Submission - Adult Mental Health Services re Government Plan 15 October 2019

Adult Mental Health Services response to Scrutiny Government Plan Review October 2019

Please find lettered responses below. The lettering relates to the Scrutiny Review Terms of Reference given below

1  Terms of reference

1. Whether funded projects meet the Ongoing Initiatives, Common Themes and, ultimately, Common Strategic Priorities?
2. Ensuring that the projects and amendments to be lodged are consistent with the requirements of the Public Finances (Jersey) Law 2019.
3. The level of resourcing, of all forms, allocated to projects and whether this is sufficient or excessive in enabling the project to meet its stated aims.
4. If project resource allocation is appropriate in relation to overall departmental budgets?
5. Whether funded projects align with Departmental objectives? [NB: if and where they exist]
6. Whether or not there are clear lines of accountability for each project?
7. The ongoing sustainability of projects.

2  Initial statement

Mental Health Services have been impacted upon by a series of senior management and director changes. We are managing legacy issues and are putting all submitted outline business cases through a Care Group Leaders review process. We will be supported by colleagues in our informatics and finance teams. We have submitted the checklist that will be used in the business case review.

The Listening Lounge has been prioritised and existing funding sourced to support its immediate development prior to the current AMD being confirmed in post. Authorisation for the spend was managed by the Managing Director Rob Sainsbury and authorised through the Mental Health Improvement Board.

3 Focus of response

• Mental Health Improvements (Capital Project)– p155 of R.91
• Mental Health (project) – P36 of R.91
• Improving access to service p47 of P.71

1. Whether funded projects meet the Ongoing Initiatives, Common Themes and, ultimately, Common Strategic Priorities?

Answer: The Government plan states:

We will significantly improve access to mental health services, bringing parity of esteem to the mental health agenda, invest in our mental health environment and building infrastructure, implement initiatives for crisis support, a listening lounge', complex trauma, Child and Adolescent Mental Health Services and mental health legislation[1]

This is the key policy driver supporting the mental health project as described at the reference above.

2. Ensuring that the projects and amendments to be lodged are consistent with the requirements of the Public Finances (Jersey) Law 2019.

Answer: The draft government plan sets outs the priorities and funding which has been allocated to each initiative each of which had a supporting business case. The Public Finance Law requires the resources to be incurred for the purposes intended. HCS finance business partner will work with the Associate Medical Director to ensure that the investment budget available and related expenditure is set up in accordance with the Government plan and the expenditure is recorded in the same manner.

3. The level of resourcing, of all forms, allocated to projects and whether this is sufficient or excessive in enabling the project to meet its stated aims.

Answer:  This is subject to review by the Care Group Leads in partnership with our Finance Business Partner. The service has a duty to contain expenditure to stay within the resources available. As such it is important that detailed budgets are agreed and where applicable that the full business case includes this level of detail.

4. If project resource allocation is appropriate in relation to overall departmental budgets?

Answer: The Mental Health Service is in the process of restructuring to provide a service that is focused on the needs of islanders. This has been outlined in a service development proposal provide by Dr Professor Max Marshall. The proposal is to go out to consultation with people with lived experience and the staff group. This flux means that we need to continually review levels of expenditure and efficiency savings. We will be (and are in relation to Estates) using a defined project management approach which will build in carefully monitored financial tolerances.

There is continual work with our Finance Business Partner to look at planned expenditure in relation to overall budget. We are confident that this provides financial oversight that ensures that excessive expenditure is avoided and monitored. We are operating in a context where it is now recognised that we are coming out of a period where there has been a sustained under investment in mental health services and estate.

5. Whether funded projects align with Departmental objectives? [NB: if and where they exist]

Answer: The Jersey Adult Mental Health Services current Standard Operations Policy (2018) gives the following aims and objectives (1.4):

• To provide timely and appropriate access to services
• To ensure that people have their mental health needs assessed and addressed
• To provide safe, high quality evidence based and where appropriate NICE compliant interventions for people aged 18 and over
• To demonstrate effectiveness of interventions by using outcomes against goals agreed with people (and their carers) using our services
• To provide interventions which improve the mental and physical health and wellbeing of people using the service

We are confident that the submissions work towards these objectives.

6. Whether or not there are clear lines of accountability for each project?

Answer: The senior responsible officer for the business cases submitted is Caroline Landon the Director General of Health and Community Services. Project assurance will be provided by the independent Mental Health Improvement Board. Operational accountability will lie with each of the service leads within the care group.

7. The ongoing sustainability of projects.

Answer: Sustainability and successful implementation is dependent on successful recruitment and retention of a high quality workforce. We are working in tandem with external education providers to develop opportunities for Jersey residents. Our service is currently under significant strain because of staff shortages however recruitment drives have been successful and we are working on developing collaboration with partners in the third and private sectors. There is increasing recognition that improving the mental health of islanders is a whole community responsibility. This is fundamental to ongoing sustainability of any improvement in the mental health of Islanders. We will also be ensuring that the interventions provided are evaluated, we expect that our offer will develop over time in response to our findings and the move towards co production and the recovery model.

In relation to estates we are working to provide the best solutions possible in the context of a future hospital redesign. The aim is to have a mental health service that is aligned with General hospital provision. This will reduce stigma and contribute to parity of esteem as well as improving the persons experience and safety.

End.