Letter - PAC to Chief Executive and Director General for Health and Community Services re Further Ac

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States Greffe

Chief Executive

Director General, Health and Community Services BY EMAIL

15 December 2021

Dear Chief Executive and Director General,

PAC requires further action and clarification on the Executive Response to C&AG's Health and Social Care Governance Report

The PAC has considered at length your initial Executive Response to the Comptroller and Auditor General's Report on Health and Social Care Governance, together with your revised responses to the Committee's subsequent Comments. The PAC is concerned as to whether you have committed fully to implementing the C&AG's recommendations and has therefore decided to seek further clarification  on your plans to  deliver a joined-up' Health Governance Strategy that encompasses all health and social care providers in the Island.

Notwithstanding that you accepted the recommendations made by the Comptroller and Auditor General, the PAC concludes that some of your responses do not adequately address the concerns highlighted in her report, especially on the Health Governance Strategy and Integrated Governance Framework.

The PAC reiterates its request for a detailed response on how the overall Health Governance Strategy will operate, and for you to explain how the Strategy will be joined-up' between the Department for Health and Community Services, other Government of Jersey departments and organisations, and non-Governmental on-Island health and social care providers. Please also provide specific evidence to exemplify a joined-up' governance strategy.

The PAC also seeks to understand how non-Government healthcare providers engage with Health and Community Services, how this is monitored, and how this will influence the eventual Health Governance Strategy.

The Public Accounts Committee requests specific further details on the following matters:

1. Some revised responses do not include target dates for implementation – please provide.
2. Please briefly explain how you expect the Integrated Governance Framework to influence and impact upon other areas of the Government of Jersey, as well as the whole Island health and social care system'. Please provide specific expected outcomes to evidence your answer.

1. How will the progress of the Framework be tracked?

2. Please advise whether you expect to modify the Framework to account for the whole Island health and social care system, or if it will be embedded' from the outset. If it is to be modified, what changes will it undergo and what quality assurance will you seek to ensure that the changes are suitable?

3. Please provide an updated timeline for the revised response to Recommendation 4 and advise how this will impact upon other work programmes within Health and Community Services.
4. Your revised response to the PAC's Comments in respect of Recommendation 5 does not appear to include consideration of our request for an Annual Quality Account in 2022. Please confirm that an Annual Quality Account is planned for, and will be published, in 2022.

1. What impact will the new Director Quality and Safety have on taking this work forward on an annual basis?
2. What responsibilities will they have regarding the publication of Annual Quality Accounts?
3. Please explain the rationale for your timescale of Q4 2023 (nearly two years) to implement a regular Annual Quality Account.

5. Please confirm whether an internal report will be drafted on the exploration of the use of other Government of Jersey Boards to understand their arrangements on responsibility, accountability, and renumeration to advance Recommendation 6, and, if so, please advise of the completion date of this work and provide the completed report (in confidence, if necessary) to the PAC.

a.  What legal and third-party advice will the HCS Department source to further understand the use of independent members on the Health  and Community Services Board, and what case studies will it consider from other jurisdictions?

6. Please provide an outline to the PAC of the proposed changes to the Government of Jersey's People and Culture Programme relating to how it will impact upon Health and Wellbeing, and how it forms a long-term strategy to deliver this.

1. Please confirm that the Government of Jersey's performance against the Strategy outlined will be reported publicly, and will include consideration of Government, Health and Social Care services and key partners.
2. Please confirm that the Strategy will be linked against public measures within the Jersey Performance Framework and the annual operational plan of the department.
3. Please explain briefly how multi-disciplinary models currently used in HCS will aid in building the capability and capacity for on-Island provision'. Please advise how this impacts on staff wellbeing.
4. You refer to utilising the People and Culture Strategy in your response, but do not refer to the Group Director for People and Corporate Services as a Responsible Officer. What impact and responsibilities will the Group Director and his function have in implementing Recommendation 6, and how will his work feed into that of the Head of Organisation Development and the Associated Chief for Allied Health Professionals and Wellbeing?
5. Please provide a realistic timeline for your revised response.

7. What is the timeline for completion of improvements to the Patient Advice and Liaison Service?

1. Please share the final report of the PALs service review with the PAC and indicate how the findings and recommendations of the review's report will feed into the improvement of performance within Health and Community Services.
2. Please advise when a permanent desk at the Gwyneth Huelin site will be established for the Patient Advice and Liaison Service, and when staffing requirements will be fulfilled.

8. Please provide an indication of when the Jersey Nursing Assessment and Accreditation System (JNAAS) will be included in all new or renegotiated contracts, and how have guidelines been revised to ensure its inclusion.

a.  How will community providers be informed of how to operate the Jersey Nursing Assessment and Accreditation System, and how long do you expect it to take for them to be incorporated into JNAAS?

9. When will a new Quality and Safety Director (and his/her team) be appointed?

1. What is the timeline for the implementation of Recommendation 15, given your revised response?
2. When do you expect the comprehensive quality and safety programme across all health and social care services to be published?

10. How regularly are benchmarks examined and revised to ensure that the Island is benchmarked against high-performing but operationally comparative and relevant jurisdictions?

a.  How do you ensure that standards are appropriate for Health and Community Service's remit and size where certain areas of NHS standard reporting may not be directly comparable?

11. Why did the Government of Jersey's Government Enterprise Risk Management site not consider the requirement of Health and Community Services before its implementation?

1. How is risk currently tracked and monitored within Health and Community Services?
2. How are those methods aligned with wider Government methodology?
3. Why and how were Health and Community Services' risks treated separately to the rest of the Government of Jersey?
4. What are the alternative ways you are using to report on Enterprise Risk Management until the department is fully integrated?
5. Has the implementing of Health and Community Services into the Government Enterprise Risk Management been marked as a high priority within the Government's own Recommendations Tracker? Please provide details.
6. Which officers have responsibility for this work?

The PAC would be grateful for a response to its questions by close of business on 11 January 2022. Please note the PAC's intention to publish your response.

Yours sincerely

Deputy Inna Gardiner , Chair, Public Accounts Committee