Governance of Health and Social Care

The Public Accounts Committee has agreed that governance in respect of Health and Social Care will form one of its key topics for review during its term of office.  As a result, there are a number of key previous reports and recommendations that have been made by the Comptroller and Auditor General which relate directly to the governance of health and social care which have been identified for follow up by the PAC.

On 26^th August 2022, an Independent Review of Clinical Governance arrangements within secondary care (commissioned by the Chief Officer of Health and Community Services (HCS) and authored by Professor Hugo Mascie-Taylor) was presented by the Minister for Health and Social Services to the States Assembly which made a number of additional recommendations around governance within the Department for Health and Community Services (HCS). The report provided comment on culture and behaviour within HCS, roles and structures, internal management of HCS and the structure of quality and safety functions.

In total, 61 recommendations were made by Professor Mascie-Taylor within the report spanning the areas previously listed. The Minister subsequently presented an action plan to the States Assembly (R.133/2022) and set out the steps that would be taken to address the recommendations arising from the report.  As a result of this review, the Chief Executive of the Government of Jersey has set up a 'turn around' team in order to address the recommendations and improve the operation of HCS.

A key action in the Minister's plan was the development of an HCS board of governance which would provide oversight and strategic leadership for the department. The Minister announced this in August 2022 and in November 2022, Professor Mascie-Taylor was appointed as a fixed term chair of this board. Since this has taken place, the Minister for Health and Social Services has drafted proposed Terms of Reference for the Board and the PAC was briefed on the proposals in March 2023.

The PAC is also aware that HCS ended 2022 with a significant overspend of its approved budget. The Minister for Treasury and Resources has written to the Chief Officer for HCS requesting a turnaround plan which will recoup the additional expenditure within HCS. This has opened up wider questions in relation to the financial management within HCS and as such, assurances are required over the processes currently in place in this regard.  

Finally, the board which is proposed to be established is focused internally on HCS and does not cover other Government of Jersey departments which may provide health related services (e.g. Children and Adolescent Mental Health Services and the Ambulance Services) and HCS commissioned services within the community and third sector. This has raised questions as to whether the proposed arrangements will have an effect across the whole of health and social care services within the Island.

Key Issues

1. Consideration is required as to how the current governance arrangements within health and social care provide assurance as to the quality of care and value for money of the health and social care system in Jersey.
   
   
2. An assessment of the proposed new arrangements for governance (the board and action plan) is required, especially to consider the difference they will make to governance and accountability, quality of service and value for money.
   
   
3. A specific follow up on open C&AG recommendations relating to health and social care is required.
   
   
4. Consideration is required of the effectiveness of financial managements within HCS given the 2022 overspend of the department and the Minister for Treasury and Resources request for a turnaround plan. This also includes examination of the financial management issues and challenges, how they are being addressed, as well as identifying and assessing the internal financial management controls.
   
   
5. Examination is required into the appointment and cost of a turnaround team with a view to identifying whether this provides value for money and how the effectiveness of this team is being monitored and measured.
    
6. The turnaround team and proposed board of governance is focussed specifically on HCS and, as such, there is a need to consider a whole system review which encompasses not just HCS but other government departments working closely with HCS and also commissioned services providing health and social care services. 
   
   

The PAC has paused the review subject to the formation of the new Committee. It shall be considering the evidence received to date and determining the final outcome in due course.