspend of approximately £52,000 in 2021.

FINDING 15

The programmes for Digital Health and Care Strategy', the Digital Care Strategy (Major Project)' and the Jersey Care Model – Digital Systems' are being operationally managed together by Modernisation and Digital but are separated for the purposes of funding in the Government Plan. The overlap and combined management of these programmes makes it difficult to analyse progress against the separately funded projects.

FINDING 16

The funding under Health P82 reinstate 2019 new and recurring' is used for support services that are already in place, but which are not built into base budgets. This funding has been used for keyworker accommodation, mental health nurse training, and establishing pathways for diabetes care and end-of- life care.

FINDING 17

Further clarity is required on the changes to the funding and impact on the transformation projects for the Maintaining Health and Community Care standards' programme.

FINDING 18

The funding requested for the Regulation of Care' project in 2022-2025 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. It is a continuation of what was approved in last year's Government Plan.

FINDING 19

An efficiency saving of £60,000 has been identified from the Compensation for Mesothelioma' scheme due to a current low demand for the scheme, however, assurance has been given that there is sufficient funding to support this benefit, should claimants come forward in 2022.

FINDING 20

Work on the Financial Independence in Old Age' project will resume in 2021 and the outcome of the scoping work would be published by the end of the year.

FINDING 21

The Community Costs Bonus (formerly the Food Costs Bonus) has been budgeted as £340,000 per year in the Proposed Government Plan 2022-2025, this has been confirmed as an error, as the budget anticipated for 2022 in P95/2020 was £361,000.

FINDING 22

Customer and Local Services has confirmed that the forecast spend for the Community Costs Bonus in 2022 in £308,000, which is lower than the budgeted £340,000.

FINDING 23

There were 1,190 total claims of the Single Parent Component benefit in 2021.

FINDING 24

The value of the Single Parent Component would not increase in 2022 and would remain at £40.39 per week.

FINDING 25

The Care Needs at Home' project has been delayed. This is due to the pandemic and the complex needs of the individuals involved in the scheme.

FINDING 26

The Disability Social Inclusion Project is making progress, and a Disability Strategy survey was undertaken in August 2021.

FINDING 27

The budget for Covid-19 Income Support Costs for 2022 is £672,000 (reduced from £5,249 million in the previous Government Plan). There is no specific provision in the Covid-19 Reserve for Income Support costs, should this be required.

FINDING 28

Health Services Improvements is the capital programme of upgrade works that are necessary to keep the current hospital operating in a compliant manner that ensures patient safety and protects service delivery until a new hospital is delivered. Previous Government Plans have allocated £5 million per year to the rolling programme of works, however, in this proposed Government Plan the 2024 budget has been reduced to £2 million, in anticipation that the Our Hospital Project is on track.

FINDING 29

£1.5 million of the £2 million budget for the Learning Difficulties' project was forecast to be spent in 2021, and there would be a request for £500,000 to be transferred to 2022.

FINDING 30

The project for JCM – digital systems' is being managed centrally by Modernisation and Digital and, operationally, it is being managed with the Digital Care Strategy' and Digital Health and Care Strategy' projects.

FINDING 31

Work to progress the JCM – Digital Systems' project has been delayed in 2021, due to prioritisation of resources for other projects in the digital health team.

FINDING 32

The Digital Care Strategy was delayed in 2020 and 2021 due to Covid and other workstream priorities. Of the £3.4 million budget in 2021, £988,092 has been spent. A request has been submitted to move the underspent budget to 2022.

FINDING 33

The mid-year review has stated that there has been progress on the In- Patient / Support Services' project, however, the update provided to the Panel conversely advises that there has been no spend or commitment in 2021.

FINDING 34

The replacement to the Benefits and Payments system is being funded by the Social Security Fund. The proposed budget for 2024 has been reduced by £1 million.

FINDING 35

£646,000 per annum will be used to fund 2 additional consultant posts in Obstetric and Gynaecological Services. This will provide consultant cover on the labour ward 24/7 and will ensure that the best practice guidance in relation to safety is met.

FINDING 36

£2 million has been spent on the Covid-19 vaccine booster programme in 2021. This has been funded by an underspend of the £5.4 million budget that was approved last year for the Covid-19 vaccine programme in 2021.

FINDING 37

In 2022, £4.1 million funding is ringfenced for the Covid-19 vaccination programme and a further £2.585 million has been provided for in the General Reserve.

FINDING 38

Screening programmes have been impacted by the pandemic and there is now a backlog of patients on waiting lists. No backlog is reported for Cervical screening, but there is concern that insufficient people have come forward. There is a delay for bowel screening, patients who should have been seen in 2020 would be screened by November 2021 and then the 2021 and 2022 cohorts would be seen during 2022. Breast screening was reported to be one year behind schedule.

FINDING 39

The Island has a 45-day pandemic stock of Personal Protective Equipment (PPE). The Government will not continue to provide PPE to all healthcare venues in the long-term, however, notice has been given to providers that this will change.

FINDING 40

The Island's PPE stocks are split across 3 storage sites, and use 8,000 sq ft of storage space. There is a further 8,000 sq ft used to store equipment from the decommissioned Nightingale Hospital.

FINDING 41

A Political Oversight Group for the Health and Social Recovery Fund was established in September 2021.

FINDING 42

The initial projects of the Health and Social Recovery Fund will include a Long- Covid response, Early Years project, and funding for Children and Young People's Education and Health. There are further projects in the pipeline, including for Children's Dental Health.

FINDING 43

The Children's Health Recovery Plan will provide investment to establish services including: a Home Treatment and Liaison Team, Perinatal mental health, Neurodevelopmental service, Child to Adult Mental Health transition pathway, and specialist medical capacity. Funding is proposed in the sum of £2 million in 2022 and increases to £3.8 million for the remaining years of the Government Plan.

FINDING 44

£500,000 has been set aside as provisional funding for the Covid-19 Helpline in 2022.

FINDING 45

A provisional £20 million has been provided for in respect of the Covid-19 Test and Trace Programme and Technology in 2022.

FINDING 46

The Proposed Government Plan 2022-2025 details a broadly consistent expenditure on replacement assets across the 4-year term of the plan, however, the information provided by the Department (of the value of equipment requiring replacement) details a higher funding requirement in 2024 than is currently provided for.

FINDING 47

The Crematorium facility in Jersey requires replacement, irrespective of the new hospital at Overdale. An estimate of £5 million across 2024 – 2025 has been budgeted to review and relocate this service for the Island.

Recommendations

RECOMMENDATION 1

The Minister for Social Security must keep the Health and Social Security Panel informed of the progress of the actuarial review of the Social Security Funds in 2022.

RECOMMENDATION 2

The Minister for Social Security should publish a report, within 2 weeks of any transfer, to detail how any funds transferred out of the Health Insurance Fund for the purposes of the Jersey Care Model or its related digital

strategies costs have been verified.

RECOMMENDATION 3

The Minister for Health and Social Services should annually publish a report, which will also be presented in advance to the Health and Social Security Scrutiny Panel, to detail the information provided to the Minister for Social Security relating to the costs incurred on the Jersey Care Model that require a transfer of funds from the Health Insurance Fund.

RECOMMENDATION 4

The Minister for Social Security should prioritise an actuarial review of the Health Insurance Fund in 2022. This should include specific analysis of the use of the HIF for the purposes of the Jersey Care Model and its related digital strategies, consideration of the impact of all withdrawals on the fund since 2020, and consider the future of the HIF, should withdrawals take place as per envisaged by P.130/2020.

RECOMMENDATION 5

As part of the wider review of sustainable healthcare funding the Council of Ministers should specifically consider repaying the HIF (from the Consolidated Fund) for funding withdrawn for the establishment of the Jersey Care

Model and its related digital strategies if no sustainable healthcare funding is operational by 2025.

RECOMMENDATION 6

The Minister for Health and Social Services should ensure that a detailed breakdown of the funding for Digital Health and Care Strategy' for 2022 is provided to the Health and Social Services Scrutiny Panel.

RECOMMENDATION 7

The Minister for Health and Social Services should provide the Panel with further details about the impact of a proposed reduction in funding to Health Service Improvements' in 2024, including the mitigating measures that will be put in place to ensure patient and staff safety is maintained despite the reduction in budget.

RECOMMENDATION 8

The Minister for Health and Social Services must provide the Panel with the outcome of the feasibility work in respect of the Learning Difficulties project, as soon as it is complete, and detailed plans for alternative accommodation.

RECOMMENDATION 9

As per the Panel's amendment to P.90/2021 (Amd 15), the digital health team within Modernisation and Digital should establish a protected, separately resourced sub-team (that includes a Manager grade role), to focus solely on the delivery of the Jersey Care Model digital systems, and the Digital Care Strategy. Regular updates on these workstreams should be reported on to the independent JCM Programme board and the Health and Social Security Scrutiny Panel.

RECOMMENDATION 10

The Minister for Health and Social Services must provide the Panel with an update on the status of the In-Patient / Support Services Refurbishments' project, including clarity on whether the budget of £1.044 million from 2021 will be transferred to 2022 and / or 2023.

RECOMMENDATION 11

The Minister for Health and Social Services must update the Panel on the Maternity Workforce Strategy when this is available in 2022.

RECOMMENDATION 12

The Minister for Health and Social Services must keep the Panel informed of any significant changes to the Covid-19 vaccination programme, particularly any developments that will have a significant impact on, or add pressure to, the project's budget.

RECOMMENDATION 13

The Panel requests regular updates on the Covid-19 Health Service Recovery' project, particularly in line of waiting list updates, work with GPs and staff / overtime updates.

RECOMMENDATION 14

There should be regular reporting on each project within the Health and Social Recovery Fund, to each of the relevant scrutiny panels during 2022 and 2023.

RECOMMENDATION 15

The Minister for Health and Social Services must provide the Panel with further detail about the proposed budget for the capital expenditure on replacement assets.

4  Departmental Budgets  

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 programmes and capital projects assigned to the Panel predominantly sit under:

Minister for Health and Social Services, Deputy Richard Renouf

Minister for Social Security, Deputy Judy Martin

Departmental Heads of Expenditure

In the Government Plan 2022 - 2025, the States Assembly has been asked to approve the proposed amount to be appropriated from the Consolidated Fund for 2022, for each head of expenditure. The tables below provide a summary of the proposed Heads of Expenditure' allocated to the Departments for 2022 and estimates produced for 2023 - 2025:

At the Public Hearing with the Minister for Health and Social Services, we asked about the movements in the estimated revenue Heads of Expenditure for Health and Community Services in 2022 – 2025. The Panel noted that the estimate increased in 2023, but decreased in 2024 and 2025. We were advised that the reduction was partly linked to the ongoing rebalancing programme.  

A further breakdown of these figures was provided on pages 22 (for CLS[3]) and 30 (for HCS[4]) of the Annex to the Government Plan 2022-24:

The 2022 resources allocated to the Ministers which fall under the Panel's remit are as follows:

The Panel noted that the resources mapped to the Ministerial portfolio for the Minister for Health  and  Social  Services  (in  the  sum  of  £236,949,000)  and  the  estimated  heads  of expenditure for Health and Community Services (in the sum of £225,790,000) do not align with each other. At the Public Hearing with the Minister for Health and Social Services, on 28th October 2021 this was queried and the Panel were advised:

Head of Finance, Health and Community Services:

The difference is in respect of COVID. The COVID expenditure for 2022 is £9.1 million and the S.P.3 is £2 million.'[6]

The Panel also queried why the estimates for the resources mapped to the portfolio of the Minister for Health and Social Services had reduced in comparison to the Government Plan for 2021-2024.

We have the 3 portfolios for the Minister. We have the H.C.S. (Health and Community Services) budgets. There has been a net reduction there of £1.6 million. The COVID head of expenditure, there has been a net reduction there of £1 million. For S.P.3 we have a net increase of £1.3 million. That is from the opening budget of 2021 to the planned budget for 2022. They are the 3 portfolios that sit under the Minister.[7]

The Panel asked for some further information about the Improvement and Innovation' service area that had been included under the Health and Community Services Heads of Expenditure. It was provided with the following breakdown:

[8]8

The Panel noted that the resources mapped to the portfolio of the Minister for Social Security did not align with the Heads of Expenditure for the Customer and Local Services Department. In the Panel's review of the Government Plan of 2021-2024 it has been advised that the Minister's portfolio budget included the majority of the CLS budget, extra COVID money for income support, a long-term care grant, and - in the years that it is payable - the States Grant.

At the Public Hearing with the Minister for Social Security, it wsa asked why the resources mapped to the Minister for Social Security's portfolio for 2022 had reduced since the previous Government Plan. The Panel were advised that:

As the Minister said, we had additional funds for coronavirus for income support and that is why the allocation for 2022, which was forecast last year to be £130 million, is now going to be around about £121 million.[9]

Special Funds

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. The SSF receives allocations from Social Security contributions from employers and working age adults and, in normal times it also receives an annual States Grant.

A review by a UK Government Actuary on the Fund as at 31st December 2017 (published 25th March 2019 as R.31/2019) had identified some long term sustainability considerations for the Fund. Prior to 2012 the amount of the States Grant had represented each year's exact cost of contributions supplementation. From 2012 to 2015 the amount of the States Grant had been set by a formula for each successive Medium Term Financial Plan. However, from 2016 to 2019 the amount of the grant had been fixed at the 2015 level (£65.3 million per year).

The Government Plan 2020-2023 (approved in 2019) proposed to reinstate the States Grant to full value by 2023, rather than reinstating it in full in 2020. During its review of the Government Plan the Panel was advised by the Minister for Social Security that the staged reinstatement of the States Grant had the best outcome, as a total of £50 million would be released to invest in the agreed priorities set out in the Government Plan to fund some of the services that were significantly underfunded, whilst still ensuring the sustainability of the fund in the long-term.

Alongside the Government Plan 2020-2023, States Members were asked to approve amendments to the Social Security (Jersey) Law 1974. The Regulations would introduce a legal requirement to reinstate the States Grant to its full value of £93.1 million by 2023. The Regulations were approved by States Members.

However, on 25th March 2020, the Minister for Social Security lodged P.31/2020 – Draft Social Security (Amendment of Law No.12) (Jersey) Regulations', in light of the ongoing Covid-19 pandemic. The Regulations proposed to remove the obligation to pay any States Grant, from the Consolidated Fund, into the Social Security Fund (SSF) during 2020 and 2021. The purpose of these changes was to further assist the Treasury and Resources Minister in addressing the financial implications of Covid-19. The Panel undertook a review of the Regulations and lodged an amendment prior to the debate. The Panel's Amendment sought to maintain, at that time, the obligation to pay the States Grant of £65.3 million into the SSF in 2021. Alongside the amendment, the Panel requested that an economic forecast was undertaken by the Treasury and Resources Minister within a six-month period to allow the States Assembly to reassess whether there was a need to remove the obligation to pay the States Grant in 2021.

The States Assembly supported the Panel's amendment which meant that no grant would be paid into the Social Security Fund in 2020 but that the Minister for Social Security would have to seek further approval from the Assembly to remove the obligation to pay the States Grant in 2021 and future years.

For the purposes of the Government Plan 2021-2024 (reviewed by the Panel in November 2020), the Minister for Social Security proposed a change to the Social Security Law to remove the States Grant for 2021. It was advised that further changes to the value of the Grant would be proposed during 2021, following agreement on the outcome of a review of the sustainability of the Social Security Scheme. This review was due to be undertaken by the Council of Ministers and would draw on the work already completed, which had gathered views on the future of the fund, contributions and benefits. With regards to the review of Social Security Sustainability, the Government Plan 2021-2024 (lodged on 12th October 2020) stated that:

We are determined to place the Social Security Fund in a fully sustainable position for future generations and will undertake a full review of the various components of the Social Security scheme over the coming months. These components include the contributions levied, other income coming into the Fund, the range and level of benefits and pensions provided and the size and investment strategy of the Reserve Fund. In particular, the balance of contributions and States Grant will be reviewed in the context of the burden of overall government levies (taxes and contributions) on individuals, workers, businesses and employers. The review will build on the public consultations, previously conducted in 2016 and 2017, and will lead to proposals to be incorporated into the Government Plan 2022.[10]

It also stated:

Ministers are determined to make sure that the [Social Security] fund continues to serve future generations and, as a priority, will undertake a full review of the various components of the Social Security scheme ahead of the next Government Plan to ensure the future balance is maintained at a fully sustainable level[11].

During a Hearing with the Minister for Social Security on 13th October 2021 the Panel was advised that no reviews had been undertaken of the social security funds in 2021[12]:

The Minister for Social Security:

Well, last year it was my plan to have a review of the social security ... all the funds, the social security fund and the health insurance fund, and actually the returns were a lot better, and then I was reminded that we are ... early next year all the funds get an actuarial review and we have enough money in there to last until 2070 ... is it 2070?

Director General, Customer and Local Services: Yes, 2070, 4 times.

The Minister for Social Security:

2070, 4 times, so they were done. They have not gone across. It will need another States decision. They have not gone across. They do not pay them into me. So it is held at Treasury and normally the States grant would come to me and it has not come to me for the last 2 years and it is not intended to come to me this year or next year, and then it goes back up to its full cost in 2024.[13]

For the purposes of this Government Plan, 2022-2025, the proposals to withhold the States Grant for 2022 and 2023 remain, but these require approval by the States Assembly.

[14]Estimate of Social Security Fund balances

14

With regard to these proposals, the Minister for Social Security lodged P.101/2021 – Draft Social Security (Amendment of Law No.16) (Jersey) Regulations on 2nd November 2021. The Draft Regulations are due to be debated directly following the debate of the Government Plan 2022-2025, if Part c) of the Proposition is passed by the States Assembly.

The report accompanying P.101/2021 states:

In the Government Plan 2021-2024 last year, Ministers made a commitment to review the Social Security Fund to make sure that it continues to serve future generations. Since then, the long-term forecast for the Social Security Reserve Fund has improved, and under this Government Plan the value of the States Grant is restored to its full value from 2024 onwards. The cost of providing old age pensions will increase with the ageing demographic but the Fund is still forecast to hold four times annual spend by the 2070s.

The next actuarial review will be carried out during 2022 and published in early 2023. This will support the next government in its long-term planning for the Social Security Fund.[15]

If the Government Plan is adopted as proposed, and the draft Regulations are subsequently approved by the States Assembly, the Government Plan notes that the estimated balance of both the Social Security Fund and the Social Security (Reserve) Fund at the end of 2025 would total approximately £2.497 million (as shown in table 40 of the Government Plan 2022-2025 - below).

16 The Panel's review last year identified that the Government Plan proposed that the States Grant of £65.3 million will be reinstated in 2024 and a sustainability measure will also be used to address the balance of £29.3 million in the same year (totalling £94.6 million). As per the table below, there is no longer a separate sustainability measure, and the proposed States Grant to the SSF is in the sum of £82.53 million in 2024.

In the absence of the States Grant to the Social Security Fund, there are proposals to draw further on the Social Security (Reserve) Fund to support the Government in facing its financial pressures.

As part of its review into the Government Plan 2020-2023, the Panel was advised that withholding the States Grant between 2020 and 2023, and reducing the grant by £30 million in 2024 would release £300 million of tax-funded money in the Consolidated Fund. This would pay for costs relating to Covid-19 over the period, and it will also help to make up for lower tax revenues, supporting ongoing public service costs and investments in strategic priorities.

FINDING 1

No review of the Social Security Fund, or social security schemes, has been undertaken in 2021. This had been a commitment from the previous Government Plan. An actuarial review of the Social Security Fund will be undertaken in 2022.

FINDING 2

It has been proposed that the States Grant from the Consolidated Fund is not paid to the Social Security Fund in 2022 and 2023. It is proposed that the Social Security (Reserve) Fund will transfer £81,255 million in 2022 to support ongoing payment of pensions and benefits.

FINDING 3

If the Government Plan is adopted as proposed, and the draft Regulations are subsequently approved by the States Assembly, the estimated balance of both the Social Security Fund and the Social Security (Reserve) Fund at the end of 2024 would total £2.497 million.

RECOMMENDATION 1

The Minister for Social Security must keep the Health and Social Security Panel informed of the progress of the actuarial review of the Social Security Funds in 2022.

Social Security (Reserve) Fund

The Social Security (Reserve) Fund (the 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.

In 2020 a transfer of £55 million was approved from the Reserve Fund into the Social Security Fund in order to support the cost of Social Security pensions and benefits and help the Government to manage the extreme financial pressures it is currently facing'.[16]

As detailed above, due to proposals for withholding the States Grant to the Social Security Fund in 2022 and 2023 (which requires approval from the States Assembly) there are proposals to transfer £81,255,000 from the Reserve Fund to the Social Security Fund in 2022 and a further £87,175,000 in 2023.

In a public hearing with the Minister for Social Security the Panel queried what impact these transfers would have on the health and long-term sustainability of the Reserve Fund and were advised:

We worked with the actuaries to update the last projections that they did for us after the actuarial review a couple of years ago. They did their best to update them based on the latest information and the valuation of the fund and given the proposed changes to the States grant, and that showed that the reserve fund would have the equivalent of 4 years' worth of expenditure in the reserve fund in 50 years' time.[17]

The Panel was further advised that recent work with actuaries had raised some concerns about the population figures used for calculations, namely:

So they used the same population assumption, the central one that they used in their last actuarial review, which is net plus 700 a year, which is roughly what we have seen in recent decades being projected forward. So, as you were saying, Minister, the outcome of the population debate and future decisions around population in the long term will also affect the balance of funds and that will need to be kept in mind.[18]

The Panel was advised that no consideration had been given to refunding the Reserve Fund in the future for the transfers out it was making to the Social Security Fund.

Estimate of Social Security (Reserve) Fund balances

20

FINDING 4

Based on the latest fund valuations and changes to the States Grant, an actuarial estimate has shown that the Social Security (Reserve) would have the equivalent of 4 years' worth of expenditure in 50 years' time. Estimates have been based on population assumptions and it is anticipated that future decisions about Jersey's population will affect the balance of the fund.

Health Insurance Fund

The Health Insurance Fund (HIF) receives allocations from Social Security contributions from employers and working-age adults and supports the wellbeing of Islanders by subsidising GP visits, the cost of prescriptions and other primary care services. Under Article 21 of the Health Insurance (Jersey) Law 1967 the HIF is under the control and management of the Minister for Social Security.

Further amendments have been made to the law which have made specific provision for the withdrawal of money from the HIF for reasons other than that which was provided for in the 1967 Law, these are set out in the table below, for reference:

The estimated balances for the HIF, 2022-2025, are detailed in the table below:

21

It is noted that the value of the HIF is estimated to reduce to £47.590 million by the end of 2025. This represents approximately one years' worth of expenditure.

Concerns about the long-term sustainability of the fund, particularly as it has been drawn on recently – and is proposed to have further funds withdrawn – to fund the work to progress the Jersey Care Model.

21 Government Plan 2022-2025, p. 169

In a written submission to the Panel, the Primary Care Body stated:

We are concerned that increased use of the Health Insurance Fund may make it unsustainable. Further consideration should be given to the proportion of funding from both the Health Insurance Fund and Treasury.

We are unaware of any plans as to how funds will be maintained. Specifically will they be raised by increased taxation or increased social security payments? Will a proportion of funds be ring fenced for Primary Care and General Practice? What funding mechanism will be instituted to protect patients whilst ensuring that Primary Care providers are maintained as viable businesses?[19]

The Panel has questioned the suitability of using the HIF for purposes other than that which were set out in the 1967 Law:

Senator S.Y. Mézec :

we know that money from the Health Insurance Fund is being used for purposes other than what the Health Insurance Fund is meant to be funding in terms of implementing the Jersey Care Model and its related strategies. How confident are you that that is being done correctly and appropriately, given that the point at which we would be making decisions on health funding into the future is pushed back further than when we initially anticipated that would be made?

The Minister for Health and Social Services:

Just to correct you, Senator, the use of the Health Insurance Fund is perfectly proper. These are Islanders' funds for primary care services. This is not a fund that is exclusively for G.P.s (general practitioners), it is for primary care services. This is what is being delivered in the Jersey Care Model; the planning of primary care services being delivered in the community. This is a proper source of funding. Were it not then the Government would have been told that this is an illegal way of proceeding but it is not.[20]

The Panel highlights that the use of the HIF has been approved through amendments to the law, however, with regards to the most recent amendment (Draft Health Insurance Fund (Miscellaneous Provisions) (Amendment No. 2) (Jersey) Law 202-) there were specific reassurances that any further transfers out of the HIF would only be brought to the States Assembly following a review of healthcare funding (see below for further details).

As noted in the Panel's summary of the Social Security Fund above, a review of the social security funds – which includes the HIF – has not been undertaken in 2021. Further to this, commitments had been provided about a wider review of the sustainability of healthcare funding have not taken place.

The Panel has lodged an Amendment to the Government Plan , which seeks several political commitments in relation to the use of the HIF as the source of funding for the Jersey Care Model (the JCM'). The Panel has lodged the amendment following concerns that, despite assurances provided in 2020, the reviews of healthcare funding and the HIF that were due to be undertaken in 2021 before the 2022-2025 Government Plan debate have not happened. At the point in which the propositions listed below were all approved by the States Assembly, the assurances provided and information available indicated that further details on the funding for the Jersey Care Model from the HIF would be available at the point of debating the next Government Plan (2022-2025) in 2021:

• P.114/2020 – Jersey Care Model' (as amended);

• P.130/2020 – Government Plan 2021-2024' (as amended); and

• P.156/2020 - Draft Health Insurance Fund (Miscellaneous Provisions) (Amendment No. 2) (Jersey) Law 202-'.

Jersey Care Model

The Jersey Care Model (JCM), P.114/2020, was debated on 3rd November 2020 and was approved by States Members 39 votes to 7. This proposal specified that sustainable healthcare funding would be operational by 2025, and that investment of £28.1 million in the next Government Plan would be requested, it was stated that this included £17 million of non- recurrent investment over a 5-year period.[21]

During his opening speech of the debate of P.114/2020 on 3rd November 2020, the Minister for Health and Social Services stated:

The Government Plan we will be debating in a few weeks recognises the need for quick action. It brings forward the need to deliver a solution to make sure that health costs are funded sustainably and it commits to undertaking a full review, which will include taking proposals to this Assembly ahead of the 2022 Government Plan to determine an appropriate model for future health and care funding.[22]

During his closing speech, he made the following remarks:

Each year we will have a Government Plan. Each year there will need to be money put into the Government Plan for up to 2025 for the costs of this. Each year up to 2025 Members will be able to debate the vote proposed. There are plenty of opportunities for reviewing this and I have no doubt Members will continually ask me questions and, of course, I have the opportunity or any future Minister has the opportunity to bring a debate to this Assembly.[23]

and

Yes, there is concern about we will not be in a position to debate sustainable funding but we are going to be working on a sustainable funding measure over the next 9 months and the commitment is to bring it forward in the 2022 Government Plan. That is what the proposition asks for, that is in the present Government Plan that commitment to do so.[24]

Government Plan 2021-2024

The Government Plan 2021-24, which was lodged on 12th October 2020, indicated that:

After investments, the JCM is forecast to save £23 million per year by 2036. However, it brings forward the need to deliver a solution to make sure that health costs are funded sustainably and  we will undertake a full review – which will include taking proposals to the States Assembly - ahead of the next Government Plan to determine an appropriate model for future health funding.[25]

Draft Health Insurance Fund (Miscellaneous Provisions) (Amendment No. 2) (Jersey) Law 202-

The transfer of funds from the Health Insurance Fund to the Consolidated Fund as a consequence of the approval of the Government Plan 2021-24 was approved by the States Assembly in  P.156/2020 - Draft Health Insurance Fund (Miscellaneous Provisions) (Amendment No. 2) (Jersey) Law 202-'. The Minister for Social Security, in her opening speech on 17th December 2020, stated that:

The 2021 Government Plan sets out further transfers in 2022 to 2024. I again will only put these forward after Ministers have completed the planned review of sustainable health funding and brought proposals back to the Assembly during 2021. The next transfer will be proposed next year after States Members have considered the proposals for sustainable health funding and the future direction of the Health Insurance Fund.[26]

In her closing speech on 17th December 2020 the Minister stated:

I understand the Deputy 's concerns. I do not share them because we will not be taking any more money out until we find that sustainable model. It will come back to the Assembly. It needs to come back to the Assembly and it will be amendable but it has to be done, as I said, before we can just carry on taking money out of the Health Insurance Fund.[27]

Government Plan 2022-2025

There is an acknowledged overlap between the review that is required for the assessment of sustainable healthcare funding and the review of the HIF as part of the Social Security scheme.

In a quarterly hearing with the Minister for Health and Social Services on 17th November 2021, the following update was provided about the wider sustainable healthcare funding review:

The review will be undertaken over the course of next year, as it is a commitment in the Government Plan 2022 and it will inform the next Council of Ministers. The aim is to have the review maybe by the beginning of 2023 so it can feed into the Government Plan 2024.'[28]

At the Panel's Quarterly Hearing with the Minister for Social Security on 21st October 2021, it was clarified that the HIF was not due to have an actuarial review for another couple of years (a review every 5 years is required by law). Officers advised that:

We need to make a decision about the Health Insurance Fund. Given the significant changes that are planned for it, it may be not very good value for money for the public to do an actuarial review while the fund is in such a state of flux.[29]

The Panel's amendment seeks to ensure a separate actuarial review of the Health Insurance Fund (HIF) is prioritised by the Minister for Social Security in 2022 and that this should include; specific analysis of the use of the HIF for the purposes of the Jersey Care Model and its related digital strategies; consideration of the impact of all withdrawals on the fund since 2020; and consideration of the future of the HIF, should withdrawals take place as envisaged by P.130/2020.

FINDING 5

The value of the Health Insurance Fund is estimated to reduce to £47.590 million by  the  end  of  2025.  This  represents  approximately  one  years'  worth  of expenditure.

FINDING 6

In 2020, Ministers committed to undertake the review of sustainable funding for the Jersey Care Model before the next Government Plan debate in 2022. This has not been undertaken.

RECOMMENDATION 2

The Minister for Social Security should publish a report, within 2 weeks of any transfer, to detail how any funds transferred out of the Health Insurance Fund for the purposes of the Jersey Care Model or its related digital

strategies costs have been verified.

RECOMMENDATION 3

The Minister for Health and Social Services should annually publish a report, which will also be presented in advance to the Health and Social Security Scrutiny Panel, to detail the information provided to the Minister for Social Security relating to the costs incurred on the Jersey Care Model that require a transfer of funds from the Health Insurance Fund.

RECOMMENDATION 4

The Minister for Social Security should prioritise an actuarial review of the Health Insurance Fund in 2022. This should include specific analysis of the use of the HIF for the purposes of the Jersey Care Model and its related digital strategies, consideration of the impact of all withdrawals on the fund since 2020, and consider the future of the HIF, should withdrawals take place as per envisaged by P.130/2020.

RECOMMENDATION 5

As part of the wider review of sustainable healthcare funding the Council of Ministers should specifically consider repaying the HIF (from the Consolidated Fund) for funding withdrawn for the establishment of the Jersey Care Model and its related digital strategies if no sustainable healthcare funding is operational by 2025.

Long-Term Care Fund

The  Long-Term  Care  Fund  (LTCF)  provides  universal  and  means-tested  benefits  to individuals with long-term care needs and is funded through a central grant from general revenues and income-related contributions from income tax payers.

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 were noted to be uncertain. The Government Plan 2020-2023 sought to increase the balance of the LTCF from the 2019 balance of £24m to £94m by 2023. To achieve this, the previous Government Plan 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.

However, as a result of an Amendment put forward by the Corporate Services Panel at the time, the contribution rate was only increased by 0.5% and, therefore, now stands at 1.5%. The current contribution rate is expected to enable the balance on the Fund to continue to increase throughout the period of the Government Plan. It is anticipated that further increases in Long-Term Care contribution rate in future years will be needed as the proportion of older people with long-term care needs is expected to increase.

The Government Plan 2022-25 states that future increases in Long-Term Care expenditure are expected to be reduced through the implementation of the Jersey Care Model and the proposed introduction of the new Care Needs at Home Benefit, as these are intended to reduce the number of individuals who will need a care home placement, instead there will be a provision of alternative care options and improved support at home and in the community.  

The Panel notes that, in 2020, the Government Plan for 2021-2024 estimated that the opening fund balance for 2022 would be £35,220,000. The Government Plan 2022-2025 estimates that the 2022 opening balance will be £51,049,000 (see table below for further details). In a public hearing with the Minister for Social Security, the Panel asked why the estimates for the Long- Term Care fund balances had improved since the previous Government Plan. We were advised that:

It is the increase [in the contribution rate to 1.5%] and I think that there has been higher income receipts than expected and, of course, the tax, and long-term care is obviously income and it is taxed, so, therefore, if we collect more money from tax we will have a higher amount coming in for the long-term care charge and that is reflected through, I think, the forecasts that this Government Plan has included and will also benefit the long-term care fund.[30]

The Long-Term Care Fund will be subject to a formal actuarial review in 2022. Estimate of Long-Term Care Fund balances

34

FINDING 7

Estimates of the Long-Term Care fund balances have improved since the previous Government Plan. This is because income receipts have been higher than expected.

5  Efficiencies

The Government Plan 2020-2023 set out the ambition to achieve £100 million of efficiencies, with the first £40 million to be achieved in 2020. The plan for £40 million in 2020 was published in October 2019 and a performance update was included in the Government 6-month report, published in August 2020. The Government Plan 2021 – 2024 set out the 2021 plan to deliver £20 million of efficiencies and other rebalancing measures.

Rebalancing and Efficiencies

The Government Plan proposes £21 million of rebalancing measures in 2022, with the intent that a further £40 million of savings will be delivered across 2023 and 2024. The table below shows the efficiencies and rebalancing totals for each Minister under the Panel's remit:

The summary description of proposals reviewed by the Panel for each Minister are set out in the table below:

Panel analysis

Minister for Health and Social Services

The Panel has noted that £6.25 million of efficiencies have been identified from the Ministerial portfolio for 2022. As set out in Table 2 in the Government Plan (and above), £3.75 million of those efficiencies are identified as general reduction in non-staff budget', £1.8 million are identified as general staffing productivity increase', and £700,000 are a spend reduction in fees and charges.

In a public hearing the Minister explained that:

Of course with a large budget and a multi-faceted service I believe there are always efficiencies that could be sought out. Over the last year or so, the department has been moving to a zero-based budgeting system that really takes a hard deep look at exactly what we need in the department and how we procure it and how we get best value for money. That is achieving next year £2 million in savings. We have many contracts with outside bodies and in our tertiary care hospitals outside in the U.K. (United Kingdom). We can review and challenge those contracts and that is set to produce savings of £750,000. In pharmacy, drugs expenditure can be reduced through constant review, managing contracts, and adoption of less expensive drugs which are just as effective. That will produce £500,000 in savings. Then we can be more efficient with our laundry and catering service, that will produce £150,000 in savings. Then we are budgeting for an increase in private patient activity and associated income to produce £550,000 in savings. There is good work going on, which I know Rose will be able to speak to, in reducing our agency staff. That is happening now with the result that we will not be paying those agency fees and we will be recruiting substantively. That is projected to provide savings of £1,800,00. I hope that gives an overview.[33]

In 2021, the Minister for Health and Social Services was asked to make £5 million worth of efficiencies through the implementation of the zero-budgeting exercise and, when questioned by the Panel in a public hearing on 28th October 2021, it was confirmed that this target had been met. The Panel noted that the proposed Government Plan 2022 -2025 identified a further £2 million of efficiencies as part of the ongoing embedding of the zero-based budgets. When asked whether these were newly identified efficiencies, or if they were carried over from those identified for 2021 it was confirmed that they were newly identified. The Head of Finance, Health and Community Services explained that:

I think it is building on the previous success of the zero-based budget and taking that to the next level, so we are exploring further options, deep dives on all of the budget to see where efficiencies can be made, economies of scale, purchasing all of those areas will continue to build. I think it is about highlighting the importance of Z.B.B. (zero-based budget) not being a separate exercise; it is embedded as part of business for health going forward. So it will continue to drive savings. We will continue to review budgets year on year to ensure that they are fit for purpose and align to the business need.[34]

In quarterly hearings and other correspondence in 2021, we have heard about the intention within HCS. to increase permanent staff levels and decrease the reliance on agencies. The Panel asked how this impacted the £1.8 million worth of efficiencies that had been identified as a staffing spend reduction. It was advised that there is a 25 – 30 per cent premium on the cost of agency staff, therefore the recruitment to substantive posts would help achieve this.[35]

FINDING 8

The Minister for Health and Social Services has been asked to make a total of £6.25 million of efficiencies in 2022.

Minister for Social Security

The Panel notes that the Minister for Social Security has been asked to make £575,000 worth of efficiencies in 2022. As set out in Table 2 in the Government Plan (and above), £371,000 of those efficiencies are identified as general reduction in non-staff budget' and the £204,000 are identified as general staffing productivity increase'.

In the Panel's hearing on 13th October 2021 it was advised that the £371,000 general reduction in non-staff budget' was made up of £311,000 reduction in the budget for television licences, as the scheme was now funded by the BBC and there was also a £60,000 reduction in the benefit budget for the compensation for mesothelioma scheme. It was confirmed that the original budget had forecast for 5 claims a year, however, the take-up had been much lower therefore the budget was being reduced to reflect the reduced activity[36].

Regarding the £204,000 general staffing productivity increase', the Minister confirmed that this was a vacancy factor, equivalent to 1%, which equalled £144,000 and an additional £60,000 that related to the Government wide voluntary redundancy scheme.

FINDING 9

The Minister for Social Security has been asked to make a total of £575,000 worth of efficiency savings in 2022.

6  Summary tables of Scrutiny RAG' ratings

The Panel has undertaken review of the various programmes and capital projects that were assigned  to  it  by  the  Government  Plan  Review  Panel,  and  passed  comments  where necessary. Following its review's Terms of Reference, the Panel carried out scrutiny of projects based upon the following guideline criteria:

• Where funding over £500,000 has been allocated

• Where funding has been withdrawn or decreased significantly from the previous year

• Where funding has been increased significantly from the previous year

• Projects which the Panel consider are of most concern (as a result of, for instance, delays, deferrals, overspends or because they are not in keeping with Common Strategic Priorities)

• Projects which have been identified as of concern by stakeholders

• Projects which are contentious and/or in the public eye.

• Projects where insufficient information has been provided and more information is sought

• Concern is held on the project's alignment with Common Strategic Priorities, social impact and impact upon children.

This section provides a summarised overview of the Panel's RAG ratings assigned to both previously reviewed programmes (GP 2020-23 / GP 2021-24) and new ones which have been identified in the Government Plan 2022-25.

Previously reviewed programmes and capital projects (GP 2020-23 / GP 2021-24)

The tables immediately below identify the programmes included in previous iterations of the Government Plan, which will continue to be invested in in 2022, and indicates whether the projects are Complete', On Track', Reduced', Delayed', Deferred' or subject to Partial Deferral'.

New programmes requiring additional revenue expenditure (GP 2022-25)

The table below identifies the programmes that will receive first-time investment in 2022 and were therefore not included in previous iterations of the Government Plan.

*FaR[37]

New capital expenditure (GP 2022-25)

The table below identifies new capital projects that will receive first-time investment in 2022- 2025 and were therefore not included in previous iterations of the Government Plan.

7  Previously  reviewed  programmes  and  capital  projects:

update reports

This section provides an update on the Programmes and Capital Projects that were previously reviewed by the Panel that it has caried out further scrutiny of in concordance with this review's Terms of Reference.

Programmes

According to the summary business case contained in R.91/2019, 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 below tables provide an overview of the funding allocations that were proposed in the 2020-23 plan and the 2021-2024 plan against what is now being proposed in 2022-25 plan:

Funding allocations approved in Government Plan 2020-2023 (£000):

Funding allocation approved in Government Plan 2021-2024 (£000):

Funding allocation requests in Government Plan 2022-2025 (£000):

During its review of the Government Plan 2021-2023 (in 2020) the Panel found that all aspects of the Preventable Diseases project had been deferred, it was confirmed that no funds had been spent or were due to be spent on the project. Instead, the growth allocated for support of preventable diseases has been used to mitigate efficiency programme challenges in 2020.'[38]

Mid-Year Report Update

The progress update provided in the Government's 6-month progress review noted that the RPD budget for 2021 (£1.2 million) was split between 3 departments, namely Health and Community Services in the sum of £551,000, Children, Education, Young People and Skills (CYPES) in the sum of £179,000 and the Public Health Team, which sits in Strategic Policy, Planning and Performance (SPPP) in the sum of £470,000. For HCS there had been a key movement in the net revenue expenditure of £1.2m for the RPD portfolio. For SPPP it was noted  that  there  had  been  a  £0.6m  increase  in  the  new  Public  Health  Directorate, predominantly due to budget transferring from HCS for the RPD programme.

Panel analysis  

The Panel learned that the RPD funding in HCS was allocated to build on existing provisions, including programmes to support stopping smoking, and health promotion capacity to raise awareness of risk factors for disease through evidence-based approaches. Funding for the project within SPPP and CYPES was focused on preventing obesity and diet-related disease such as diabetes, certain cancers, and cardiovascular disease in future generations. The Panel has been advised that this area has been identified as having limited investment compared with other major risk factors for disease, with large gaps in preventive service provision.

In its hearing on 28th October 2021, the Panel asked the Director of Public Health for an update on the 2021 RPD funding and was advised:

Currently this budget is underspent because of practical reasons in trying to, for example, establish some programmes in schools. But there have been areas of spend, nonetheless. So money has been spent on the smoking cessation, on breastfeeding, and in trying to promote healthy eating in particular. The plans now are for there to be a considerable increase in activity in 2022 where these things are going to be much more possible to promote.[39]

The Panel received an update on the breakdown of 2021 funding by letter, this detailed that:

SPPP

Current 2021 spend to date as at 5 November: £131,850

Due to COVID-related restriction in schools and public health staff being diverted to support the pandemic response, SPPP are forecast to underspend on the RPD budget.

CYPES

Due to impact of COVID-19 on school activity, CYPES is not due to spend from the RPD budget in 2021.

RPD budget within CYPES 2021: £179,000 Current Spend 2021: £0

Projected spend 2021: £0

HCS

In 2021, the RPD budget has been underspent for a variety of reason discussed later, however, we have made excellent progress across a variety of programmes and are looking forward to continuing and expanding our work into 2022. A breakdown of costs spent is highlighted in the table below

44

The Panel asked about the RPD programmes that had been delayed for schools and was advised that several evidence-based programmes had been piloted in 2019, focussing on early years and primary school settings. Following positive outcomes, there had been plans to expand these in 2020, however, this work had been delayed by the pandemic. The Panel was advised:

COVID-19 related school closures and restrictions halted this work and prevented the planned expansion, with Public Health being fully diverted to the pandemic response throughout 2020 and much of 2021. This has led to significant underspends in the RPD budget across departments, although work has been underway to reinstate provisions since the summer.[40]

The Panel was pleased to learn that the diabetic retinal screening has been reinstated after a period of 3 years. It also noted the appointment of a screening programmes manager, to assist in the effective running of all screening programmes.

In 2022 work will include progress on the smoking cessation project and the UNICEF baby friendly programme (which Family Nursing and Home Care has been commissioned to provide). The Panel was also advised that:

The appointment of three health promotion leads at the end of September has allowed us to start planning wide reaching and meaningful campaigns for later this year and into  2022.  The  team  have  made  inroads  into  many  government  organisations including: closer to home, diabetes centre, cardiac rehab, fit-for-life physio and drugs and alcohol services. A large number of third sector charities have been engaged and links within the Portuguese community embedded. These vital communications will be invaluable in providing next year's campaigns. OASIS planning is commencing for Diabetes  Awareness  and  Cervical  Screening  and  this  year  we  are  supporting European Antibiotic Awareness Day (Nov). Video material and new leaflets (including translation) are currently being produced for diabetic retinal screening and fit for life. Health promotions have been supporting the launch of FIT and the organisation of the GP talks. Health promotions have had/will have a presence at the Health Living Festival, Jersey Heart Group and COPD Day.[41]

The 2021 budget has been underspent, for various reasons including practical issues and delays and efficiencies that were identified and required due to Covid-19 pandemic pressures, however, the Panel notes that activity on programmes is expected to increase at the end of 2021 and throughout 2022. A wide range of projects and campaigns planned for the 2022 and the appointment of three staff (Health Promotion Leads) in September 2021 will help facilitate this.

Based  on the  information  provided, the  Panel maintains  its  green RAG  rating for  the programme. The Panel observes that whilst the project has been subject to delays, progress has been made on a number of areas and there is significant progress planned for 2022.

FINDING 10

All aspects of the Preventable Diseases' project budget – which is split between HCS, CYPES and SPPP - are underspent in 2021. Activity was expected to increase towards the end of the year and into 2022.

The Jersey Care Model (P.114/2020. Amd.Amd.) was approved by the States Assembly on 3rd November 2021.

The  Panel  had  previously  undertaken  a  review  of  the  Jersey  Care  Model  proposition (published as S.R.5/2020).

The original business case for the programme provided a summary of the Jersey Care Model (JCM) and its key proposals, for which the funding was requested. The three overarching objectives of the JCM are:

• To ensure care is person-centred with a focus on prevention and self-care, for both physical and mental health; and

• To  reduce  dependency  on  secondary  care  services  by  expanding  primary  and community services, working closely with all partners to deliver more care in the community and at home; and

• To redesign health and community services so that they are structured to meet the current and future needs of Islanders.

The establishment of the JCM is intended to address problems such as the demand from Jersey's ageing population, the gaps of service identified and, also, coordinate the services provided.

The below tables provide an overview of the funding allocations that were proposed in the 2020-23 plan against what is now being proposed in 2021-24 plan:

Funding allocation approved in Government Plan 2021-2024 (£000):

Funding allocation requests in Government Plan 2022-2025 (£000):

Mid-Year Report Update

Provided an update on the first phase of the programme of work, which commenced in 2021. This included the restructuring and extension of the HCS Change Team and the co-design and implementation of new governance structures including:

• the set up of a Health and Care Partnership Group;

• the set up of two advisory groups to support the programme design (the Clinical and Professional Forum and the User Experience Panel);

• the set up of the Independent Oversight Group to monitor progress of the programme; and

• recruitment  for  the  chairs  for  the  Health  and  Care  Partnership  Group  and  the Independent Oversight Board (due to complete in August).

Furthermore, it was reported that the Intermediate Care services has been expanded and, also, that the commissioning strategy (relating to the development of partnerships for care delivery) was progressing well.[42]

Of the budget of £6.6 million for 2021, the actual spend for the year to date was £1.104 million. Panel analysis  

In a hearing with the Minister for Health and Social Services on 28th October 2021, the Panel asked for a further breakdown of the 2021 Tranche 1 funding for the JCM. It heard that:

Director, Improvement and Innovation:

The current forecast for this year is that £6.6 million will be spent on the Jersey Care Model, as provided. There is a breakdown of programme management, which £2.1 million was allocated. The current forecast is that £1.9 million will be spent. A further breakdown I am happy to provide after - I do not have it with me here - in terms of current spend and forecast. The breakdown in broad terms is around intermediate care; it is about community services and then secondary unscheduled care as well, just to showcase the different areas.[43]

The Panel asked for a breakdown of the 2021 spending for the JCM and was provided with the following:

49

The Panel notes that the above is in line with the budgeted funding, however, it is unable to analyse this limited detail any further.

As a result of the Panel's amendment to P.114/2020 – Jersey Care Model', and the Minister's subsequent amendment to our amendment, it has had the opportunity to review the progress of the delivery of the Jersey Care Model on a regular basis. This has provided the Panel with greater assurances in respect of the funding requested under this project. However, the Panel has been concerned to note the delays experienced in the establishment of the independent oversight board (the Board'). The creation of the Board, as suggested by the Panel's amendment, was a key factor in the support of P.114/2020.

In a letter to the Panel, dated 20th September 2021, in response to a query about the establishment of the Board, the Minister for Health and Social Services explained that:

The process has taken longer than anticipated due to the lengthy process that had to be undertaken to keep the recruitment independent. To ensure independence, officers and scrutiny panel members agreed to ask the Jersey Appointment Commission (JAC) to oversee and lead on the recruitment. The resulting process was longer than anticipated.[44]

The letter also confirmed that the process for the appointments to the Board should be complete by the end of November 2021 and that officers were working towards the Board's first meeting in December 2021.

The Panel has lodged an amendment to the Government Plan that, inter alia, seeks political commitments to ensure that there is support provided to the Board so that it can publish a review of Tranche 1 and 2021 funding as soon as possible, but by the end of March 2022 at the very latest.

The funding for the JCM is sourced from the Health Insurance Fund (HIF) (see chapter 4 above). At the times of Assembly approval for: i) the JCM (P.114/2020 in November 2020); ii) the Government Plan 2021-2024 (P.130/2020 in December 2020); and iii) the amendment to the Draft Health Insurance Fund (Miscellaneous Provisions) (Amendment No. 2) (Jersey) Law 202-' (P.156/2020 in December 2020) the assurances provided and information available indicated that that there was a commitment to design a sustainable funding model for primary care costs in 2021, for approval by the 2022-2025 Government Plan. It was understood that this would be informed by a review of the structure and use of the Health Insurance Fund also undertaken during 2021.

Further detail on the background to the assurances is detailed in the report accompanying the Panel's amendment to P.90/2020.

Considering the above, the Panel has decided to change its RAG status of this programme to red. This is due to concerns about the progress of the establishment of the independent oversight board and the delays to the provision of information that is required to review the future of sustainable healthcare funding for Jersey.

FINDING 11

There have been delays to the establishment of the Jersey Care Model (JCM) Independent Oversight Board, however, appointments are expected to complete in November 2021 with the first meeting anticipated in December 2021.

In R.91/2019, the business case stated that the requested funds for this programme were required to deliver Health and Community Services' plans 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; and

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

During its review of the Government Plan 2021-2023 (in 2020) the Panel found that, of the £3.2 million that was allocated to the Mental Health' project for 2020, only £1.7 million would have been spent by the end of 2020. Furthermore, the recruitment of new staff to support individuals with complex trauma had been delayed due to Covid-19.

The below tables provide an overview of the funding allocations that were proposed in the 2020-23 plan and the 2021-2024 plan against what is now being proposed in 2022-25 plan:

Funding allocations approved in Government Plan 2020-2023 (£000):

Funding allocation approved in Government Plan 2021-2024 (£000):

Funding allocation requests in Government Plan 2022-2025 (£000):

Mid-Year Report Update

The progress update provided in the Government's 6-month progress review detailed that the forecast budget of £4.8 million for the year was on track. The mid-year report detailed that there  had  been  £1.6m  of  Mental  Health  additional  investment  to  continue  to  drive improvements in mental health services, with new facilities and new services such as crisis prevention and intervention' teams.

Panel analysis  

The Panel notes that the increased investment to adult mental health services in GP20-CSP2- 2-02 of £1.6 million in 2021 (total of £4.8 million in 2021 compared to £3.2 million 2020) has been planned since the approval of the Government Plan for 2020-2023 (P.71/2019) in 2019. The funding was a planned increase pre-pandemic, and the funding amount has not been changed despite the changed context of mental health services in 2021/22.

In a public hearing the Panel queried why the budget for 2022 (£4.1 million) was reduced in comparison to the budget for 2021 (£4.8 million) and was advised:

Head of Finance, Health and Community Services:

In terms of the reduction, it is not a reduction, it was a reprofile. If you go back to the business case of 2020, the original business case stated £4 million across each of the years. In 2020, due to slippage, this was deferred and £0.8 million was deferred into 2021. So the figure for 2022 is correct.[45]

The Panel requested further information regarding the breakdown of spending in 2021 and the proposed funding for 2022. We were provided with the below table, for reference:

The Panel has compared the figures provided in the table above to the breakdown provided of £3.2 million funding in 2020, namely:

• £0.4m would be spent on facilitating the transfer of Child and Adolescents Mental Health Service (CAMHS) to CYPES (Children, Young People, Education and Skills) and improving operational accountability for the delivery of CAMHS;

• £1.1m would be used to appoint various roles to support the crisis support services;

• £0.3m would be allocated to undertake a 2-year pilot on a listening lounge;

• £0.8m would be spent on recruiting a team of professionals to form a complex trauma team;

• £0.6m would be put towards recruiting a team of 8 FTEs to ensure that HCS can meet the statutory obligations under the Mental Health (Jersey) Law; and

• £0.6m would be used to further develop the Mental Health Strategy aligned to the Jersey Care Model.

The Panel highlights that the breakdowns include a line for legislation (e.g. budget of £629,000 for 2021). We note that there is a separate line in the Government Plan for Mental Health Legislation, GP20-CSP2-2-03 (see the programme detail below).

The Panel notes that the proportion of funding for crisis resolution has increased since its review of the Government Plan in 2020 but, highlights from the table above, that the estimated budget for 2022 is £291,667 lower than the budget for 2021 (and is £144,597 lower than the forecast spend for 2021). The Panel queries if this is a realistic budget based on the increased pressures on mental health services due to the pandemic. Furthermore, the 2021 forecast annual spend on complex trauma (as per the table above), is more than £700,000 below budget. The Panel was not provided with this information in time to submit further questions about this.

In a public hearing on 17th November 2021 the Group Managing Director of Health and Community Services stated:

We have to be clear that we have invested, so we have had an additional £4 million into these services. The Listening Lounge alone, when we established this service it was quite a definitive expectation between £150,000 and £300,000. The cost of the service is significantly much more than that and we are funding that additional activity and we continue to fund that. We work with that provider every day around their activity requirement. They have gone up to around 26 staff, which we have supported in terms of them needing to recruit and that is taking a lot of activity. In relation to the wider services, there is definitely a need for us to ensure we have more capacity in crisis prevention and in the home treatment function, so that is the area that we are focusing on. There is funding within that, within the Government Plan.[46]

From the information provided, the Panel is unable to identify the sums allocated in 2021 and 2022 for the Listening Lounge. From its previous review of the Government Plan, the Panel is aware that the total funding for the Listening Lounge service was estimated to be £428,000 at the end of 2020 (the budget was £300,000). The Panel received confirmation that the Listening Lounge would continue to be funded.[47]

In a submission to the Government Plan Review from the Service Lead at the Listening Lounge, the Panel was advised:

We continue to see an upward trend in demand that is mirrored by referral rates to JTT/PATS, as outlined in the most recent HCS Quality and Performance Report (September 2021). This also identifies pressure points across several mental health services, manifesting as increased bed occupancy and unacceptable waiting times that are falling short of service standards.

The prior allocation of additional funding towards mental health provision was very much welcomed but, whilst there has been some progress in driving change, mental health support remains far from where it needs to be. A second Listening Lounge in the West of the island has been discussed previously, and certainly investment in additional community spaces that are shaped by the voice of service users would bolster the current network of accessible support by creating more front doors for islanders, across all ages and stages of life. It is essential that funding allocated to mental health services in the Government Plan is proportionate to the current context and level of need, and provides scope for a considered and proactive approach to service development. Islanders' wellbeing needs to be prioritised as part of the island's ongoing recovery from the pandemic.[48]

The Panel has noted (in previous hearings and in the HCS Quality and Performance Reports) the backlog of referrals for certain services such as Jersey Talking Therapies. The Panel was keen to understand how this would be addressed by the funding provided in the Government Plan and queried the issue in a public hearing on 28th October:

Deputy K.G. Pamplin:

.So how is the money in this Government Plan going towards improving that situation? So the same situation where G.P.s are having a backlog of referrals, people need to be seen, talking therapies, et cetera, in mental health services. What is being spent and how is the money being proportionally invested to make the same urgent changes needed for the same service, if that makes sense?

Associate Managing Director, Mental Health and Adult Social Care:

The investment will be in looking at bringing outside resources in to try to bring that waiting list down, to try to mitigate and bring down all the waiting lists. So there is an action plan in place to do that and we are going ahead with that. We need to address the amount of people we have, for example, for autism, A.D.H.D. (attention deficit hyperactivity disorder), also J.T.T. (Jersey Talking Therapies). So there is a combination to look at and it is important that we look at all those lists together. That may involve having outside help and that is where we need to purchase the extra support to try to mitigate and bring down the waiting list.[49]

From its review of the Government Plan last year, the Panel is aware that Covid-19 accelerated the crisis response / resolution work through the introduction of community triage, intensive outreach through the Home Treatment Team (HTT), and the strengthening of a focused liaison function. Per the breakdown of the budget provided above, this item forms the majority of the spend and the Panel is concerned that the original budget and plans for the funding have been de-prioritised. As the Panel has outlined in its amendment to the Government Plan, additional pressures caused by the Covid-19 pandemic deserve additional funding and not the spread of funding that was initially intended for other matters.

In a letter to the Panel received on 29th November 2021, the Minister for Health and Social Services confirms a response to the following question:

What is the focus of the mental health team for the priority of services in 2022?

• Continue to deliver the capital scheme for Clinique Pinel

• Further develop the Crisis Prevention and Intervention Model with ongoing recruitment into key roles across Medical, Nursing, Psychology and Therapy staff groups. I would note we are introducing a Jersey approach to CPA in 2022 which will see consolidation of the new model of care (Jersey Care Model)

• Establish a long-term contract for the Listening Lounge

• Continue recruitment into the Complex Trauma pathway (Psychologist staff)

• Covid recovery

• Develop CAMHS-AMH transition plans

• Improve JTT waiting times

• Reduce inpatient admission prevalence and MH Law application as a result of the Crisis Prevention and Intervention Model.[50]

The wording of the Government Plan acknowledges the adverse impact that Covid-19 has had on mental wellbeing. There is a partial address of this issue with the new proposals for the establishment of a Health and Social Recovery Fund (CSP2-C-11) and the Children's Health Recovery Plan (CSP2-2-04), however, (other than support for perinatal mental health and the child to adult transition pathway), the initial proposed projects do not include any

additional funding for adult mental health services. There has also been separate funding for capital expenditure on the mental health estate, as per the Mental Health Improvements' Capital programme (per the 2020-2023 Government Plan). However, the Panel is conscious of worthy initiatives supported by the funding in GP20-CSP2-2-02 that have faced increased pressures from the effects of the Covid-19 pandemic, which are still present in Islanders' lives.

In a submission from Focus on Mental Illness to the Government Plan Review, the Panel was advised that:

The impact of Covid in terms of increase [sic] demand for mental illness services does not feature in the Government Plan. As a charity we are already seeing the devastating impact on some families affected by severe mental illness and the impact of Covid on family life.[51]

The Proposed Government Plan (P.90/2021) itself states that:

The impact of Covid-19 on Islanders' mental health cannot be overlooked. We continue to commit to delivering services that will most effectively meet the needs of people with mental health conditions as well as those whose mental wellbeing has been adversely affected during the pandemic. Our Mental Health improvement plan is progressing well and will continue in 2022 with the aim to embed improvements to mental health services, ensuring we deliver the best care and support.[52]

In a public hearing on 28th October 2021 the Panel specifically queried the funding for mental health services:

Deputy K.G. Pamplin:

is there enough money in the Government Plan 2022 to meet the demand of, as predicted, the tsunami of people coming forward who need that mental health support for all those reasons? Is this enough?

Associate Managing Director, Mental Health and Adult Social Care: There might not be. Because there is a huge demand.[53]

 In considering the above, the Panel has changed the RAG status of this programme from amber to red. The Panel has decided that it will undertake a follow up review of Mental Health Services in December 2021-February 2022.

FINDING 12

The budget for Mental Health Services programmes under GP20-CSP2-2-02 in 2022 is £4.1 million. This budget was allocated to the programme in 2019, pre the Covid-19 pandemic.

FINDING 13

Clarification is required from the Department about the inclusion of the Mental Health Legislation' budget in the breakdown of spend for GP20-CSP2-2-02.

The below tables provide an overview of the funding allocations that were proposed in the 2020-23 plan and the 2021-2024 plan against what is now being proposed in 2022-25 plan:

Funding allocations approved in Government Plan 2020-2023 (£000):

Funding allocation approved in Government Plan 2021-2024 (£000):

Funding allocation requests in Government Plan 2022-2025 (£000):

Mid-Year Report Update

The progress update provided in the Government's 6-month progress review detailed that of the annual budget (of £629,000), the forecast spend was estimated to be £580,000.

Panel analysis  

As per the analysis provided on GP20-CSP2-2-02 Mental Health' (above), the Panel noted that the breakdown for 2021 and 2022 in Table 1 provided above included a line for legislation (budget of £629,000 for 2021), however, this is provided for as a separate project (GP20- CSP2-2-03) in the Government Plan. Due to the timing of this review and the provision of the information in Table 1, the Panel has been unable to question this further.

In its review hearing, the Panel asked about the progress of the mental health legislation work in light of the pressures faced by law officers drafting laws because of Covid. The Panel was informed that:

Associate Managing Director, Mental Health and Adult Social Care:

We  have  managed  to  recruit  with  additional  investment  enabling  2  additional authorised officer posts. There is recruitment still in progress just now, so we have managed to achieve successfully, so hopefully this will resolve the problems.[54]

The table provided by the Department above (in the Panel analysis of GP20-CSP2-2-02, Mental Health), indicates that the forecast spend for 2021 (£576,147) and the estimated budget for 2022 (£537,271) are both under the indicated budget.

The Panel is content with this sum and this programme, as it is consistent with previous years, however, it would like clarity on whether it is being counted under GP20-CSP2-2-02 (Mental Health),  in  addition  to  the  separate  programme  of  GP20-CSP2-2-03  (Mental  Health Legislation).

FINDING 14

The Mental Health Legislation has forecast an underspend of approximately £52,000 in 2021.

In 2020 the Panel found that a number of projects in the Government Plan appear to request funding for similar areas of work; namely the Digital Health and Care Strategy', the Digital Care Strategy (Major Project)' and the Jersey Care Model – Digital Systems'. It was advised that whilst the funding is split for Government Plan purposes, operationally the HCS digital strategy project will be delivered as one programme.

From the Panel's reviews of previous Government Plans, it is aware that the following work was scheduled under this programme:

• EPrescribe or EMPA was scheduled to go live in February 2020. Clinical trials begin November 2019 and, subject to successful trials, on track to go live in February;

• Primary Care Integration as an integration platform is complete and is due to be signed off in September;

• GP Order Communications – Radiology: is currently in clinical trials and should formally go live 1st November 2019; and

• GP Order Communications – Pathology: Q1 2020 is the target go live date but again is subject to clinical trials.

The below tables provide an overview of the funding allocations that were proposed in the 2020-23 plan and the 2021-2024 plan against what is now being proposed in 2022-25 plan:

Funding allocations approved in Government Plan 2020-2023 (£000):

Funding allocation approved in Government Plan 2021-2024 (£000):

Funding allocation requests in Government Plan 2022-2025 (£000):

Mid-Year Report Update

The progress update provided in the Government's 6-month progress review explains that the programme has progressed with a competitive tender to source a new Patient Administration and Electronic Patient Records system which will replace the current TrakCare solution. A shortlist has been produced and a decision is expected early in the second half of 2022, and implementation will start later in the year. Some projects have been deferred to 2022, e.g. the Electronic Data Management System project. However, there had been progress on the continued roll out of Electronic Prescribing and Medicine Administration and sourcing a replacement for the end of life Picture Archiving and Communication system.

Panel analysis  

As noted above, the programmes for Digital Health and Care Strategy', the Digital Care Strategy (Major Project)' and the Jersey Care Model – Digital Systems' are being operationally managed together by Modernisation and Digital but are separated for the purposes of funding in the Government Plan.

The Panel has been provided with an update on the Digital Care Strategy capital programme (see below for further details), however, we are unable to separate the funding out for Digital Health and Care strategy in 2021. We have been advised that some of the digital health projects have experienced delays in delivery in 2021.

FINDING 15

The programmes for Digital Health and Care Strategy', the Digital Care Strategy (Major Project)' and the Jersey Care Model – Digital Systems' are being operationally managed together by Modernisation and Digital but are separated for the purposes of funding in the Government Plan. The overlap and combined management of these programmes makes it difficult to analyse progress against the separately funded projects.

RECOMMENDATION 6

The Minister for Health and Social Services should ensure that a detailed breakdown of the funding for Digital Health and Care Strategy' for 2022 is provided to the Health and Social Services Scrutiny Panel.

In the Government Plan 2020-2023 there was a request for approximately £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 proposals of P.82/2012 – A new way forward for Health and Social Care'.

The Panel received confirmation that the funding requested for this was not transformation funding for the Jersey Care Model, but rather the ongoing revenue impact of previous transformation programmes that are not built into base budgets, but support services already in place.

The below tables provide an overview of the funding allocations that were proposed in the 2020-2023 plan and the 2021-2024 plan against what is now being proposed in 2022-2025 plan:

Funding allocations approved in Government Plan 2020-2023 (£000):

Funding allocation approved in Government Plan 2021-2024 (£000):

Funding allocation requests in Government Plan 2022-2025 (£000):

Mid-Year Report Update

Detailed that this funding was for business-as-usual activities and that there were no specific projects associated with it.

Panel analysis  

The Panel asked for an overview of the transformation programmes this funding has been used for to date and an update on the outcomes and were advised that:

The Minister for Health and Social Services:

My understanding, Deputy , is that it has previously been used for providing keyworker accommodation in the public sector, for mental health nurse training, to establish a diabetes care pathway, and also an end-of-life care pathway.[55]

The Panel noted that there have been no specific changes or updates to note on this funding programme since its review last year and it was therefore satisfied to maintain the Scrutiny RAG status as green for this review.

FINDING 16

The funding under Health P82 reinstate 2019 new and recurring' is used for support services that are already in place, but which are not built into base budgets. This funding has been used for keyworker accommodation, mental health nurse training, and establishing pathways for diabetes care and end-of-

life care.

In 2020 the Panel found that the funding allocations for the Maintaining Health and Community Care Standards' project would reduce significantly over the following 4 years, due to financial pressures arising from the Covid-19 pandemic.

The original business case had outlined that the funds would allow the Health and Community Services Department to continue to transform and modernise and, also, to ensure that existing services were funded sustainably in respect of changing demographic and the requirement to maintain standards in line with other jurisdictions. We understood that the 4 main drivers of costs which supported the need for the requested funding were:

• Healthcare inflation;

• Changing health and social care standards;

• Increasing (non-demographic) demand; and

• New treatments and ways of working.

The below tables provide an overview of the funding allocations that were proposed in the 2020-2023 plan and the 2021-2024 plan against what is now being proposed in 2022-2025 plan:

Funding allocations approved in Government Plan 2020-2023 (£000):

Funding allocation approved in Government Plan 2021-2024 (£000):

Funding allocation requests in Government Plan 2022-2025 (£000):

Mid-Year Report Update

Detailed that this funding was for business-as-usual activities and that it was not a separately funded programme.

Panel analysis  

Last year, the Panel noted that the 2021 budget had been reduced from its original figure of £11,464,000 in the Government Plan 2020-2023, to £10,000,000 in the Government Plan for 2021-2024. The 2022 budget had been £15,907,000 (in GP 20-23) and had subsequently been reduced to £12,250,000. The Panel was advised that the reduction in funding was due to financial pressures from the Covid-19 pandemic.

In a hearing with the Minister for Health and Social Services the Panel queried the ways that the transformation projects had been affected by the changes:

Deputy M.R. Le Hegarat :

Basically we are asking about maintaining health and community care standards. Obviously, it was reduced in last year's Government Plan due to the pressures created by the pandemic. What we are asking now is can you advise how the transformation projects have been affected by the change in funding?

Head of Finance, Health and Community Services:

The first point in order that is for 2022, if you look at the overall maintaining health and community standards for business as usual, we have had an increase within that area of £1.7 million for 2022. There has been an increase there.

Deputy M.R. Le Hegarat :

That is not what I was presented in front of me.

Head of Finance, Health and Community Services:

I can take that away and have a look at that for you. But there has been a net increase year on year from 2019, 2020 and 2021. Overall funding obviously has decreased because of the efficiencies targets and the rebalancing programmes. But if you take that area in isolation there has been an increase.[56]

In a follow up letter the Panel was advised that:

The increase referenced below [£1,750,000] has been based on a movement from an adjusted 2020 allocation provided therefore further information is required to establish reinstated movement. A full analysis will be provided once all financial movements have been confirmed.[57]

The Panel would like further detail to be provided to clarify the figures queried above, together with some further information about the impacts on the transformation projects, before it can make an informed decision on findings and recommendations.

Based on the information above, the Panel has changed its RAG rating of the project from green to amber for 2022.  

FINDING 17

Further clarity is required on the changes to the funding and impact on the transformation projects for the Maintaining Health and Community Care standards' programme.

R.91/2020 provided limited explanation for the request of £200,000 per year for 2020-2023. However, from the information we were provided during our review of the Government Plan 2020-2023, we know that this funding relates to an MTFP addition (2017-2019) and that £200,000 user pays income was included from 2018 for regulation of carers under the Regulation of Care Law. The funding with the MTFP did not allow for the increased costs of regulation and, subsequently, the funds requested in the Government Plan are to cover the shortfall.

The below tables provide an overview of the funding allocations that were proposed in the 2020-2023 plan and the 2021-2024 plan against what is now being proposed in 2022-2025 plan:

Funding allocations approved in Government Plan 2020-2023 (£000):

Funding allocation approved in Government Plan 2021-2024 (£000):

Funding allocation requests in Government Plan 2022-2025 (£000):

Mid-Year Report Update

Detailed that this funding was for ongoing business-as-usual activities to provide additional base budget to address the shortfall in income that leaves a structural deficit in the Office of the Chief Executive budget.

Panel analysis  

The Panel understands that the £200,000 per annum relates to additional income that was expected to generate on introduction of the Regulation of Care Law, and was originally proposed in the final Medium Term Financial Plan. As this income has not been realised, this provides additional base budget to address the shortfall in income that leaves a structural deficit in the Office of the Chief Executive budget and was originally included in the 2020 Government Plan.

The Panel has maintained its green RAG status of this programme as there have been no significant changes to report.  

FINDING 18

The funding requested for the Regulation of Care' project in 2022-2025 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. It is a continuation of what was approved in last year's Government Plan.

In 2018, the States Assembly agreed (P.124/2018) to provide one-off payments to individuals (or their dependents) with diffuse mesothelioma, a disease associated with historic exposure to asbestos fibres. The scheme was introduced in 2019 and required permanent funding from 2020 onwards. Funding was approved in the Government Plan 2020-2023 to meet the obligations to provide permanent financial support to asbestos victims and their families.

The below tables provide an overview of the funding allocations that were proposed in the 2020-2023 plan and the 2021-2024 plan against what is now being proposed in 2022-2025 plan:

Funding allocations approved in Government Plan 2020-2023 (£000):

Funding allocation approved in Government Plan 2021-2024 (£000):

Funding allocation requests in Government Plan 2022-2025 (£000):

Mid-Year Report Update

It was confirmed that no new Mesothelioma claims have been paid in 2021. Panel analysis  

The Panel was mindful that Customer and Local Services had identified a saving of £60,000 in 2022 from the compensation for mesothelioma scheme. It was advised that the original forecast had been to budget for approximately five claims a year, however, the actual activity was much lower. This had been reflected in a budget adjustment in the funding allocation for the 2021-2024 Government Plan and a further £60,000 had been identified from the 2022 budget due to the low number of claims.

The Panel was provided with confirmation that there was a contingency in place within Treasury, should claimants for the benefit come forward.[58]

FINDING 19

An efficiency saving of £60,000 has been identified from the Compensation for Mesothelioma' scheme due to a current low demand for the scheme, however, assurance has been given that there is sufficient funding to support this benefit, should claimants come forward in 2022.

The original business case (in the Annex to the Government Plan 2020-2023), detailed that during 2020, the Social Security Minister and her Officers were due to investigate ways in which the Government could help people maintain their financial independence as they get older, as one of the elements of the wider Social Security Review. It was advised that the work would include investigating a workplace pension scheme which would give every worker access to a second pension on top of their Social Security pension. They would also be looking at other ways to encourage savings and make the best use of the increasing numbers of older workers in our economy.

In the review of last year's Government Plan the panel found that the Financial Independence in Old Age' project was deferred in order to re-prioritise officer time to other urgent pandemic related policy work. A new timeframe for this project has yet to be agreed and was expected as part of the next Government Plan submission. There had also been a revised – and reduced – budget for this project moving forwards. The Panel found that it could not support the request for any further funding for the Financial Independence in Old Age' project until the outcome of the investigation is known, and proposals of a way forward are brought to the States Assembly.

It was also recommended that the Minister for Social Security provide the Panel with a report detailing the outcome of the scoping work that was undertaken at the end of 2019 in respect of the Financial Independence in Old Age' project. This recommendation was accepted by the Minister.

The below tables provide an overview of the funding allocations that were proposed in the 2020-2023 plan and the 2021-2024 plan against what is now being proposed in 2022-2025 plan:

Funding allocations approved in Government Plan 2020-2023 (£000):

Funding allocation approved in Government Plan 2021-2024 (£000):

Funding allocation requests in Government Plan 2022-2025 (£000):

Panel analysis  

No update was provided on this matter in the Government's mid-year report.

The Panel has not received the report detailing the outcome of the scoping work that was undertaken at the end of 2019 in respect of the Financial Independence in Old Age' project during 2021. In a public hearing with the Minister for Social Security the Panel was advised that work on this project would resume in 2021.

During the Panel's review hearing on 13th October 2021 the following detail was provided about the scoping work undertaken in 2019:

So they [D3P] did do a kind of a draft scoping report, a good quality draft scoping report before COVID, but they will need to finalise that and make some small updates, given what has happened in the last year around international experiences. But I would hope they would be able to do that and then we will be able to obviously publish that, as the Minister was saying, hopefully by the end of the year, but that is doable. I think what is also important, as the Minister has also said, is that we are picking the work up again. Most of the report is mainly looking at what they did already before COVID but we will be moving forward and looking at ... you know, considering the work, looking at the options in Jersey, how Jersey is working, and making sure with the Minister that we can all hand over that to the next Government and make sure we continue the progress on the project at that point.[59]

The Panel will consider the scoping report on the Financial Independence in Old Age' in due course.  

As per the findings last year, the Panel cannot support the request for any further funding for the Financial Independence in Old Age' project until the outcome of the investigation is known, and proposals of a way forward are brought to the States Assembly. We therefore maintain the amber RAG status of this expenditure programme.  

FINDING 20

Work on the Financial Independence in Old Age' project will resume in 2021 and the outcome of the scoping work would be published by the end of the year.

The Food Costs Bonus (FCB) was an annual benefit provided to households with 5 years Jersey residence, where the household did not receive income support and did not pay income tax. It appeared in the 2020-2023 Government Plan as a renewal of an existing scheme (originally the GST (Bonus) Regulations that were first established in 2008). However, the FCB was replaced following the approval of P.95/2020: Draft Community Costs Bonus (Jersey) Regulations 202-' (the Regulations').

The name of the legislation was changed in order to recognise that the Bonus (having been increased by 13.8% in line with overall RPI for a 5-year period) now assists low income households with more than just food costs. Also, the value of the bonus was increased to £258.25  following  the  Assembly's  adoption  of  an  amendment  to  the  Government  Plan proposed by the Corporate Services Panel.

The below tables provide an overview of the funding allocations that were proposed in the 2020-2023 plan and the 2021-2024 plan against what is now being proposed in 2022-2025 plan:

Funding allocations approved in Government Plan 2020-2023 (£000):

Funding allocation approved in Government Plan 2021-2024 (£000):

Funding allocation requests in Government Plan 2022-2025 (£000):

Mid-Year Report Update

Confirmed that the Community Cost Bonus had paid 1,087 household claims in 2020, at a total value of approximately £280,000. Customer and Local Services was planning to publicise the scheme again in Q3/4 to ensure that eligible people also benefit from the scheme in 2021.

Panel analysis  

The Panel noted that P.95/2020: Draft Community Costs Bonus (Jersey) Regulations 202-' detailed that the estimated expenditure for the Regulations would be:

• 2020: £340,000;

• 2021: £351,000; and

• 2022: £361,000.

The Panel noted that the increases for 2021 and 2022 had not been reflected in the proposed Government Plan. This was queried with Customer and Local services, which confirmed that the budget for the Food Cost/Community Cost Bonus was maintained at £340,000 in the proposed Government 2022-2025 and did not increase as per the proposition P95/2020.

It is noted that the Government Plan in 2020-23 correctly reflected P95/2020, but in error, both the 2021-24 and 2022-25 Government Plans repeated the 2020 budget into future years – i.e. £340,000 per annum.  

The Director of Customer and Local Services confirmed by email that:

The proposed budget of £340k is enough to cover the current forecast expenditure for 2022 (which is £308k), however, either the budgets in P95/2020 should have been used or an explanation included why they weren't. I can confirm that the reduction in budget has not been included in any rebalancing or savings.[60]

On querying the error, the Panel was further advised that:

Whilst  it is  disappointing  that  the  P.95/2020  budgets  were  not  replicated  in  the Government Plan 2021-23 [sic] there has been no impact on the public in the provision of the underlying benefit. This was repeated in the preparation for the 2022-24 [sic] Government Plan. Again there is no impact on the public in the provision of the underlying benefit.[61]

The Panel notes that the estimated £308,000 was calculated based on the number of people who were forecast to receive the benefit (advised as 1,192 people) multiplied by the benefit amount of £258.25.

The Panel is content that the forecast expenditure is lower than the budget, however, would like to ensure that the Minister provides the Panel with updates on the numbers of people applying for the benefit and also details about the publication of the scheme at the end of 2021 / in 2022.

The Panel notes that the Community Costs Bonus is set per Triennial Regulations, therefore the next Social Security Minister will consider the next three-year period in 2023. Any decision will be subject to a debate in the States Assembly.  

FINDING 21

The Community Costs Bonus (formerly the Food Costs Bonus) has been budgeted as £340,000 per year in the Proposed Government Plan 2022-2025, this has been confirmed as an error, as the budget anticipated for 2022 in P95/2020 was £361,000.

FINDING 22

Customer and Local Services has confirmed that the forecast spend for the Community Costs Bonus in 2022 in £308,000, which is lower than the budgeted £340,000.

The previous States Assembly (via approval of P.113/2017 and P.28/2018) agreed to provide a single-parent component as part of the income support system and identified funding for 2018 and 2019. The component provides an additional £40.39 per week to a single parent receiving income support.

The below tables provide an overview of the funding allocations that were proposed in the 2020-2023 plan and the 2021-2024 plan against what is now being proposed in 2022-2025 plan:

Funding allocations approved in Government Plan 2020-2023 (£000):

Funding allocation approved in Government Plan 2021-2024 (£000):

Funding allocation requests in Government Plan 2022-2025 (£000):

Mid-Year Report Update

Advised that the Income Support Single Parent component supported 1,209 households. The cost during the first 6 months of 2021 was £1,269,764.

Panel analysis  

The Panel was advised that there were 1,190 total claims for this benefit in 2021. Benefiting from this, there were, 1,417 adults and 1,587 children. It was noted that of these children, 333 were under 5 years old[62].

The Panel noted that the funding for 2022 was higher than for future years 2023-2025. This was queried and the Panel was advised that the adjustments would have been made in conjunction with forecasts from the Fiscal Policy Panel.

The Panel noted that the Minister for Social Security had increased the majority of the income support components for 2022 (as per P.46/2021) but that the Single Parent Component had not been included in this and was to remain at £40.39 per week.

FINDING 23

There were 1,190 total claims of the Single Parent Component benefit in 2021.

FINDING 24

The value of the Single Parent Component would not increase in 2022 and would remain at £40.39 per week.

During its review of the Government Plan 2020-2023, the Panel was told that the funding for this project would be used to develop proposals to support disabled adults living at home and their informal carers. Specifically, the funds in 2020 had been identified to support a pilot project to provide additional financial support to a small number of lower income families, effecting between 100 and 200 families. The experience gained in 2020 would then be used to inform a wider scheme available from 2021. The 2021 budget also included a budget allocated to providing additional support for carers.

In 2020 the Panel found that following initial planning of the Care Needs at Home' project, investigations with individual families had to be postponed due to the pandemic, and the project was deferred.

The below tables provide an overview of the funding allocations that were proposed in the 2020-2023 plan and the 2021-2024 plan against what is now being proposed in 2022-2025 plan:

Funding allocations approved in Government Plan 2020-2023 (£000):

Funding allocation approved in Government Plan 2021-2024 (£000):

Funding allocation requests in Government Plan 2022-2025 (£000):

Mid-Year Report Update

The project had been delayed as a direct result of the pandemic. Panel analysis  

In the Government Plan Review hearing with the Social Security Minister on 13th October 2021, the Panel was advised that the had been some progress in 2021, however, this was then subject to further delays:

We are dealing with a small cohort of incredibly vulnerable shielding families. So the work was picked up early in 2021 when you start beginning the meetings in the first people's households again. That work was progressed. We started writing to the families. However, with the increase in case numbers around May/June time we decided to pause the work again. It is vitally important that these meetings take place with the person. So we did discuss the option of doing them remotely, but we need to be ... it is going to involve one, possibly 2, more likely 2, officers visiting these people in their own homes, seeing them in their own environment, and it is very important that we do not put any pressure on them or worry them, particularly in these times. So I think the intention now is to pick up those meetings again. We are in the process of working with colleagues in health and community services to write to those families and pick up those meetings. Once the meetings have taken place, which we are hoping will be complete by Q1 or Q2 of next year, that will be when we will have the data to launch the pilot scheme.[63]

The Panel queried the continued delays to the project and were satisfied that this was due to complex needs around certain individual cases, and within the context of rising numbers of Covid-19 cases in June 2021.

As the Panel reported in 2020, until there is further detail provided on the outcome of the pilot scheme, now expected for 2022, it is unable to conclude whether the resources allocated for 2022- 2024 are appropriate. The amber RAG status is maintained.

FINDING 25

The Care Needs at Home' project has been delayed. This is due to the pandemic and the complex needs of the individuals involved in the scheme.

The funding identified for this project was intended to build on the existing Closer to Home project in 2020 and support the roll out of a wide range of projects from 2020 onwards. The original Disability Strategy for Jersey was published in May 2017, with an update produced in February 2020, however newer updates and changes had been required to take account for contextual changes such as Covid-19 and the Jersey Care Model. The Government launched a Disability Strategy survey in August 2021, which would help Islanders influence the next phase of the strategy.

The below tables provide an overview of the funding allocations that were proposed in the 2020-2023 plan and the 2021-2024 plan against what is now being proposed in 2022-2025 plan:

Funding allocations approved in Government Plan 2020-2023 (£000):

Funding allocation approved in Government Plan 2021-2024 (£000):

Funding allocation requests in Government Plan 2022-2025 (£000):

Mid-Year Report Update

This was reported to be on track, following the recruitment of three staff to deliver the strategy. Costs had been reported as £53,000.

Panel analysis  

In a hearing with the Minister for Social Security on 13th October 2021, the Panel learned that a further piece of work was being undertaken to account for this and review completed actions, which would see an updated report produced by the end of the year.[64]

The Director of Local Services advised the Panel that:

Just to confirm, that is not just about strategy, that is looking at, as a community, how do we feel about disability, where can we improve, how accessible is government and the private sector, et cetera. It is a snapshot of where we are as an Island.[65]

and

Just to conclude, in terms of this year's actions, we are on track. Like anybody, it has been a stop and start year but the infrastructure is there, we have the groups, we have more volunteers, we have a wide group of experts by experience and we will work with them as we have done to deliver the strategy, but we also need to look further and aim a bit higher. What the strategy sets out is fairly helpful but it is a baseline and I think if we are really going to be an inclusive society we need to work, listen and co-produce future services for Islanders to access.[66]

The Panel was content with the progress that had been made and was satisfied to maintain the RAG status as green for this programme.

FINDING 26

The Disability Social Inclusion Project is making progress, and a Disability Strategy survey was undertaken in August 2021.

The Income Support scheme is a single, means-tested benefit that provides support towards the costs of housing, living, health needs and child care. It supports people who have a low household income; pass the Income Support residence test; and, are working, looking for work, or are exempt from looking for work.

The original business case for this programme sought additional funding to cover excess income support costs, arising as a result of the Covid-19 pandemic. The pandemic and subsequent lockdown in 2020 had a significant impact on trade and business which resulted in an increase in Income Support claims and costs. As stated in the original business case, the increase in claims began in late March 2020 and was a result of individuals losing their jobs or suffering reduced hours/pay and income. The number of income support claimants increased from 5,636 in February 2020 to a peak of 6,559 in May 2020. In 2020 the numbers slowly declined but, as at the Panel's previous review in November 2020, remained well above the previous pre-Covid-19 baseline level.

The below tables provide an overview of the funding allocations that were proposed in the 2021-2024 plan against what is now being proposed in 2022-2025 plan:

Funding allocation approved in Government Plan 2021-2024 (£000):

Funding allocation requests in Government Plan 2022-2025 (£000):