Wednesday 15 February 2017
The President of the Committee for Health & Social Care, Deputy Heidi Soulsby, gave the following statement today providing a general update on the work in health and social care over the last quarter
Sir,
My statement today is intended to update members and the community generally on what has been happening in Health and Social Care over the last quarter and our plans for the coming months. Of course Health and Social Care is a large and complex organisation with a mandate that stretches across many areas that touch people's lives on a daily basis. It would be impossible to cover every aspect of what has been achieved this quarter. I therefore apologise to those staff who have made a huge contribution to significant pieces of work in the last few months and which I don't cover in this statement. But I would like to thank them all now for making good things happen.
It has been an intense, but productive, quarter for the Committee for Health and Social Care.
In November, we received a visit from the Nursing and Midwifery Council. This was the latest in a series of reviews following the circumstances surrounding the death of a baby in 2014. Each visit has demonstrated improvements since the NMC undertook its first extraordinary review.
However, this visit was different. What the NMC found in November gave independent confirmation that Health and Social Care is a very different organisation from what it was 2 years ago. In fact, notable changes were found since the NMC's last visit 7 months previously. They noted, in particular, the impact of positive leadership, significant improvements in culture and team working.
For the first time, the NMC said they have no intention of returning unless they feel it necessary or are invited. It is difficult to put across what that really means. Those at the debrief meeting who had helped make it possible knew. There was an audible intake of breath when Jackie Smith the head of the NMC told us. Sir, the 2014 extraordinary review had a huge impact on Health and Social Care generally and the nursing and midwifery staff in particular. Understandably it hit morale, with recruitment and retention being seriously impacted, but it also increased sensitivities which may go some way to explaining actions taken only a few months later. There is still a way to go, we need to further develop the culture from one of blame to one of learning and continuous improvement, something that the Chief Secretary has stated he is committed to doing, but we are now in a better place than at any time in recent years to focus on the future.
Last month saw the publication of a report entitled; Independent Review into the Health and Social Care Need, Provision and Governance in Alderney, undertaken by Professor Wilson of Aberdeen University. The aim of this review was, as set out in the terms of reference to, 'deliver evidence-based practical information for cost-effective recommendations to improve the health and wellbeing outcomes of the Alderney public'.
However, the primary recommendation of the report, was to provide a full apology to Dr Lyons and support him back into practice. I can confirm that I have written to Dr Lyons to reiterate the apology made by my predecessor for the shortcomings in the investigation as identified in the Good Governance Institute Report into the affair, but also to apologise for the impact that events had on Dr Lyons and the wider Alderney Community. As I have already said publicly, many years ago someone close to me was accused of something they did not do, was subject to an investigation and eventually exonerated. I know this was a very difficult time for those involved and therefore when I give my apology I do so with sincerity.
In relation to the second part of the recommendation, to supporting Dr Lyons back into practice, I can advise that, whilst little was made of this in the report, Health and Social Care has reached out to Dr Lyons on more than one occasion, with our Medical Director offering his support in person and the Chief Secretary having also offered to meet him last year. The Chief Secretary wrote to Dr Lyons last week, reaffirming Health and Social Care's commitment to do all we reasonably can to re-establish his practice. I have also expressed my hope to Dr Lyons that he is willing to enter into mediation and that I would be happy to meet him should that assist the process. I do hope that we receive a positive response to our genuine requests.
Sir, in my speech on taking this office, I stated my commitment to building bridges with Alderney. I am pleased to advise that since then, again, whilst not acknowledged within the Wilson report, significant work has been undertaken by Health and Social Care, and ESS for that matter, in supporting health and social care provision in Alderney. I can provide a list to members separately but it is worth highlighting the following: proactively establishing a VTC link, supporting the new dentist, providing financial support to the pharmacy, improving the digital connection at the MMH for x-rays, installation of a renal dialysis machine, a maternity services support action plan, close discussion with Alderney GPs to improve blood testing facilities and work with them to improve massive blood haemorrhage procedures. All recommendations of the GGI report have been actioned and all but 3 have been completed. There is considerably more that has been done and that isn't even including the work being undertaken as part of our overall transformation programme.
With regards to those recommendations of the Wilson report that have not already been actioned, we are developing a comprehensive action plan that we will present to Alderney States Members next month. We have also requested that there be an oversight group headed by the Chief Executive of the States of Alderney to ensure drive and delivery. And as actions are completed we will announce them publicly. However, the work required does not fall only into the lap of the Committee for Health and Social Care. The assumption that it is only for the Committee for Health and Social Care to action the recommendations is a mistaken one and the need to establish responsibilities for health and social care in Alderney needs to be established as part of this process.
Sir, Sadly, the events of 2 years ago can't be undone and I know there are those who will struggle to achieve closure. I understand that. However, there is a need to move on. The Buddha said, 'Do not dwell in the past, do not dream of the future, concentrate the mind on the present moment. You can never plan the future by the past.'
My message to the States of Alderney and the people of Alderney as a whole, is that we are committed to truly transforming health and social care on the Island for the future and we ask that you work with us today to make that commitment a reality.
Away from the headlines, the Committee has met with the Committee for Home Affairs around progressing the recommendations of the February 2016 Policy Letter on proposals regarding Guernsey's future ambulance service, specifically the transfer of the budgetary and non-clinical oversight role for the Emergency Ambulance Service from the Health and Social Care to Home Affairs. It has become apparent from those meetings and other discussions that, whilst there were sound reasons for this recommendation, both Committees believe that, at least at present, the ambulance service is a better fit with Health and Social Care. Consequently, it was agreed at our last joint meeting to return to the States in June to seek to rescind that recommendation.
The Committee has also met with the Committee for Employment and Social Security over the last few months, with the principal discussion being around the MSG contract. I can advise that at a joint meeting held on 7 February, both Committees agreed the terms of the contract presented to them and have authorised both myself and the Chief Secretary to sign it on behalf of the States of Guernsey subject to the agreement of one outstanding clause.
There has naturally been a lot of interest around why it has taken so long to get to this point. However, it should be understood that at a cumulative cost of £100m, this is the largest contract for the States of Guernsey and it was not something that should be rushed unnecessarily. Throughout the negotiation process, great care has been taken to address the needs of the States of Guernsey, to put in place effective control mechanisms and drive best value. Consequently the new contract bears no relationship with the one in place today. Key points of the contract include;
Greater cost control. Costs have been contained through an agreed decrease in the total contract value in the first three years of 3%, 2% and 1% respectively.
There will be clear performance metrics, which will be baselined this year and monitored throughout the contract term.
We have the ability to review services and engage MSG with the ongoing transformation programme.
A single governance framework will be in force. This is designed to ensure that Health and Social Care, MSG and eventually all health care providers across the Bailiwick, work to a recognised single standard and assurance process in respect of clinical governance.
And finally there will be a single complaints policy. All complaints that arise are to be triaged through a single contact point. The whole process will be overseen by the Chief Secretary of Health and Social Care, and the Chairman of MSG. The resulting service user experience will be based on the provision of cohesive, joined up services, controls and user communications; the 'one voice' approach to customer service.
These are significant improvements to the current contract that have taken time to develop and I am quite happy to let it be known that the Committee for Health and Social Care has made it clear the red lines which we would not cross to ensure we got a contract in the best interests of the people of the Bailiwick. Time will tell, but I am hopeful that this contract will enable more joined up working and make the transformation of health and social care possible. I would like to thank the Chief Executive as head of the Programme Board and States Treasurer as head of the Internal Negotiating team in particular for their work in enabling us to get to this place. I would also like to thank the MSG for their publicly voiced commitment to transformation. Health and Social Care hope the new contract will facilitate a true partnership with MSG where we seek to work together to transform the services we collectively provide for the changing needs and benefit of the community.
The last quarter has seen the transformation programme get real traction.
An autism framework has been approved and passed to the Disability & Inclusion Strategy Working group, a dementia care framework has been drafted and will be reviewed by the Committee in the coming weeks. A care and support framework is currently in development which will improve care pathways and help people get the care they need, where they need it. The Clinical Reference Group established as part of our new single governance structure, comprising professionals across the sector, has redesigned the hip and knee pathway and the most recent figures show that this has resulted in a reduction in the length of hospital stays for hips from 7.07 nights to 5.29 and for knees from 8.07 to 5.68. This is good for patients as stays over 5 days lead to an increased likelihood of acquiring an infection and loss of muscle mass. November also saw the launch by the Chief Nurse of the care values framework for health and social care professionals, with various workstreams now in progress, including the implementation of the findings of the skills mix review.
Health and Social Care has invested £500k to replace all 771 PCs running Windows XP. These are being deployed at a rate of 90 a week and the project is due to be completed on time and budget by the end of next month. This hardware refresh has also enabled us to upgrade various core applications. The project that will truly enable transformational change though is the replacement of the current dated network infrastructure. The opportunities to improve the way we deliver health and social care, particularly through mobile technology, are all too clear. From telehealth and telecare, to allowing staff access to records in the community we could do far more. The project is in its design phase, with a complete audit of the existing network having been undertaken and we are on track to achieve contract signature for the work by the end of this year.
Elsewhere, we have continued to have dialogue with our Jersey counterparts on areas of mutual interest. This includes work on developing a pan-Island regulatory framework and preliminary discussions on a joint review of the role of the Medical Officer of Health. It is also hoped that we can work together on a review of the medicinal use of cannabinoids.
Finally, in terms of transformation, we were delighted to be able launch CareWatch at the beginning of this month. CareWatch goes to the heart of our belief that we can only transform through listening to and working with the wider community. This is something that I know our non-States member Mr Roger Allsopp OBE has wanted to see for a long time and I am delighted that he has agreed to be its Chair. CareWatch will be a community partnership forum drawn from interested organisations and individuals. It will have an advisory and consultative role, helping to set priorities for improving provision and to design services.
Last, but no means least, I turn to finances. No update on health and social care would be complete without that of course. So to the big reveal. Back in May, the Committee for Health and Social Care was confronted with a predicted overspend of between £4.5m to £7.9m. Something the previous Board was unaware of I have to say. A couple of months ago, following an enquiry by our esteemed printed media, I advised that, given the position we were in 8 months previously I would be pleased if we could get our overspend below £1m. I thought the comments on the article online were very interesting, ranging from the fact we had a third world health service, through to 'only £1m overspend' to 'she's been duped by the civil servants'.
Well sir, I have to say today that we have not managed to get our overspend under £1m. That's because we do not have an overspend. I am very pleased to report today that Health and Social Care has come in approximately £700,000 under budget. This is an incredible achievement. Remember, that HSSD set itself a £1.9m stretched savings target against the 2016 budget. Given HSSD's financial track record T&R didn't believe this could be achieved, and I have to say I thought it would be best described as a challenge at the time, and £1.15m was set aside as a contingency. The truth is, we didn't think we would either earlier in the year and requested the funding to cover the overspend at the time. However, the year-end outturn means that Health and Social Care has effectively made £1.45m worth of savings in 2016.
This has not been achieved by cuts. It has been achieved through stronger financial controls, reporting, challenge and ownership across the organisation. It is the physical proof of what the NMC have said and which I referred to earlier and, indeed what Professor Wilson said in his presentations last month, and that is the development of leadership at all levels and teamwork across the organisation. Huge credit for this goes to the Chief Secretary and Senior Operating Officer in particular for getting us to where we are today.
However, be under no illusions, the current model of health and social care is unsustainable. The 2016 outturn has only been possible through the exceptional efforts of staff throughout health and social care. It will be impossible to continue on this track without changing our model of care. Now, members can't fail but be aware of the crisis that has hit the NHS. We hear daily about delays to see GPs, long waiting times at A&E and people having to wait on trolleys for hours in corridors waiting for a bed. Whilst thankfully we have not seen anything like that here, winter pressures have resulted in fluctuating bed capacity which has put stress on staff at the PEH. The truth is that the impact of our ageing population is becoming increasingly evident year on year throughout the service. From the hospital and ambulance service to nursing & residential care homes and wider community care.
This is why transformation is essential. This is why the Committee for Health and Social Care is committed to transformation. It is our top priority. And prioritisation is a key word here. As would be expected in an organisation with 2,000 people that runs 24 hours a day, 7 days a week, stuff happens. We have to balance all that with the need to focus on medium to long term strategic change. It is big task which we can't and shouldn't do alone. I hope that I have made it clear throughout my statement how we are actively working together with other Committees, staff, partner organisations and the wider community to design a health and social care service that meets the needs of the population, now and in the future. I also hope members will believe me when I say that we have started as we mean to go on, and that with focus, drive and commitment to working together we can make good things happen.
