Tanscript - Transfer of Services Review - Public Hearing with Minister for Home Affairs 2019.07.12

The Transfer of the Ambulance Service and C.A.M.H.S. (Child and Adolescent Mental Health Service) Review Panel

Transfer of the Ambulance Service and C.A.M.H.S. Witness: The Minister for Home Affairs

Friday, 12th July 2019

Panel:

Deputy T. Pointon of St. John (Chairman) Deputy R.J. Ward of St. Helier

Deputy K.G. Pamplin of St. Saviour

Witnesses:

Connétable L. Norman of St. Clement , The Minister for Home Affairs

Mr. J. Blazeby, Director General, Justice and Home Affairs

Ms. K. Briden, Group Director, Public Protection and Law Enforcement, Justice and Home Affairs.

[10:00]

Deputy T. Pointon of St. John (Chairman):

I do not know whether you are aware but I am the chair of this review panel, which was set up by the Health and Social Security Panel and the Education and Home Affairs Panel because there are items on our agendas as individual panels that cross the services. One of those things is Justice and Home Affairs and the responsibility for ambulance. That is why we are here today, to talk about that. I would like to draw your attention, if I may, to the paper on the table, which I know you are very familiar with. I would like to draw to the attention of the public that we do not permit recording as there is already a record of the meeting. Could we please switch our phones off or put them on silent? Now I am going to ask the people present to introduce themselves, for the public's benefit. I am Trevor Pointon, Deputy of St. John , and I chair this review panel.

Deputy R.J. Ward of St. Helier :

Deputy Robert Ward and I chair the Education and Home Affairs Scrutiny Panel, so that is why I am on this panel.

Deputy K.G. Pamplin of St. Saviour :

Deputy Kevin Pamplin. I am vice-chairman of the Health and Social Security Scrutiny Panel and that is why I am on here.

The Deputy of St. John :

We also have Andy Harris , who is our officer, and Lindsay Barron. If you would not mind introducing yourselves. If you do come to the table you can introduce yourselves then.

The Minister for Home Affairs:

Len Norman, Constable of St. Clement and Minister for Home Affairs.

Director General, Justice and Home Affairs:

Good morning, Julian Blazeby, director general, Justice and Home Affairs.

Group Director, Public Protection and Law Enforcement, Justice and Home Affairs:

Good morning, Kate Briden, group director for public protection and law enforcement in Justice and Home Affairs.

The Deputy of St. John :

Thank you very much. We will get down to the business. Have you any questions for us initially you would like to air? No. Okay. We are here specifically to talk about the amalgamation with ambulance and the fire service. As part of the One Government structuring plan, ambulance, we gather, has moved out of the health service. Could you let us know who originally conceived this idea?

The Minister for Home Affairs:

I cannot name names because it all happened before I became Minister for Home Affairs, or a Minister at all. But what I understand, it all formed part of the OneGov proposal to the structure and modernising the public sector, which is to reduce duplication, promote collaboration, dismantle silos, increase co-operation, increase productivity; those were all the aims of the OneGov structure. My understanding is that it came out of that.

Deputy R.J. Ward :

The original concept of OneGov that came before the employment of the new director general or chief officer, I forget what he is called.

The Deputy of St. John : Chief executive.

Deputy R.J. Ward :

That is the one. So from the original plans for OneGov all that time ago? Because on the OneGov plan we have very clearly heard that the ideas for change came before some employment, so are we talking that early on the idea of transferring the services?

The Minister for Home Affairs:

Sorry, Deputy , I really cannot I do not know if Julian can but my understanding was it came after Mr. Parker's employment as chief executive but it may well have been floated before that. But of course I was not involved at that time.

Director General, Justice and Home Affairs:

I can confirm that is the case. When the new chief executive was appointed and the proposals were modernisation to transform the Government this was one of a number of proposals put forward, as you know, in terms of creating new departments and it was consulted on in terms of the new target operating model for the Government of Jersey.

Deputy R.J. Ward :

So the idea came after the appointment of a new chief executive?

Director General, Justice and Home Affairs: Correct.

The Deputy of St. John :

When did the ambulance service first get wind of this proposed change?

The Minister for Home Affairs:

It is difficult for me to tell you because I was not there. I do not think it is a matter of "getting wind" of it, I think there was a consultation period on the OneGov proposals. Soon after Mr. Parker arrived I imagine. It was pre-2018, if I remember rightly, the consultation took place. Obviously I am not privy to what specific consultations took place at that time. As I say, it was before my time being involved. I know that everybody had the opportunity of making representations.

The Deputy of St. John :

What was the outcome of that consultation? Are you able to tell us about that?

The Minister for Home Affairs:

All I can tell you is that subsequently the decision was made and the ambulance service was transferred to Home Affairs officially in February this year. The Chief Minister signed the Ministerial Decision.

The Deputy of St. John :

From our point of view, it is not clear what the rationale is behind this move into Justice and Home Affairs for what is, in essence, a medical emergency service. We are not very clear about that. I wonder if you can explain what that rationale is.

The Minister for Home Affairs:

I think you really need to ask the people who made the decision.

Deputy R.J. Ward :

But we do not know who they are because it is not clear who we would question.

The Minister for Home Affairs:

It seems to me that it is clear. It was on the recommendation of the chief executive to the Chief Minister. He is the one who made the decision to implement that recommendation. All that I can tell you is that I am aware the decision was made in line with the OneGov principles to be customer focused and to have simple structures and have the people work together collaboratively and co- operatively.

Director General, Justice and Home Affairs:

If I may add, just going back to when the consultation on the - as was then - States of Jersey target operating model when the new chief executive was appointed, so that was quite clear; a 90-day consultation. You may have seen the documentation to form new departments so G.H.E. (Growth, Housing and Environment), Justice and Home Affairs, and within that consultation document in relation to this, the Justice and Home Affairs Department describe the 7 organisations that were going to sit within Justice and Home Affairs. For this panel, one of those was ambulance. So that 90-day consultation was quite clear that ambulance was being proposed to move from Health to Justice and Home Affairs. During that 90-day consultation, one of your previous questions was

when did the ambulance service first get to hear about this; quite clearly during that consultation they were aware of it and they were indeed consulted. Obviously that then prompted a number of responses from the ambulance service, which clearly indicated they were aware of it because the documentation was open for all to see. That was I think in March.

Deputy R.J. Ward : 6th March.

Director General, Justice and Home Affairs:

6th March 2018. So that is when they became aware very clearly, both Health and obviously within the ambulance service, that there was a proposal.

The Deputy of St. John :

It still does not explain what the rationale was that we have been over this ground in Home Affairs meetings on a number of occasions but quite clearly an ambulance service has clear and defined links with a health service.

The Minister for Home Affairs: Absolutely.

The Deputy of St. John :

Rather than with a Justice and Home Affairs Department. So where did this fit come from?

The Minister for Home Affairs:

It is a matter of co-operation and collaboration between all of the emergency services; police, fire, ambulance and, to a degree, customs and immigration. It was only yesterday I had a meeting with the senior team from ambulance - one of the quarterly meetings with them - and it was so pleasing to hear about the work that is going on between them and the other emergency services; the training situations, the response situations. Have you been to the new control room yet?

Deputy R.J. Ward : Yes.

The Minister for Home Affairs:

Since the ambulance and fire people went in there because

Deputy R.J. Ward :

I do not think we have, no.

The Minister for Home Affairs:

It has made such a difference. I was up there just a few weeks ago and they are so pleased with the additional co-operation now there is between the response units and control room for the police and the control units for fire and ambulance working together. They gave me 2 or 3 examples of where there was improved response and more appropriate response because they were there and able to talk to each other. There is so much co-responding, particularly those 3 emergency services, that that was one of the logics of bringing them together. You see the training regime is now much closer than they have ever been before, whether it is generic physical training or diversity training, blue light driving training. A new thing we were told about yesterday, a device which I think is in the police, the chemical thing.

Director General, Justice and Home Affairs: It is in the fire service.

The Minister for Home Affairs:

It is in the fire service. To identify chemicals when there is a spill. Now all of the guys, including the police and the ambulance, can now have access to that when it is appropriate for them to do so. We have had examples only last week of a fire team moving to the ambulance station, taking an ambulance out to an event where a paramedic was already there but only in a car and needed more support. This is terrific co-operation of working together, which gives you a reason, if you like seeing all that gives you operational reasons why they can work together. You can make the argument they are mainly Health; of course they are mainly Health and they have to keep extremely close relationships with Health and the clinical governance has to be maintained at the highest possible level. Organisational and communication between the medical staff at the hospital and the paramedics and the technicians have to be maintained at a high level.

The Deputy of St. John :

I am very clear that ambulance, fire, police and all the other emergency services, coastguard, R.N.L.I. (Royal National Lifeboat Institution), will work together and have always worked together.

The Minister for Home Affairs: It is even better now.

The Deputy of St. John :

Nothing you have described is any different to all of that. Ambulance have a specific role in health in that they service most of the areas of health in one way, shape or form. Whether it is conveying patients from home to hospital, whether it is dealing with people in their own home at a care level and avoiding an admission to hospital, whether it is dealing with transferring somebody in the dead of night back home when a bed is required. These are all very intimately involved interactions that take place between health and ambulance. The emergency aspect of the ambulance service's role is only a proportion of the work that goes on between the service as an entity and health. It is really surprising that simply because it has a blue light an ambulance becomes part of an emergency response service known as Justice and Home Affairs rather than Health and Home Affairs. Is that not an unusual position for ambulance to find itself in?

The Minister for Home Affairs:

The decision, as I say, was made before my time and I am not here to justify decisions made by other people at a different time. But I can tell you this, I welcome the ambulance service and I welcome the staff of the ambulance service - every single one of them - into the Home Affairs family. I am not Minister for Justice - I think there was a mistake in the paper - I am Minister for Home Affairs only.

[10:15]

The Chief Minister is the Minister for Justice. But of course their work is diverse and varied, as you quite rightly say. But so is the work of the police, so is the work of the fire service. They co-respond so often and they have to work together so closely. One of the reasons for the need for the OneGov programme is to break down the silos and not build them up. I welcome the ambulance service into the Home Affairs family and the work they do, I am sure, will even be enhanced.

The Deputy of St. John :

We talk about breaking down silos but we found ourselves in the position of having to create a new panel to be able to look specifically at these new arrangements because we are unable to ask Health certain questions and ask you certain questions, which you cannot answer, and they cannot answer, in relation to the changes that are taking place. It suggests to me, and we have talked about this, that rather than trying to obtain clarity the reorganisation is muddying waters.

The Minister for Home Affairs:

I do not know where the evidence for that is. I do not think you have asked me any questions that I have not answered. I am totally open and honest with you and colleagues and that has always been my policy and my principle, and I would not like to think I am trying to hide anything from you. Absolutely not. I said to you a few minutes ago, please come to the control room again and have another look now that the ambulance and fire people are there. But also come to the ambulance station. I do not know if you have been down there yet. One of the things we are working on and we have just had some - I must not give away secrets - we are going to have some money voted in the capital programme, if the States agree, for a co-location of headquarters for ambulance and fire, which I think both services is very excited about. With us leading that, hopefully we can achieve, and I have given the director general and the staff at Home Affairs a target to get the bricks coming out of the ground in the new headquarters before my term of office finishes in 2022.

Deputy R.J. Ward :

You talk very positively, if I may say, about the transfer. Are you seeing any negatives at all? Are you seeing any staff who perhaps are concerned? Are you dealing with their concerns? Because what I cannot picture in my mind is what was so wrong that you have now fixed with this transfer of services. What was not working in the ambulance service which would now be better because of the transfer? We can see there will be positives in terms of relocating. Even the shared response of the control room; everything is positive, there are no negatives there at all in your view.

The Minister for Home Affairs: Yes, there is.

Deputy R.J. Ward :

What has been fixed by this move that was there before that was not working?

The Minister for Home Affairs:

It is difficult for me to say because I was not involved with them before they

Deputy R.J. Ward :

So how are you making the comparison then because you are seeing all the positives but how can you compare against the negatives if you were not there before?

The Minister for Home Affairs:

What I am doing is communicating with the staff at all levels. Earlier this year I instigated a monthly meeting with representatives of the Ambulance Staff Association and the Fire Staff Association and we meet on a monthly basis at the moment. That may be a bit too much but that is what we are doing at the moment. I welcome that. Any concerns that they may have they have to direct to me and to my Assistant Minister, who is away at the moment and why I was up here this morning. That is how we are doing it. Of course regular meetings with the senior management team at the ambulance as well. I had a wonderful experience a few weeks ago by spending 12 hours on a shift with the team. There are so many improvements we were talking about yesterday and one of them was because of the they changed the rostering system at the ambulance service and because of that the level of sickness has gone down by 62 per cent by changing systems. The demand for ambulance service is going up by approximately 4 per cent a year but the staff and the management team, because of that, rearranged the rosters, are introducing more technology and again we are looking at more technology coming into the system to improve what they can do, at least maintain the levels of service that they provide without increasing costs. That is a good thing. There is a very positive attitude. What I detect a very positive attitude.

Deputy R.J. Ward :

Improving the level of service around improving costs but working less and doing so are a lot happier, it does seem like a miracle working

The Minister for Home Affairs:

That is the impression I get. When I went to the control room a few weeks ago, after the ambulance people had moved there, there was a negative. They missed talking to their colleagues directly in the same building and getting a little satisfaction in finding out what happened to that call. We have got to find a way of making sure they can communicate easier. I think there was a problem with the microwave as well, but I think that was resolved quite easily. But that was the level of concern, which is pretty low. Important but not a problem.

Director General, Justice and Home Affairs:

Can I maybe just give a couple of examples in answer to your question in terms of where they have come from to where they are now and how things have improved? It was made quite clear just by a senior ambulance team that for a whole host of reasons, and not being critical of the previous Health regime, that the ambulance service felt as though they were the poor relations in relation to a much bigger because they are a very small unit, as you know, compared with the bigger Health Department and its footprints across the Island. We have been able to, with the Minister's support, and hopefully it will be approved going forward, around the capital programme for example, to get some bids in to enhance the control room, the combined control. When I first arrived in the Island there had been a 5-year conversation around trying to bring police, fire and ambulance together and it was not able to be achieved because there were differences between the then Health Department and what was the C.C.A. (Community and Constitutional Affairs), in fact they are in one department now, it has made that conversation and that transfer of service into a combined control very easy to do. Similarly, they do not have any electronic patient records whereas the police had investment through support in relation to smart police and using mobile technology. So we have now got a project in place and hopefully we will get the support and investment so we can get electronic patient record forms. At the moment they use A3 pieces of paper when they are stood in the house with a patient. I have done it. I have had to fill it in on behalf of ambulance

The Deputy of St. John :

Which is pretty standard throughout ambulance services in the U.K. (United Kingdom).

Director General, Justice and Home Affairs:

The south-west have had it for 5 years, electronic patient records, so it is not completely standard.

The Deputy of St. John :

Is it also jumping the gun when Health have not got records electronically compatible with ambulance?

Director General, Justice and Home Affairs:

No, because obviously we are talking very closely with Health and they have a bid in for an electronic patient record system itself, so the 2 will connect.

The Deputy of St. John :

As a matter of interest, who are they going to?

Director General, Justice and Home Affairs: Who are they going to?

The Deputy of St. John :

Who are they going to for their ?

Director General, Justice and Home Affairs: Who, Health?

The Deputy of St. John : Yes.

Director General, Justice and Home Affairs:

I am not sure. But this is with support, the ambulance service wanted this.

The Deputy of St. John :

You do not know who they are going to in order to go to the same people to create the electronic records.

Director General, Justice and Home Affairs:

But the chief ambulance officer and his staff are absolutely engaged with Health. I might not know who they are exactly going to; we are very closely linked to the south-west region and we are possibly going to look at how we can procure with them because they work with the Isles of Scilly, which is not a dissimilar environment to here. I may not know but the important thing is the relationship with the ambulance service and Health continues and that is very much a joint piece of work.

Deputy K.G. Pamplin:

Can I just clarify? There will be a bid in the Government Plan for funding to finally put forward an across-the-board uniformed digitalised patient record; hospital, all health providers, ambulance? Is that what you are saying?

Director General, Justice and Home Affairs:

Certainly the ambulance one is in through Justice and Home Affairs and the Health and Community Services bid is in in terms of the

Deputy K.G. Pamplin:

So into the Government Plan that will come forward?

Director General, Justice and Home Affairs:

Yes. That was on the stocks a couple of years ago and never got pushed forward whereas through our department we know what is helpful.

Deputy R.J. Ward :

We are going a little bit off target as to what we were questioning on then; so the record keeping, and that is fine. I did ask for examples. But we are thinking more practically in terms of have you gone forward on things you want to or can I talk a little bit about consultation?

The Deputy of St. John :

We are on this relationship with the Health Department. Do you think there are any disadvantages to moving ambulance outside Health?

The Minister for Home Affairs:

They moved outside Health in the name because the Minister for Home Affairs is now politically responsible for them. But they are not outside Health, are they? They are an integral part of Health. The communication, the relationships have got to be maintained.

The Deputy of St. John :

Which brings us back to the idea that the public are finding it very difficult to understand why you moved this service out of Health.

The Minister for Home Affairs:

I have not moved this service out of Health. When I became Minister for Home Affairs the decision had already been made and was formally made in February this year. I have not made that decision.

Deputy R.J. Ward :

No, but you are supportive of that decision and you are very

The Minister for Home Affairs: Of course.

Deputy R.J. Ward :

Okay, so therefore if it was you, you would have made that decision. I think we are splitting hairs here. I think it is important that we say

The Minister for Home Affairs:

I was not involved in the decision-making process, can I make it absolutely the Chief Minister signed the responsibility over to the Minister for Home Affairs and I accepted it with open arms.

The Deputy of St. John :

What is the relationship going to be between the ambulance service and Health?

The Minister for Home Affairs:

I do not quite know what level you are talking about but it will be excellent and it will improve and it will grow.

The Deputy of St. John :

That is a generalised reference. What is the relationship going to be in terms of its practical development, the way in which it is seen out day to day, where are we going with clinical governance and so on and so forth because these are all issues that we fear might get lost by the way?

The Minister for Home Affairs:

Not on my watch, Chairman. Clinical governance is absolutely essential to the good and full operation of the ambulance service and its relationship with Health. I just received a note this morning about who are members of the Clinical Advisory Group and there are about 10 of them. There is, as you probably know from your own experiences, an ambulance medical director based in Health. There are consultants on the group as well; nurses, a sister, a risk manager, so all of that is going to be strengthened and formalised through a service level agreement between the ambulance service and Home Affairs and the Health and Community Services Department.

The Deputy of St. John :

In moving ambulance out of Health and continuing a strong governance arrangement, has there needed to be any appointments made in Health to cover that change?

The Minister for Home Affairs:

Not that I am aware although Health were talking about appointing a clinical governance person at Health, which was going to happen anyway. But I do not know if that has happened or not.

Director General, Justice and Home Affairs:

No, there has been no additional posts appointed by Health and Community Services to enable to support this move at all. If I could support the Minister's view in terms of clinical governance. If you want reassurance, the ops manager who sits underneath the chief ambulance officer, who is responsible for clinical governance, said yesterday at the ministerial meeting that as far as he is concerned, clinical governance has not deteriorated or changed at all. So that is very good reassurance.

The Deputy of St. John : Of course it is early days.

Director General, Justice and Home Affairs: Six months, you are right. It is still early days.

The Minister for Home Affairs:

It is essential, Chairman, the level is maintained and enhanced.

The Deputy of St. John :

So there have not been any additional appointments and so no additional cost implication. What are the cost implications that you see as part of this move to your own budget?

The Minister for Home Affairs:

No significant change. What we are hoping for and expecting is as time goes by, as they co-operate more together, amalgamate together, and particularly if we can get the new combined headquarters for the 2 services, there has to be room for some efficiencies. But as far as I am concerned, it is not about saving money. It is about providing an enhanced service for the public, the sort of service that the public want, need and, quite honestly, deserve.

[10:30]

It is the level of service that I am more concerned about than saving money. Of course if we can be efficient in the greater scheme of things

The Deputy of St. John :

Is it possible to describe those enhancements at this point in time?

The Minister for Home Affairs: Enhancements to service?

The Deputy of St. John : Yes.

The Minister for Home Affairs:

No, its response times, its training, its having the right people attending incidents at the right time within response time limits. That is one of the reasons for the combined control room. That is already paying dividends. I have not got any numbers yet but they are telling me it is paying dividends.

The Deputy of St. John :

In the day you have 3 emergency ambulances.

The Minister for Home Affairs: Three sometimes 4, yes.

The Deputy of St. John :

How are you going to stretch those resources to improve response times?

The Minister for Home Affairs:

Through technology, so the response times are already very good. Through triaging, through making sure that the right resources are being despatched to the right events because you will know again from your earlier life there are times when you can send a full emergency ambulance, which is not really needed; he just needs a bit of reassurance. It could be dealt with by primary healthcare or whatever. It is working in that area. The demand is increasing, there is no question about that. The change to the rostering has made so much difference to

The Deputy of St. John :

I am very interested in that. What changes in rostering have taken place?

The Deputy of St. John :

I forget what they were before but now they are 12-hour shifts. I cannot remember what the shifts were before because it was before my time.

Director General, Justice and Home Affairs:

They were doing a shift pattern; they finished at say 7.00 a.m. and then for the next 8 hours they were on call. So they would often go home, go to bed for an hour's sleep and then get called back in again, which there are a number of issues there. It is the health and safety of staff let alone having to get out and respond, whereas the Minister said they are now on 12-hour shifts and that has reduced sickness and is much better in terms of staff welfare. They are not going to be getting out of bed and keeping on call. So that is a significant change. It is not about stretching resources. It is about making the most of the resources we have got. Some brilliant examples only last week, we were hearing yesterday where - and the Minister has already touched on it - the fire service was helping out the ambulance service and vice versa. That is already accelerating. They are generating these ideas themselves; driver training, diversity training that was not going on previously, sharing resources. Those are good benefits.

The Deputy of St. John :

Previously it has been mentioned that it might be that fire officers would respond to an emergency call out of an ambulance nature.

The Minister for Home Affairs: They did.

The Deputy of St. John : How does that work?

The Minister for Home Affairs:

Just to give an example, paramedics attended an incident some time last week. I cannot remember what day it was. In a vehicle, I am not sure whether an ambulance was not available or whatever the reason, and the situation changed and that paramedic needed an ambulance attending. Two fire officers walked across the road, took up the ambulance and worked with the paramedic on this incident with a positive result at the end of the day. That is the sort of thing that can happen. You do not have to ask. "Of course we will do it." That is the teamwork. That is the relationship which is building up.

The Deputy of St. John :

That is called interoperability or co-operation.

The Minister for Home Affairs: Absolutely.

The Deputy of St. John :

One can see the case for that. Where do the fire service fit into being responders to medical callouts?

The Minister for Home Affairs:

They are trained first responders. That is the first point to make.

The Deputy of St. John :

To what level of technical training are they?

The Minister for Home Affairs:

I cannot remember. I would have to get that information for you but it is first responding, the detail of which I have got but I have not got with me.

The Deputy of St. John :

It would be interesting to know at what level they function.

The Minister for Home Affairs:

Yes, of course. But if you have a situation where all the ambulances are tied up at events and there is an incident which needs some medical attention, better to get someone there who is first responder trained than nobody at all, at least they can see the individual who needs assistance.

Deputy R.J. Ward :

Can I just ask a question on that? But there is no risk then that somebody is responding with a level of first aid which is not adequate for a really serious incident that you can say: "Well, we have had responses and response times are still good"? The appropriate response was not there, just as it is not now if it does not happen, because they are on another call or there is a limited resource. Getting somebody who is better than nothing I agree but the level of training could be as high as somebody who has been on the first aid course as well.

The Minister for Home Affairs:

It is a bit more than a first aid course.

Deputy R.J. Ward :

But it is not at such a clinical level as ambulance staff. I know there is a significant difference there.

The Minister for Home Affairs:

But there is a difference in ambulance staff as well, from paramedic, technician individually so

Deputy R.J. Ward :

Of course but I do not think it is even at the level of technician, is it?

The Minister for Home Affairs:

No, but it is important to make a response and this sort of situation I mean whenever there is a call for an ambulance an ambulance will go but sometimes

Deputy R.J. Ward :

That is the exception now, is it not? At the moment that would be the exception, would it not, but it seems to me that we are heading towards that perhaps becoming the rule?

Director General, Justice and Home Affairs:

With the fire chief and the ambulance chief a couple of weeks ago we had a conference call with the East Midlands Ambulance Service and in Lincolnshire and we talked their co-responding, co- transporting, very clear levels of medical training for the fire officers and we are looking if they do not already have it here we are looking for it is F.R.E.C. (First Response Emergency Care), you may be aware of it. There are different levels. There is the appropriate level of training deployed but our policy is always to despatch and send an ambulance first, even if there is not one available; it is never send in a fire resource to a medical incident.

Deputy R.J. Ward : That will not change?

Director General, Justice and Home Affairs:

No, that absolutely will not change. Of course because of the 3 ambulances and demand sometimes there is an opportunity to send a trained resource. It is common place in the U.K. and chief fire and ambulance officers

Deputy R.J. Ward :

Just to confirm though, and one of my concerns is that as the demand grows in the future and the demand is clearly that we will need more ambulance staff, if you can come up with statistics to say: "But we are responding very well" will that not get in the way of your bid for more ambulance staff when you go to the Council of Ministers for more money and they say: "But hold on, you are telling us that your response times are really good and your changes for that fire staff" could you not be, if you like, kicking yourself in the shins, so to speak, with these actions?

The Minister for Home Affairs:

Deputy , what worries me about that question is it implies that what we should do to make sure we get resources is not to respond on time to any event.

Deputy R.J. Ward :

I am not implying that at all.

The Minister for Home Affairs: I know you are not but

Deputy R.J. Ward :

I am talking about appropriate response because it is really important.

The Minister for Home Affairs:

Appropriate response is absolutely right and what our business is all about. While response times are vitally important what is slightly more important than response time, I think, is results you achieve when you get to the site and the incident. But, no, we have no interest in playing those games. We are interested in providing a service to the public. If we need more resource I will fight for more resource and you will see evidence of that over the next few days.

Deputy R.J. Ward :

Good. Glad I asked the question.

The Deputy of St. John :

I am going to be finished very shortly but my colleagues have got lots of questions for you. We have talked about ambulance and fire working closely together and it is rightly so that they should, of course. When you talk about them working closely together are you talking about them amalgamating? If it is the latter, what are you doing to make the restructure valid in law, as in the requirements of P.24?

The Minister for Home Affairs:

It depends quite on what you mean by amalgamation but you will recall we had the debate in the States a few weeks ago, which made it quite clear to me that the States wanted to see dedicated services, if you like. The words "dedicated" chief officer for the fire chief officer and for ambulance chief officer and police should remain separate. That is our position. That is the States position. In fact, we already have a chief ambulance officer. We will be appointing in the next couple of weeks, 3 weeks hopefully, a dedicated substantive fire officer. Amalgamation at that level is off the agenda for the time being because if that were to happen I would have the department and the services themselves would have to make a very robust case for me because I would not want to take anything less than a robust case to the States. But what we look for is not amalgamation but the sort of co- operation, the working together that we have been talking about for the last few minutes, and importantly to me and to make sure that works to the best level it can is a joint headquarters. That is going to be my priority for the next couple of years.

The Deputy of St. John :

We are looking at quite significant changes and at the beginning of the year we had a business plan which supported the ideas that were then in train. Since then of course the world and its grandmother has changed to some degree, and the Education and Home Affairs Scrutiny Panel has made a number of requests to receive an updated business plan. We have not had that updated plan to date and we wondered whether or not that could be made available to us.

The Minister for Home Affairs: The business plan for what?

The Deputy of St. John :

There was a business plan published in January in relation to the target operating model and of course that has rather changed.

The Minister for Home Affairs: It has significantly.

The Deputy of St. John :

But we have not had any update to that business plan at all. As I say, we made requests and I suppose in a sense I am making a request again.

The Minister for Home Affairs:

As a business case, in the traditional sense of that, there is not one at the present time.

Director General, Justice and Home Affairs:

Obviously you had the original business case and the consultation document, you have had the final consultation document post the proposition P.24 and the changes, and then we have now got another plan in terms of the service review, which we no doubt will come on to. We are very happy to share that with you.

The Minister for Home Affairs:

The service reviews have just taken place with the ambulance service and the fire service led by their chiefs and the acting chief, co-ordinated by Kate Briden, and the results of that will be coming out in the next couple of weeks and that of course we will immediately share with you. But I think you have had all the documentation that has been produced and that is the way I want to make it stay because we have no secrets. We really have not. I know some of the things we do we are trying to hide things but there is nothing to hide at all. Things change, things move on, opinions change, views change. We are always happy to share that with you.

Deputy R.J. Ward :

An integral part of that is the consultation processes. I was going to ask some more about the 90- day consultation but perhaps you can have that in the back of your mind while I ask the questions on the consultation because I think the questions are the same. There was a consultation process with fire and ambulance, which has now finished. Do you feel that the business case in January, which will now be different, contained enough detail to have an informed consultation process in those people that you consulted with, i.e. fire and ambulance?

The Minister for Home Affairs:

When you look back you can always improve things. But it was a pretty solid business case. I think the consultation was a pretty good example of how to do consultation properly. When States are consulting, or when anybody is consulting, there is always a suspicion of: "Well, you have made your mind up already" and this sort of thing. But clearly in this case we had not because we listen very careful and we changed things quite significantly from the original model.

Deputy R.J. Ward :

So the services responded well to the consultation?

The Minister for Home Affairs:

They certainly did. I mean I think we had well over 200 responses from individuals within the services.

Deputy R.J. Ward :

Will we be able to see their responses?

The Minister for Home Affairs:

I thought they had been

The Deputy of St. John : No.

Director General, Justice and Home Affairs:

Have you seen the final consultation document? Not the one that went out at the start of the consultation. We have since finished consultation and published a document. We have sent it to the Scrutiny Officer.

Deputy R.J. Ward :

If I am honest, I have got about 15 tabs open, there is an awful lot of documentation.

[10:45]

Director General, Justice and Home Affairs:

But we sent that to you and that is quite comprehensive and very honest feedback in terms of the consultation. So it is meaningful. Lots of responses. We are not saying it is all positive. There are lots of comments in terms of unhappiness and critical and that, but you get that in consultations.

Deputy R.J. Ward :

Was there a general acceptance of the benefit of the business case to ambulance service in terms of workload or financial savings and the benefits that would happen to them? Was there a theme in the responses, that the benefits of your business case were seen and accepted by the ambulance service, in your opinion?

The Minister for Home Affairs:

I do not think it is a matter of acceptance. What we were getting - and quite rightly and quite expectedly - was the worries and concerns about any changes that were proposed. One of the big things the chairman has highlighted this morning was on the assurance of clinical governance continuing; it was about the expertise of the work at that time. We were consulting on having a single chief for both fire and ambulance, worrying about and looking at the skillsets that would be appropriate. The responses to the consultation I would say were robust and that was good, so the

Deputy R.J. Ward :

But it was only done to tier 3, was it not?

The Minister for Home Affairs:

Yes. We have not gone further than that.

Deputy R.J. Ward :

Do you think it was clear for those below tier 3?

The Minister for Home Affairs: That would be clear.

Deputy R.J. Ward :

It would be clear to them as to how that would impact on them in the long term?

Director General, Justice and Home Affairs:

The business case, as you rightly identified, did not do a whole top to bottom organisational new model. It was very clear that it proposed, as the Minister said, a single - in this case - fire and ambulance chief and then the plan was to get that individual appointed and then for them to work collectively with the 2 services, to then do a more comprehensive target operating model 3, 4, 5, 6. That was always the plan. You can do it that way or you can do it the other way, you can do it all in one go. The proposal was to do it at the top, therefore the responses to the consultation were not around how it would affect the front line staff, for example, because it would not have done.

Deputy R.J. Ward :

Do you think there was clarity on what those jobs at tiers 3 and 4 would look like? It is not the idea that you have already made your mind up, it is the idea of the clarity of consultation, because we have seen a lot of these consultations and target operating models and I think we and others are concerned about the clarity. It may well be that you have a very clear picture, but when it goes to somebody who is on the front line, seeing how that is going to impact on how they will do their day- to-day job is not clear, so therefore it is very difficult to respond with clarity. Do you think that there are any themes that came in the response that you responded to and the level of consultation that they could do, i.e. 3 and 4 job descriptions, were they clear what their managers, what their line of accountability would be, the line of responsibility? Other things, such as if you are a fire officer and you are suddenly doing more medical care, which might be a slightly higher level of training, the insurance that goes with that, the protection against things that go wrong.

Director General, Justice and Home Affairs:

Because we were not going to that level, there was not that detail, because the proposal, we were not consulting on how tiers 4, 5 and 6 - so technicians, paramedics, fire paramedics - were working with firefighters. This was one of the challenges around the consultation. We were looking at keeping all as is in terms of the 2 services, but doing some changes at the top. I often describe it as only a 5 per cent change and 95 per cent of the organisations would remain the same. Then the plan would have been to get a single head appointed and that individual to then work with the organisations to start to integrate them and collaborate together.

Deputy R.J. Ward :

So it would have had implications for the lower tiers, but you would not know what those implications were?

Director General, Justice and Home Affairs: Correct, yes.

Deputy R.J. Ward :

But you were asked to give comment on the changes essentially without knowing what the implications were. Do you see the issue that might be there?

Director General, Justice and Home Affairs:

Certainly you mentioned whether themes came out. When you read the final consultation document, there will definitely be themes that came out and there were around management of risk, command resilience, because those areas were concerning the most senior of those 2 organisations. It was not really around how operationally staff would be deployed.

The Deputy of St. John :

You see, we are not assisted in this endeavour, given the most recent consultation document I have is 4th February. I do not know whether we have had something sent

Director General, Justice and Home Affairs:

I apologise, Chairman, but we did send it to your Scrutiny Officer.

The Deputy of St. John :

Right. Did we have a breakdown of the areas of responsibility in that document?

Director General, Justice and Home Affairs:

It is a very comprehensive document. I am happy to take questions again once you have had a chance to read it.

Deputy R.J. Ward :

Will there be a further consultation with the new business plan and what level of consultation will there be as you go down the tiers? I suppose the big question is if the consultation comes back and staff are very unhappy, how do you deal with disagreement? Because I always think this is a really important question: it is really easy to deal with agreement in all relationships, from marriage to running an island, but it is disagreement that is the problem. When there is general disagreement, particularly with professional bodies - which I think is particular, these people really know their job and we have huge respect for the work they do - how are you managing that disagreement? I think it is a really important thing to look at, because you are going to consult and there were themes of concern. They have been dealt with. As you go down to the grass roots level, so to speak, if you will excuse the term

The Minister for Home Affairs: Front line, yes.

Director General, Justice and Home Affairs: Operational front line staff, yes.

Deputy R.J. Ward :

Yes. The final bit that goes with that - I might as well ask you now - is if you go into this model and in a couple of years you recognise honestly that this is not working, is there the possibility of changing back, so to speak, or is there the facility there to say: "This is not working. The consultation points have come out that we saw as disagreement"? It is how you disagree, not how you agree. I go back to that theme again: what is your plan?

The Minister for Home Affairs:

I am not quite sure where you think we are planning to go, because their

Deputy R.J. Ward :

No, and to be quite frank, we are not sure where you are planning to go and I do not think the ambulance service and the fire service are. That is the concern.

The Minister for Home Affairs:

They ought to be, because we are talking with them all the time. We have just had, as I say, the there is no consultation per se going on at the moment because there is nothing to consult on, okay, so there is no consultation going on at the moment. What has been going on is a communication exercise, which Kate Briden has been leading with the chief officers of both fire and ambulance on the service reviews. Kate will be able to speak for herself, but I think she had an excellent response from all levels of staff in fire and ambulance. Now, what we are putting together is a report based on those service reviews and how individually and independently those services are going to address any issues which may have been flagged up by those reviews. But they have been flagged up by themselves, it is not something which someone has come in and imposed upon them, they have done it themselves.

Deputy R.J. Ward :

Those people that you are consulting with, they are clear about their positions in the new structure as well, are they? They have been positioned in the new structure so they know what their roles are and work they will be doing as you go through the consultation?

Director General, Justice and Home Affairs:

Kate may want to answer. As the Minister just said, there is not a new structure.

The Minister for Home Affairs: There is no new structure.

Director General, Justice and Home Affairs:

If we look at the current model, we have got the ambulance service and we have got the fire service and that has not changed, no personnel have changed, no structural change.

Deputy R.J. Ward :

So the people at the top of those services know that they are secure in what they are doing and they can enter into this consultation process knowing where they are going in the future?

The Minister for Home Affairs:

Yes. There is no consultation process going on.

Deputy R.J. Ward :

Okay, the communication process.

The Minister for Home Affairs:

But the chief ambulance officer is in post and has been for some time. We are appointing in the next few weeks a chief fire officer. They have secured his place, so there are no issues there.

Director General, Justice and Home Affairs:

Everybody has been communicated with, written to in a formal H.R. (human resources) process to say: "The consultation is finished, it is over. There are no changes."

Deputy R.J. Ward :

That is good. I just want to ensure people are secure in their posts, because if you are not secure in your post and you go into a communication, it could be a very different communication if you are secure in your post.

The Minister for Home Affairs:

That was a risk and one of the challenges over the last 12 months, because acting fire, acting police, acting customs and immigration.

Deputy R.J. Ward :

That is what I was thinking of.

The Minister for Home Affairs:

It has been a challenge for them, I recognise that. All of them have responded very professionally and very properly and I respect them all for that. I do not know if you want

Group Director, Public Protection and Law Enforcement, Justice and Home Affairs:

Can I just say briefly about the service reviews? The communication was very intense in relation to that. We have done some engagement around the consultation process, but then when we moved into the service review process we did even more. We had a number of opening sessions about the service review, where we presented Julian did some follow-up to the consultation and then we presented what the service reviews would be about. I had a number of engagement sessions with chiefs from fire and ambulance throughout the month or 6 weeks or so of the most intense part of the process. Then as we concluded the process, we did a lot of work on preparing what we would present to the staff and the chief officers, so the acting chief fire officer currently and the chief ambulance officer presented the findings of those reviews to their staff. Universally in those sessions it was supported that there are real benefits from the fire and rescue and ambulance services working more closely together. Some of the examples the Minister has given you already are the grounds of that, and also that where we are looking at things like people plans and technology and estates for the future, it would absolutely make sense for the services to work together with their appropriate other parts of Government, so the States and H.R. and so on. That is universally supported in the services. I think there is some real excitement there, that there are some real opportunities and some real innovation. There are really good ideas coming up from the ground about what we can do and I have been really pleased with that.

Deputy R.J. Ward :

When you say "universally supported" you mean throughout the levels of staff?

Group Director, Public Protection and Law Enforcement, Justice and Home Affairs: Yes, absolutely.

Director General, Justice and Home Affairs: And associations as well.

Deputy R.J. Ward :

From your engagement

Group Director, Public Protection and Law Enforcement, Justice and Home Affairs: And the associations.

Deputy R.J. Ward :

From your engagements, you connect?

Group Director, Public Protection and Law Enforcement, Justice and Home Affairs: Yes.

Deputy R.J. Ward :

I am conscious of time, sorry.

Deputy K.G. Pamplin:

Unsurprisingly, I have drilled into the numbers and some data. A lot of this, what I am about to ask, is based on the 2017 service report from the ambulance service and what information is available. It could be rough numbers, but if you could nod either way. There are 7 emergency ambulances: is that still correct?

Group Director, Public Protection and Law Enforcement, Justice and Home Affairs: Yes.

Director General, Justice and Home Affairs: That is right, yes.

Deputy K.G. Pamplin:

Three single response cars: is that still correct? Two major incident vehicles?

Director General, Justice and Home Affairs: Yes.

Deputy K.G. Pamplin:

One 4-wheel drive with major incident and trailer, that is still sort of roughly where we are?

Director General, Justice and Home Affairs: Roughly, yes.

The Minister for Home Affairs: That is about right, yes.

Deputy K.G. Pamplin:

As part of the service review, are you able to say that any of that will be enhanced or reduced based on amalgamating with other blue light services?

The Minister for Home Affairs: No change.

Deputy K.G. Pamplin:

In 2017, 98 per cent of calls that were classed as category A reached within 19 minutes and 68 per cent of emergency calls within 8 minutes. There has been an increase of medical 999 calls of 14 per cent in the past 5 years, 300-plus calls a year last year. Is any of this based on the response, that the numbers are going up and the percentage of callers? I add to that, at the moment - I know you have mentioned it a couple of times - there are 3 ambulances on duty between 6.30, 7.00 and 10.00 and 2 overnight. Are there going to be any changes or impact based on those rising numbers and what is available at present?

Director General, Justice and Home Affairs:

There are not any plans to increase vehicles or staff at the moment. What we are looking at through the service reviews is identifying where improvements can be made. Those service reviews, as Kate mentioned, were led by, in this case, the ambulance service, who identified areas where they could improve. Co-responding and co-transporting will help with that and that is a good use of resource and public money. We need to make sure that we are making the best of that. For example, we are looking at an advanced paramedic. An advanced paramedic would go out and treat, but make sure the person does not go into hospital and gets treated there and they are left at home, which is a closer to home initiative, which you will appreciate. There are opportunities to reduce demand by deploying staff in a different way.

The Minister for Home Affairs:

You might not take up an ambulance, but the other thing which has been and they will still be there ready for the emergency. But the other thing which you will well know the ambulance service has done to help improve response times is to have the ambulances deployed at different parts of the Island. Rather than everyone being in town, they now have got one usually based at Bel Royal, which is attendances in the west of the Island and that is

Deputy K.G. Pamplin:

Yes, because the response times to the west have been quite low for the last few years.

The Minister for Home Affairs:

Yes, and another one now at Longueville to deal with the east of the Island. They did try at Le Hocq for a while, which I was very pleased about, but very sadly, it did not work as well as at Longueville or at Five Oaks, I think. It has been at Longueville recently while the roadworks have been going on.

Deputy K.G. Pamplin:

That is right, you see everyone walk in.

The Minister for Home Affairs:

There are all these sort of things, which are relatively simple things, but it improves the efficiency and the responses.

Deputy K.G. Pamplin:

Sure. To go on to the first responders, the community first responder scheme, which has been running for a number of years, had 15 people signed up for it in 2015. In 2018, when it was promoted last year, there were only 6 community first responders. Last October a press release went out and there was a lot of work to try to increase that number. Is that scheme going to continue or has it been successful in upping the numbers to carry forward as part of this review?

[11:00]

Group Director, Public Protection and Law Enforcement, Justice and Home Affairs:

It is going to continue. They have upped the numbers. I am afraid I do not have the number to hand. Obviously we can find that and give it to you afterwards.

Deputy K.G. Pamplin: Sure. But that is going to

They are in the process of training the new batch of community first responders. There are at least 2, if not 3, cohorts of training, so it is a substantive number.

Deputy K.G. Pamplin: So it is more than 6 now?

Group Director, Public Protection and Law Enforcement, Justice and Home Affairs: Yes. They will be active as soon as they are trained.

Director General, Justice and Home Affairs:

It has been revitalised. There is some new technology to get the information quicker through an app to deploy, so the controller can see exactly where the community first responders are.

Deputy K.G. Pamplin:

For those who are listening and watching, that is just basically they are there to make a difference between the survival or death while the ambulance is being despatched as well. Back to the numbers, again these are based on the 2017 and 2016 report, 32 front line staff.

Group Director, Public Protection and Law Enforcement, Justice and Home Affairs: It may have fluctuated slightly, but it is about that.

Deputy K.G. Pamplin: Three managers?

Group Director, Public Protection and Law Enforcement, Justice and Home Affairs: It is more than that.

Deputy K.G. Pamplin: More than that now?

Group Director, Public Protection and Law Enforcement, Justice and Home Affairs: Yes.

Deputy K.G. Pamplin:

Twelve combined control officers, possibly 14, because there were 2 that were recruited. But this leads on to my next question and how this changes with the one area for callout. How is that

changing, because they were combined control officers for fire and the ambulance? How has that changed?

Group Director, Public Protection and Law Enforcement, Justice and Home Affairs:

You are right, it was 12. It is due to be 14. Those 2 new recruits are being trained now. At the moment they are running as fire and ambulance controllers in that new environment at police H.Q. (headquarters) and the police are running exactly as they are. Then part of the project that we are working on is the continuance of the next phase of the combined control room is what that staff model looks like for the future and how we get the best out of them being in the same environment, but that is in the quite early discovery process mapping stages at the moment.

Deputy K.G. Pamplin:

So it is still to be finished. I make that roughly 70 staff that ambulance employ. Is that going to increase or decrease?

Group Director, Public Protection and Law Enforcement, Justice and Home Affairs: I think it is about 80.

Deputy K.G. Pamplin:

It is up since the report? Where they say in the 2017 report it is 70 staff, it is up by 10?

Group Director, Public Protection and Law Enforcement, Justice and Home Affairs: Yes.

Director General, Justice and Home Affairs: Yes, I think it is nearer 80, if not just over 80.

Group Director, Public Protection and Law Enforcement, Justice and Home Affairs: But that would include all the patient transport staff as well. There are a number of those.

Deputy K.G. Pamplin:

That number will not change as part of this restructuring model?

Director General, Justice and Home Affairs: There are no plans for a change.

The Minister for Home Affairs: No plans to change.

Director General, Justice and Home Affairs: No, not at all.

Deputy K.G. Pamplin:

Also, interestingly, in the 2017 report they list a number of priorities for 2018. I will not go through all of them, but interestingly, staff development have the most, leadership training, succession planning, delivery of the workforce plan, which is in the 10-year plan, service redesign to meet the needs of the acute service strategy and the future hospital, which will probably be paused for the next 10 years. My question is in all of their list of priorities - and there are many - where does that fit in now and how is the line of sight of reporting going to change as part of this restructuring?

Director General, Justice and Home Affairs:

I will start maybe. I think it is fair to say that a number of those listed priorities probably have not been fully realised and achieved yet and we are keen to support the ambulance service to help them achieve that.

Deputy K.G. Pamplin: Why not, do you think?

Director General, Justice and Home Affairs:

I referenced earlier on about all the changes that were previously going on in Health before ambulance moved out. They felt as though they were such a small part of a much bigger organisation that they probably did not get the full support that they maybe could have benefited from, shall we say. The chief ambulance officer has made that quite clear to us and we are listening loud and clear to that, as is the Minister, so we are keen to help them achieve some of that. We can do that with the fire service as well. Do you have anything to add to that?

Group Director, Public Protection and Law Enforcement, Justice and Home Affairs:

I think some of those aspects have been worked on, the implementation of the workforce plan, for example. That has introduced leading ambulance paramedics, who are more visible leaders on the station during the day and can also act as first responders and some of their shift changes and the interaction with the intermediary crew came through that workforce plan. There has been tangible implementation of those objectives, things around staff development. Continual staff development is always underway on our clinical side, but some of it around the leadership side was recognised in the service review as not having been maximised and we will be putting plans in place for that to change. But I think the broad direction of travel, as Julian said, on the wider how we deal with acute care, advanced practice across the ambulance service and the Health and Community Services Department, that is all still being worked on.

Deputy K.G. Pamplin:

The other thing that jumps out of the 2017 report is the concern of the staffing in terms of if there is a major incident in Jersey - and I draw your attention to the unfortunate and horrific stabbing incident crime that happened a few years ago - many police officers at that time were then out of action for a very long time and so they had to have a system in place to bring in resources. If there was a massive incident in Jersey which affected a lot of life, a lot of those staff, in H.R. policy, would have to take time out. The concern here at the moment is there is not that support network and where would the resource come from? Would it be Guernsey, would it be the U.K. and how would that work? Because at the moment, 32 front line staff roughly, living with an increased what was it, 14 per cent 999 emergency medical calls in the last 5 years, can you see the concerns there with the balance of

Director General, Justice and Home Affairs:

The operational resilience if there is a major incident, it is the same challenge for any organisation on this Island. It is just a unique feature, as you well appreciate, of the Island. There are well- established joint emergency service interoperability programmes in place, both on-Island, pan- Island, across Guernsey and particularly with the ambulance service in the south-west. There are mutual aid plans in place for major incidents; there is training for major incidents every year, for big exercises. The last one I think was a sort of cruise liner that came in or 2 ferries that collided and what was the impact and how quickly can we get resources and support. That is worked on in detail with Health and Community Services as well. Those provisions are the same in fire, same as the police and other organisations, so confident that they are quite robust. They get tested regularly and the governance is in place to make sure that we are in a position where we can call on those resources if we do need them.

Deputy K.G. Pamplin:

My final question in all of this is again the line of sight. When they have got in their 2017 review all these priorities and all this work going on, what is their line of sight of when they are not achieving that? Is that the Minister for Health, is that now you? How does the accountability for not achieving the 2017 priorities that clearly you are saying are not being worked on, plus there is all this change going on, plus you are introducing a new system? Can you see where we are coming from, the concerns? What is the response, the line of management up and down to ensure next year, when we go: "Oh sorry, 30 priorities have not been achieved"?

Director General, Justice and Home Affairs:

I am sure the Minister will cover off his accountability, but from our point of view, we hold a monthly senior leadership team meeting where the service heads all come to the meeting, where we look at performance right across a range of things, whether it is staff absence, whether it is managing response times and budgets. The service improvement plans have got a full work programme that Kate Briden is overseeing. I am confident that the accountability is absolutely in place now. Then of course you get held to account by the Minister. I am sure the Minister will cover his

The Minister for Home Affairs:

The Minister gets held to account by Scrutiny Panels of the States. That is vitally important. When I stood for the job 12 months ago, I said I would be the champion for these services. I hope they think I have been, and the support they need, they will get. But we will also challenge them to ensure that they are providing the service that we want and they have got the facilities and the resources to do it.

Deputy K.G. Pamplin:

Absolutely, but that is the key point. If the front line staff are only 32, who are going out and dealing with medical emergencies, 3 ambulances a day, constantly being called out, yes, the shift pattern has now changed to 12 hours

The Minister for Home Affairs: It has improved so much.

Deputy K.G. Pamplin:

But only 2 ambulances a night, which we know is an issue with an overburdening problem on the hospital, where people go in, so can you not see for front line staff, again the management structure changes for the front line staff

The Minister for Home Affairs:

Yes, but we have communication with those folk as well through their association and through individuals. We are a small place, you know, and we talk to each other. I have meetings with the staff associations. They can communicate direct to my level if they need to.

Deputy K.G. Pamplin: No, of course.

The Minister for Home Affairs:

It is preferable that they do it through their line managers, of course, but at the end of the day they are all here.

Deputy K.G. Pamplin:

But it is also important that good data, all these statistics, I have just said they have been out there for 2 years, one year, have got to be fed in.

The Minister for Home Affairs:

Yes, absolutely. No problem with that.

Director General, Justice and Home Affairs:

Just for the record, in relation to the broader operation piece, obviously there is a good relationship with St. John 's Ambulance on the Island. They have got a number of good vehicles and trained people, so I just wanted to say that for the record in terms of that broader response.

Deputy K.G. Pamplin:

There is no plan to copy the Guernsey model of charging people for their ambulance?

The Minister for Home Affairs: No, I have no plans for that, Deputy .

Deputy R.J. Ward :

We have some questions about integration and what it will look like. It might be just me, but I need to know what something is going to look like, if we are going to get an understanding. But I suppose what I will do is I will vouch it in a question. Given that you will be coming up with a new business plan because the first one has been slightly changed, has that changed the nature of what you mean by an integrated it says in the business plan: "effective, efficient and integrated blue lights and emergency response service which is collaborative and responsive to the needs of Jersey communities." Is that integration the same as the original business plan or will there be any changes to what you mean by that? Because the word "integrated" is different from simply "collaborative", is it not? It does imply one service perhaps. I just want to know, what will it look like? If I call an ambulance because I have overreacted because I am a hypochondriac - which I am - then is a fire engine going to turn up, which I

The Minister for Home Affairs:

I remember a Scrutiny Panel we came to here, and I think both I and the director general made the point we are not going to put firefighting apparatus on the back of paramedics. I was going to say when

Deputy R.J. Ward :

But we are increasing the role of firefighters, are we not?

The Minister for Home Affairs:

I was also going to say we are not going to put firefighters in ambulances, but that is not quite true, because they do it voluntarily and off they go to specific

Deputy R.J. Ward :

But if this becomes integrated, is that not changing their role - that is my concern - to a point whereby

The Minister for Home Affairs:

No, absolutely not. It is not changing their roles at all. When there is a call for an ambulance, an ambulance will be deployed. When there is a fire, a fire engine will be deployed. When a dinghy turns up at St. Catherine's, all of them are going, except possibly the fire service. But the services, we respect the spirit of the P.24 proposition. The services are separate services, but working ever closer together for the benefit of the public, not for my benefit, your benefit, the benefit of the public. That is what all of us in the services, and us in politics, have got to remember. That is what we are doing it for, nobody else, not the individual, not the paramedics, not the police, not the firefighters. The public are the ones that all of us are serving.

Deputy R.J. Ward :

As the changes filter down the tiers and get to the front line, can you reassure us that there will be a real consistent engagement in the effectiveness that comes and therefore any changes will be driven by those who are delivering the service on the front line, i.e. if jobs are changing so much that people are feeling uneasy and so on, because I think that is the concern for those on the front line?

The Minister for Home Affairs:

Deputy , you are absolutely right, because if individuals who are involved day-to-day directly, because they have got to produce, they are the ones who know more about how to do these things than we do.

Deputy R.J. Ward : No, absolutely.

The Minister for Home Affairs:

We have got to listen to them. If you do not communicate properly, you get all sorts of rumours being spread about them and we have got to keep that will happen anyway, but we have got to keep a lid on them and tell people the truth, but also enhance their training, enhance their development so they feel valued - and they are valued, as we all know - but we have got to keep proving that.

Deputy R.J. Ward :

Just one final thing on the transfer and the integration, it would require more training for firefighters, significantly more training, and not only that training, but it would need to be kept up-to-date. That is a massive commitment regards training.

Director General, Justice and Home Affairs:

It is interesting that when we have done a deep dive into this issue around co-responding and co- transporting that the fire service was sent to the U.K. almost 5 years ago - well before the Minister's time and well before my time and Kate's time - to go and be medically trained, then they came back and we further enhanced trained by the Jersey Ambulance Service. Then an M.O.U. (memorandum of understanding) was created and signed by both the then fire chief and the current ambulance chief 5 years ago. One could argue this is not even new. What has happened is it probably has not been as effective as it could be, so 5 years ago they were trained to a good level of medical training. What we are now doing is listening to the staff and some of them want to get these additional skills. Refresher training is critical in terms of making sure they are up-to-date with their medical advances and changes and we are looking to do that with the support of staff associations and the chiefs of both services. This is not new. The integrated piece, we can integrate training, we can do joint training and others. The strategic, as you mentioned, still remains and what that will look like in 5 years' time, who knows, but at the moment we are working very closely with the services and listening to them and they want to. An example the Minister gave a couple of weeks ago was a really good example, where that did not come from on high, that was an instinctive reaction with their training to go and support colleagues. That is probably a really good testament to how they can work together.

[11:15]

The Deputy of St. John :

I understand that you have recently sent a delegation over to Lincolnshire to have a look at the way that they function over there as a combined service. Do you have any feedback on that for us?

Director General, Justice and Home Affairs:

I am sorry, I am slightly laughing, because we were going to send I say "send", Kate was going to go with a number of senior people, but it never happened, for a variety of reasons. We had a conference call with them and with East Midlands Ambulance Service. They are not a combined service, they are 2 separate services, but we very clearly heard from both the senior ambulance

personnel and the senior fire personnel that they work very closely together and with full support from unions, the Fire Brigades Union U.K. and the Ambulance Association, in terms of co- responding and co-transporting, very good examples. I think we were told it had been going on for 20 years, which came as a surprise to a number of us, so some very positive feedback. Both the fire chief and the ambulance chief were on those conference calls and we have got a good link in there if we want to look at their policies and procedures and understand a bit further, but we did not get to go to the U.K.

The Deputy of St. John :

I understand that they plan to build a combined centre for some £17 million, which is now currently £6 million over budget, so

The Minister for Home Affairs: A familiar story, yes.

The Deputy of St. John :

Yes, so have you got any plans for the future in relation to development of a combined centre? Because bearing in mind if you go down that route, you have sort of made these decisions irreversible really, have you not?

The Minister for Home Affairs: Are you talking about co-locating?

The Deputy of St. John : Yes.

The Minister for Home Affairs:

Yes. As I said earlier, that is one of our priorities, supported by both services as well. Hopefully we will have some money in the budget for the next year to start the appraisal. I have forgotten what the word is, but we are working on that, because both the ambulance well, particularly the ambulance station is well past its sell-by date, even though it is only a 1980s building. I am not sure if you have been down, but you are more than welcome to take your panel to have a look and see why there is a concern. But we do want to see an amalgamated H.Q. at least started by 2022, but there is a lot of work to do.

The Deputy of St. John :

So really 2022 is the point of no return?

If I could add, there are many examples in the U.K. of combined location premises. They are not joined services, but it is just very good use of public money to have one estate that houses emergency vehicles, where they have a very similar profile in terms of servicing, cleaning, whether it is infection control or whether it is other things, training rooms, senior management space, conference facilities. It is good use of public money to create one estate.

Deputy R.J. Ward :

So that decision has been made that that will happen and it will not be consulted on with staff. The consultation happened after the business plan and we wonder whether consultations just to touch on that topic of consultations again, should the consultations be happening before decisions are made? Is that not what creates the atmosphere of: "Well, it is a token consultation"? I am not saying that it is, but does it not create that atmosphere when: "This is a decision that has been made, now we are consulting on you"?

The Minister for Home Affairs:

I think we have got a good answer to that.

Group Director, Public Protection and Law Enforcement, Justice and Home Affairs:

We have. In the course of all of the service review conversations with fire and ambulance, we have raised this as a concept, so clearly there is governance and political work to be done on it, but as a concept we would say: "Joint station, good idea or not?" Universally supported that it is a good idea because of the reasons that Julian has just outlined, in effect similar services coming together, sharing facilities, an opportunity to have a really good facility for both services.

Deputy R.J. Ward :

It is universally accepted as a concept, yes.

Group Director, Public Protection and Law Enforcement, Justice and Home Affairs: Yes.

Deputy R.J. Ward :

Yes, just like OneGov was universally accepted as a concept, but the reality is becoming very different.

Group Director, Public Protection and Law Enforcement, Justice and Home Affairs: There is more work to do.

Director General, Justice and Home Affairs: But this is with front line staff and the associations.

Group Director, Public Protection and Law Enforcement, Justice and Home Affairs: Yes, absolutely.

Director General, Justice and Home Affairs:

We are saying: "Look, what does it look like? Joint H.Q." with all the description I have just laid out and everybody is going: "Yes, we get that."

Group Director, Public Protection and Law Enforcement, Justice and Home Affairs: Yes. So more work to do, keep them engaged in these conversations

Director General, Justice and Home Affairs: There is, yes.

Group Director, Public Protection and Law Enforcement, Justice and Home Affairs:

as we go through the process, but at this point everyone is supportive of that concept.

Director General, Justice and Home Affairs: They will be fully involved in terms of

Group Director, Public Protection and Law Enforcement, Justice and Home Affairs: Absolutely.

Director General, Justice and Home Affairs:

As the Minister said, we have got a small amount of money set aside to do a scoping review next year or this year and into next year: "What does it look like? What facilities?"

Group Director, Public Protection and Law Enforcement, Justice and Home Affairs: Feasibility.

Director General, Justice and Home Affairs: Feasibility, yes.

The Minister for Home Affairs:

Feasibility, yes. That is the word I was searching for before.

Yes, and they will be involved in that as we go through the whole process, front line staff and managers.

The Deputy of St. John :

I think we are getting close to the end of the session, but I would just like to ask: do you see any changes in legislation coming forward in relation to fire and ambulance?

The Minister for Home Affairs:

As far as fire is concerned, we will be bringing forward the firework regulations under the Explosives Law. There is no legislation, as far as I am aware of, from ambulance at the present moment. I cannot think of anything else from the fire service.

Director General, Justice and Home Affairs:

The only other thing we are looking at is the Civil Contingencies Act, which is something we do not have in Jersey, but that is more broadly around emergency planning. There is nothing else in the pipeline.

The Deputy of St. John :

Fine. We are on time, we are early. Have you any questions for us?

The Minister for Home Affairs:

No. Grateful to come and explain our position to you, but I repeat the invitation, if you have not been, we can arrange for you to go the ambulance station and fire station, if you so wish, but the ambulance station is the one you are particularly interested in, meet the staff, meet the chief. We would welcome facilitating that for you.

Deputy R.J. Ward :

Can I just say one thing? Just to check, I think you did say it before but I did not jot it down, that the permanent recruitment to the roles of chief fire officer and chief ambulance officer are made or being made.

The Minister for Home Affairs:

The chief ambulance officer has been in post for a number of years and the chief fire officer will be appointed in the next few weeks.

Deputy R.J. Ward :

So both of those posts will be there?

Yes. Indeed, you have seen the advert for the police chief as well and customs and immigration, that will be done in a few weeks as well.

The Deputy of St. John :

Anything more? No, okay. Thank you very much indeed. Come again.

The Minister for Home Affairs: Thank you, Chairman.

[11:21]