StatesofJersey-HealthandSocialServices ... and wellbeing/R... · Health and Community Services Board 08 July 2019 Agenda Item 08 to account by seeking assurance about HCS activities

States of Jersey - Health and Social ServicesHealth and Community Services Main Board

HCS Board CommitteeSt. Paul's Centre, St. Helier

8 July 2019 15:00 - 8 July 2019 17:00

Overall Page 1 of 56


AGENDA

# Description Owner Time

1 Welcome and Apologies 15:00

2 Declarations of Interest

3 Patients StoryFor discussion

TBC 15:10

4 Professional's StoryFor discussion

Dr Adrian Noon

15:20

5 Minutes of the previous meetingNo previous Minutes

6 Matters Arising and Action LogNo Matters Arising

7 Chairs ReportFor information

Agenda Item 01 Chairs Welcome.docx 9

15.40

8 Board Secretary - Corporate Governance StructureFor information

Agenda Item 08a Board Secretary Presentation - C... 13

Agenda Item 08b Corporate Governance Organogr... 15

Bernard Place

15;50

9 Director Generals Report For Information

Agenda Item 09 Director General Report.docx 19

Caroline Landon

15:55

10 Approval of Board Terms of Reference (Schedule of Decisions Referred to the Board and the Scheme of Delegation)

For Discussion

Main Board HCS Schedule of Decisions Version 1.... 23

Chair 16:00



11 New Risks Escalated to the Board

Agenda Item 11 New Risks Reported to Board BAF... 33

16:10

11.1 Absence of Board Assurance FrameworkFor information

Group Medical Director

16:15

12 Management Executive Team 16:20

12.1 Assurance Report of the Chair of the Management Executive Committee

Verbal

Director General

13 Quality and Peformance 16:25

13.1 Quality and Performance ReportFor information

Agenda Item 13a Quality and Perfomance Report C... 37

Agenda Item 13b Qualty and Performance Report... 41

Chief Nurse - Quality Group

Managing Director -

Performance

13.2 Assurance Report of the Chair of the Quality and Performance Committee

For Assurance

Steve Pallett

14 Finance and Modernisation 16:30

14.1 Financial Performance ReportPaper - for information

Agenda Item 14a Finance and Moderniation HCS B... 43

Agenda Item 14b Finance and Modernisation 8.7.1... 45

14.2 Assurance Report of the Chair of the Finance and Modernisation Committee

For Assurance

Hugh Raymond

15 People and Organisational Development 16:35

15.1 People and Organisational Development ReportPaper - for information

Agenda Item 15 People and Organisational Develo... 47

Group HR Lead



15.2 Statement of Intent for the CommitteeFor information

Group HR Lead

15.3 Assurance Report of the Chair of the People and Organisational Development Committee

Verbal

Jeremy Macon

16 Risk 16:40

16.1 Risk Committee ReportFor information

Briefing Paper - States of Jersey Community and Social Services for Adults and Older Adults – Follow-Up (R.42/2019) – Executive Response with the Comments of the Public Accounts Committee

Agenda Item 16a Risk Committee Summary Report... 49

Agenda Item 16b Risk Committee HCS Board Exec... 53

Agenda Item 16c Board Briefing Paper States of Je... 57

Group Medical Director

16.2 Assurance Report of the Chair of the Risk CommitteeVerbal - For Assurance

Steve Pallett

17 Any other business notified prior to the meeting 16:45

18 Board Members Reflection on Board Today 16:50

19 Date of Next MeetingThe next meeting of the Main Board will take place on 30 September 2019 in St. Paul's Centre, 3.00 p.m. - 5.00 p.m.


INDEX

Agenda Item 01 Chairs Welcome.docx............................................................................................9

Agenda Item 08a Board Secretary Presentation - Corporate Governance Struct..........................13

Agenda Item 08b Corporate Governance Organogram.pptx..........................................................15

Agenda Item 09 Director General Report.docx..............................................................................19

Main Board HCS Schedule of Decisions Version 1.2 DRAFT FOR ISSUE.docx...........................23

Agenda Item 11 New Risks Reported to Board BAF Issued 20190701.docx.................................33

Agenda Item 13a Quality and Perfomance Report Chief Nurse.docx............................................37

Agenda Item 13b Qualty and Performance Report Chief Nurse.docx............................................41

Agenda Item 14a Finance and Moderniation HCS Board Executive Summary.do........................43

Agenda Item 14b Finance and Modernisation 8.7.19.docx............................................................45

Agenda Item 15 People and Organisational Development Report.docx........................................47

Agenda Item 16a Risk Committee Summary Report.docx.............................................................49

Agenda Item 16b Risk Committee HCS Board Executive Report 20190708.docx.........................53

Agenda Item 16c Board Briefing Paper States of Jersey Community and Social..........................57


Health and Community Services Board 08 July 2019 Agenda Item 01

1

Health and Community Services Board

8 July 2019

May I give a warm welcome to the States Members, members of the public, representatives of the

media and invited partners of Health and Community Services to this our first meeting of the Health

and Community Services Board.

Why are we establishing this board?

Health and Social Care must change if we are to sustain high standards of care for islanders. In line

with the Government’s Common Strategic Policy to improve Islanders’ wellbeing and mental and

physical health, we must focus on preventing ill health and encourage caring for ourselves so that

more islanders stay healthy and independent for as many of their years as possible. However, for

those who do fall into ill health, we will develop care closer to home, delivered through greater

emphasis on primary care services, facilities in the community or care provided in our own homes. At

the same time we recognise the need for a strong General Hospital and our duty to provide excellent,

acute and secondary care when that is needed. So our health and care system must change and evolve.

We have to find new ways of working, putting patients and users of our services at the centre of all

that we do. In Jersey, that involves not just Health and Community Services but GPs and other primary

care providers, charities and other third sector organisations.

How does Health and Community Services wish to drive that change?

Overarching all our structures will be the Health and Community Services Board – this Board - which

will meet regularly to be provided with assurance about the standards and performance of the services

provided by Health and Community Services. It will hold us to account for the ambition of Health and

Community Services to create a healthy island with safe, high-quality, affordable care that is accessible

Agenda Item 01 Chairs Welcome.docxOverall Page 7 of 56


2

when and where our service users need it. It will provide visible leadership and it will, I hope, inform

and create greater understanding of the services we provide, what we are striving to achieve and the

risks we face. I want the Board to create a culture of openness and candour and instil an eagerness to

learn and improve.

And how might the board develop in time?

Initially it is a Health and Community Services Board because Health and Community Services as a

department needs to change - not least because the Comptroller and Auditor General told us that we

were not good enough at being accountable and not open enough to proper public scrutiny. But as

the Board develops and with the support of our partners we want it to become the all Island health

and care board concerned, not just with the care delivered by Health and Community Services, but all

of us in a partnership that is the health and care system of the whole island including primary care

providers, the voluntary sector and commercial providers. That is why we have asked a GP

representative to join the Board, and why we have asked representatives of Family Nursing and Home

Care and Jersey Hospice Care to be members of the Board as they are very substantial providers of

services. But there are also many other voluntary bodies working in the health and care sector so we

have selected as representative of them for the time being ‘MIND Jersey’, ‘Jersey Alzheimer’s

Association’ and ‘Brighter Futures’. Importantly, we want to invite a representative of patients and

users of our services to become a member of the Board. The representatives I have mentioned will

rotate each year to involve other people and other providers as the Board develops.

I just want to say a few words about what the Board is not.

I must emphasise it is not a statutory board or corporate body, it is not replicating the National Health

Service in the UK. It does not replace or dilute any of the responsibility presently held with respect to

Health and Community Services by, first of all, the States Assembly, secondly by Ministers, thirdly by

Scrutiny panels or fourthly by the Director General of the department. Instead the Board will be the

vehicle through which I as Minister, and the Director General will choose to discharge our most



3

important responsibilities and obligations. It has been established with the support of the Council of

Ministers, other States Members, the Comptroller and Auditor General and many other bodies or

individuals who have been urging us to take this step.

For more detail I refer to what is available on-line at (web address) but to begin the business of the

Board I would like us all to introduce ourselves so I am ……………………………………..




1 Introduction

1.1 Assurance

1.2 Assurance provides evidence and certainty to the Board that what it intended to be happening is actually happening in practice. It helps the Board answer a key question “Do we really know what we think we know?”

1.3 Corporate Governance

Corporate Governance is concerned with the structures, systems and processes by which the Health and Community Services Department leads, directs and controls its functions, in order to achieve organisational objectives and by which it relates to its partners and the wider community.

2 Purpose of the Board and its Committees

2.1 The Board

The Board is the oversight oversight body of the Health and Committee Services (HCS) Department. Its role is to provide oversight of healthcare strategy for the Departments services, establish and uphold its governance and accountability framework, including its values and standards of behaviour and to ensure delivery of its aims and objectives. It does this through effective challenge and scrutiny of performance across all HCS activities. The Board will therefore hold HCS executives

Agenda Item 08a Board Secretary Presentation - Corporate Governance Structure.docxOverall Page 11 of 56


to account by seeking assurance about HCS activities. The Board will have oversight of any major risks to HCS not achieving its strategic objectives

2.2 Quality and Performance Committee

The purpose of the committee is to enable the Board to obtain assurance that high standards of care are provided by Health and Community Services (HCS) and in particular, that adequate and appropriate governance structures are in place throughout HCS.

2.3 Finance and Modernisation Committee

The purpose of the committee is to support the Boards strategic direction and stewardship of Health and Community Services (HCS) finances, investments, assets and financial sustainability.

2.4 Risk Committee

The purpose of the committee is to assist the Board in the oversight of risk management and the effectiveness of internal control within Health and Community Services (HCS)

2.5 People and Organisational Development Committee

The purpose of the committee is to assure the Board that the People and Organisational development function is able to deliver its strategic objectives

2.6 Management Executive Committee

The purpose of the committee is to serve as the senior decision making group beneath the Board and to assist the Director General as the accountable officer in achieving the strategies, aims and objectives of Health and Community Services (HCS).

3 Conclusion

3.1 Terms of Reference for the HCS Board and its Committees and a Glossary of Terms will be available on the Health and Community Services website after their approval at the respective inaugural committee meetings.

Agenda Item 08a Board Secretary Presentation - Corporate Governance Structure.docxOverall Page 12 of 56

GOVERNANCE & RISK MANAGEMENT: EVERYONE’S RESPONSIBILITYHealth and Community Services

Agenda Item 08b Corporate Governance Organogram.pptxOverall Page 13 of 56

HCS GOVERNANCE ORGANISATION CHART


HCS INTEGRATED GOVERNANCE FRAMEWORK




HCS Board – July 2019

REPORT OF THE DIRECTOR GENERAL

Our Organisation

It has been a busy first two quarters for our teams. We have significant organisational change taking place with our Target Operating Model (TOM) and we hope to have placed all our senior leadership teams by the end of September. We acknowledge this has been a long and sometimes arduous process for our staff and the period of uncertainty has gone on longer than we would have wished. There are lessons learned for us going forward but I am confident that at the end of this process we will be in a much more robust position, future proofing our organisation to deliver care for our patients.

We have created a structure whereby our organisation is Clinically and Professionally led and accountable, the hand that touches the patient will also be managing the business of care delivery. We have initiated this from Executive level with our Executive Triumvirate of our Chief Nurse Rose Naylor, our Medical Director Dr John McInerney and our Group Managing Director, Rob Sainsbury. The Executive Triumvirate manage the organisation operationally and the Director General provides strategic oversight and is the accountable officer. We will be replicating this triumvirate structure throughout our Care Groups but with the addition of our AHP leaders also supporting our care group models and we will be devolving budgetary and decision making authority down the organisation to empower our Clinicians and Professionals to lead. This clinically led apparatus will be most apparent in our Management Executive Committee (MEX) a meeting that will be attended by all the Care Group Triumvirates and where the business of the organisation will be managed. Our aspiration is that our Clinicians and Professionals will start to develop and drive rapid, high impact action programmes that will help to modernise and standardise the care we offer to our patients.We have now completed the recruitment of our Associate Medical Directors (AMD) and they commenced in post on July 1st. This is a significant milestone in our Organisations journey towards Clinical and Professional leadership, we need to support our Clinical and Professional leaders to establish their teams and empower them to change the mode of care delivery for our patients. We look forward to seeing the changes they will enact that will benefit our patients and our staff. The Executive team extends its thanks to the Clinical Directors who have now left their roles, their leadership and input to HCS has been significant.

We have identified that we need to make urgent changes in the care we deliver for our patients presenting with Mental Health issues. We recognise that the care we have delivered for some patients has not been delivered as responsively as we would have wished for and we apologise to the patients and families that feel we have let them down.We are urgently addressing the issues around our Mental Health estate facilities and we commit to having redeveloped our Orchard House site in 2020 so that we are able to provide the care our patients are entitled to and deserve.

Agenda Item 09 Director General Report.docxOverall Page 17 of 56


We are urgently addressing our staffing shortfalls across our Mental Health teams and our recruitment campaign is proceeding at pace and is resulting in promising conversion from applicant to recruit.We have established a Mental Health Improvement Board with a Chair independent of HCS to seek assurance re the work programmes we have in place.We still are not where we need to be re provisioning Mental Health to the same standards of Physical Health. We commit to Islanders to focussing our most urgent attention on this work programme and will be bringing the programme plan through our Quality and Performance Committee and our HCS Board as a standing item until we are fully assured that service provision is safe, sustainable and meeting the needs of our patients. This is our most important priority and the work programme is led at Executive level by our Medical Director.

The C&AG report highlighted significant gaps in our governance framework and we have taken immediate steps to start addressing those gaps. We have reviewed and overhauled our governance structure to begin putting in place processes that ensure there is Executive oversight from ward to Board that the care we are providing for our patients is safe. We have created a new position within our Structure, of Board Secretary and Bernard Place is currently acting into that position for us. This role is integral to ensuring our governance assurance framework in the form of our committees and our Board are operating effectively and appropriately to manage our business safely. We also hired external expertise re governance and risk to create and implement our governance framework and help us to implement it at service level. This has and continues to be one of our most important work programmes and is led at Executive level by our Chief Nurse and Medical Director.

We are working on an efficiency programme across our organisation to ensure we are delivering value for money and spending the Jersey ‘health’ pound as effectively as we can. We have already identified efficiencies that can be achieved by working differently internally within HCS and we are working to provide more robust information for our Clinical and Professional Leadership Teams so that they have information to manage by, which has been a historical issue for our organisation. Our efficiency programme this year is not about headcount reduction, we are working to maximise the budget we have available so that HCS is able to provision robust service going forward. We are also reviewing all our contracting arrangements that we have in place with partners Island wide to ensure the services we commission are outcome focussed against investment to ensure we are meeting our patient’s needs.

We are fortunate to have the opportunity to build a new care facility for our patients and we are working with partners and colleagues from Primary care, Secondary Care and the Third Sector to develop a new model of care delivery for our patients. We have already had great engagement from colleagues and our aspiration is to have completed this piece of work by the end of September in order to present our proposal to the Political Oversight Group (POG) who are overseeing the delivery of ‘our Hospital’ It has been hugely heartening and humbling to witness the engagement of colleagues across all sectors in helping to talk about and start to flesh out the skeleton of a different way of delivering care building firmly on the P82 framework of care and working to deliver a care



model that delivers care closer to home, is safe, sustainable and value for money. We are fortunate in having the full support of the Ministerial team in encouraging this programme of work and we aim to deliver a model that is worthy of robust debate and discussion at the September meeting of POG.

I have been visiting the Island as part of my induction since February and commenced substantially in post in April 2019. I have been meeting with colleagues from across HCS, Primary Care and the Third Sector and have been learning about the breadth and variety of care that is delivered across Island. I have been struck by the passion and dedication manifested across all sectors and I have been awestruck by the volume, commitment and enthusiasm of what is the most vibrant third sector I have encountered in my career.

We, as an Executive Team are aspiring to work with colleagues in a form that is more collaborative and joined up so that we can utilise available funding across Island to deliver the best care for our patients. I am honoured to be the Director General of Health and Community Services and lead my Executive colleagues. We as an Executive team recognise that we are entrusted to serve and to ensure the care we deliver for patients is:

Safe Quality driven Sustainable Responsive Outcome focussed Measurable Value for Money

JULY 19



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HEALTH AND COMMUNITY SERVICES BOARDSCHEDULE OF DECISIONS REFERRED TO THE BOARD AND THE SCHEME OF DELEGATION

VERSION CONTROL

Version Author Date Changes1.0 Andrew Carter 16-04-2019 First Draft1.1 Bernard Place 22-05-2019 Second Draft Track

Changes and Comments1.2 Bernard Place 04-06-2019 Board does not replace any

responsibilities discharged with respect to health and community services by the States Assembly, Council of Ministers, individual States

Members or States Assembly Scrutiny. Nor

does the Board change the role of the HCS Director

General as the Accountable Officer for the Department.

i

Approved by the Health and Community Services Board on [Insert Date]

Main Board HCS Schedule of Decisions Version 1.2 DRAFT FOR ISSUE.docxOverall Page 21 of 56

Page 2 of 9

HEALTH AND COMMUNITY SERVICES

Contents

1. Introduction 31.1 Reservation of Powers 31.2 Role of the Minister for Health and Community Services 31.3 Role of the Director General for Health and Community Services 31.4 Caution of use of the delegated powers 31.5 Absence of the Minister, Directors or Officers to whom powers have been delegated 31.6 Review and awareness of delegated 3

2. Schedule of Decisions Reserved to the Board 4

3. Decisions / Duties delegated by the Board to Committees 53.1 Management Executive Committee 53.2 Audit and Risk Committee 53.3 Finance and Modernisation Committee 63.4 Quality and Performance Committee 73.5 People and Organisation Development Committee 8


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1. INTRODUCTION

1.1 Reservation of Powers

The HCS Board does not replace any responsibilities discharged with respect to health and community services by the States Assembly, Council of Ministers, individual States Members or States Assembly Scrutiny Panel. Nor does the Board change the role of the HCS Director General as the Accountable Officer for the Department. Subject to the powers described in its delegated authority the Board may make arrangements for the exercise, on behalf of Health and Community Services (HCS), of any of its functions by a committee or sub-committee, appointed by a minister, director or officer of HCS in each case subject to such restrictions and conditions as the Board thinks fit. The HCS Board sets out in this document a schedule of decisions reserved to itself and to ensure that management arrangements are in place to enable the clear delegation of its other responsibilities. This document sets out the powers reserved to the Board to draw up a schedule including financial limits and approval thresholds reflecting those directed by the Government of Jersey Office of the Chief Executive and the Department of Treasury and Resources. However, the Board remains accountable for all of its functions, including those, which have been delegated and would therefore expect to receive information about the exercise of delegated functions to enable it and maintain a monitoring role.

1.2 Role of the Minister for Health and Social ServicesThe Minister is the elected member of the assembly responsible for determining the strategic direction of Health and Community Services within the Government of Jersey. The Minister exercises these powers recognising that good physical and mental health and well-being depends on departments across the whole Government of Jersey. The ministerial leads for these departments are partners in supporting the HCS Minister to discharge his portfolio responsibility.

1.3 Role of the Director General for Health and Community ServicesThe Director General is the accountable officer for the delivery of Health and Community Services within the Government of Jersey.

1.4 Caution of the use of delegated powers

Powers are delegated to directors and officers on the understanding that they would not exercise delegated power in a matter that could reasonably and knowingly be a cause for public concern.

1.5 Absence of the minster, directors or officers to whom powers have been delegated

In the absence of a minster, director or officer to whom powers have been delegated, those powers shall be exercised by that minister, director or officer’s superior unless alternative arrangements have been approved by the Board. If the Minister is absent, powers delegated to them may be exercised by the minsters assistant and in their absence a nominated acting officer. If the Director General is absent, powers delegated to them may be exercised by the group-managing director and in their absence a nominated acting officer.

1.6 Review and awareness of delegated powers

The schedule of delegation is reviewed annually. As part of ensuring a sound system of governance prevails, there is a requirement for staff with budgetary and/or senior managerial reasonability to sign a statement acknowledging awareness of this document and agreeing to apply its content to their everyday approach to carrying out their role for HCS.


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2. SCHEDULE OF DECISIONS RESERVED TO THE BOARD

General Enabling ProvisionThe board may determine any matter, for which it has delegated or statutory authority, it wishes in full session within its statutory powers. Regulations and Control

1. Approve Reservation of Powers to the Board.2. Establish, amend and suspend HCS Strategic Objectives.3. Ratify the exercise of powers, which the Board has retained to itself by the Minister.4. Approve a scheme of delegation of executive powers from the Board to committees or sub-

committees, which it has formally constituted and authorise the delegation of a committee’s executive powers to a sub-committee.

5. Approve financial delegation limits.6. Require and receive the declaration of Directors, Board Members and its invited Board partners

interests that may conflict with those of HCS and/or the government of Jersey determining the extent to which that director or other may remain involved.

7. Establish terms of reference and reporting arrangements of all committees that are established by the Board.

8. Receive reports from committees to take appropriate action on. 9. Confirm or otherwise the recommendations of HCS’s committees where the committees do not

have delegated powers.10. Authorise the use of the seal and agree a policy to define those documents that must be sealed. 11. Ensure the quality and safety of Health and Community Services including education, training and

research delivered by HCS; applying the one government approach set out by the Government of Jersey.

Appointments / Dismissal

1. Approve the appointments to each of the committees, which it has formally constituted and approve the terms of such appointments.

2. Confirm appointment of members of committees as representatives outside of HCS

Strategy, Plans and Budgets1. Define the strategic aims and objectives of HCS each year.2. Approve proposals for ensuring quality and developing clinical governance in HCS.3. Approve and monitor the HCS risk management strategy.4. Approve the HCS financial plan and annual budget.5. Approve annually the HCS operational plan.6. Approve the opening of bank or investment accounts.7. Approve proposals on individual contracts of a capital or revenue nature amounting to, or likely to

amount to, over £x,xxx,xxxx.8. Approve capital expenditure and business cases including approval of variations amounting to over

£x,xxx,xxxx.9. Approve of increases in the real terms cost of revenue or capital developments identified specifically

in the financial plans of HCS, or reported individually in any board agenda, provided that the cost increase can be funded within one of the approved provisions or reserves where the increase >10% of the value in the agreed financial plan.

10. Approve purchase orders amounting to over £x,xxx,xxxx.11. Approve participation in a tendering exercise where retaining a service provided by HCS amounts to

over £x,xxx,xxxx and where acquiring a new service amounts to over £x,xxx,xxxx.12. Indicate individual compensation payments subject to the approval of the State’s Employment

Board where needed).13. Approve the level of non-pay expenditure on an annual basis.

Policy Determination

1. Set out the programme of key policy developments needed assure statutory and regulatory compliance with both Government of Jersey and United Kingdom authorities


Page 5 of 9

2. Receive assurance through the relevant Board Committee that Health and Community Services is compliant with the necessary statutory and regulatory requirements and, where there is a risk of or actual compliance failure, to set in train the necessary authorisations and oversight arrangements for compliance.

Audit

1. To approve and/or note any programmes of audit agreed with the Government of Jersey audit functions

2. To receive reports from Scrutiny, Comptroller and Auditor General and other sources of external review and to approve the responses to the findings and recommendations of any such reports.

Annual Reports and Accounts

1. Approve the HCS annual report and annual accounts.Monitoring

1. Receive Board Assurance Framework reports and reports from committees in respect of their exercise of powers delegated such as the Board of Directors sees fit.

2. Continuous appraisal of the affairs of HCS by means of provision of information to the Board as the Board may require from Directors, committees and officers of HCS.

3. Receive reports on all aspects of HCS performance, particularly those covering performance against budget, financial plans, performance and improvement plans and measures of activity and quality.

3. DECISIONS/DUTIES DELEGATED BY THE BOARD TO COMMITTEES

Management Executive Committee

The purpose of the committee is to serve as the most senior decision making group beneath the Board and to assistant the Director General in achieving the strategies, aims and objectives of Health and Community Services (HCS).

The Management Executive Committees key responsibilities are:1. Leadership and Management of HCS, within the direction and culture set by the Board2. Planning and implementation of strategy, operational plans and policies3. Ensuring achievement of agreed operating and financial performance targets4. Oversight and mitigation of risk5. Prioritising the allocation of resources, within the budget agreed by the Board6. Monitoring and performance management of major capital schemes. 7. Providing advice to the Board on strategic and operational matters as required8. Ensuring an effective and consistent approach to corporate and operational messaging to enable

strong stakeholder engagement.

Risk CommitteeThe purpose of the committee is to assist the Board in the oversight of risk management and the effectiveness of internal control within Health and Community Services (HCS)

The Committee will:

1. Review the establishment and maintenance of an effective system of risk management and infection prevention and control across the whole of HCS’s activities.

2. Review the adequacy and effectiveness of:o The underlying assurance processes that indicate the degree of achievement of HCS

objectiveso The policies for ensuring statutory and regulatory compliance with requirements of the

Government of Jersey and United Kingdom


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o The policies and procedures for all work related to counter fraud.

3. Utilise the work of internal audit, external audit and other assurance functions to improve the effectiveness, efficiency and safety of Health and Community Services

4. Approve the terms of reference and memberships of its sub-committees, overseeing their work and receiving reports for consideration and action as necessary.

5. Ensure there is an effective internal audit function that provided appropriate independent assurance to the Committee and Board.

6. Review the work and findings of external auditors and consider the implications and management's responses to their work.

7. Ensure that there is an appropriate and effective clinical audit programme. The remit of the Committee will cover the processes for clinical audits, whereas the outcomes of clinical audits will considered by the Quality and Performance Committee.

8. Review the work of other committees within the organisation, whose work can provide relevant assurance to the Committee's own areas of responsibility.

9. Request and review reports, evidence and assurances from directors and managers on the overall arrangements for governance, risk management and internal control.

10. Monitor the integrity of the financial statements of HCS and any formal announcements relating to its financial performance.

11. Ensure that the systems for financial reporting to the Board including those of budgetary controls are subject to review as to the completeness and accuracy of the information provided.

12. Review the adequacy and security of HCS arrangements for its employees and contractors to raise concerns, in confidence, about possible wrongdoing in financial reporting or other matters and ensure that these arrangements allow proportionate and independent investigation of such matters and appropriate follow up action.

13. Review the effectiveness of the arrangements in place for allowing staff to raise (in confidence) concerns about possible improprieties in financial, clinical or safety matters and ensure that any such concerns are investigated proportionately and independently.

14. Ensure that HCS has appropriate and effective Whistle Blowing arrangements. The remit of the committee will cover the processes, whereas the issues and themes will be considered by the People and Organisational Development Committee.

Finance and Modernisation CommitteeThe purpose of the committee is to:

1. Support the Boards strategic direction and stewardship of Health and Community Services (HCS) finances, investments, assets and financial sustainability.

2. Review arrangements for procurement, productivity and efficiency across HCS, including plans to deliver savings and service and workforce transformation.

3. Provide assurance to the Board about the integrity and deliverability of HCS financial and efficiency plans.

4. Provide assurance to the board concerning all aspects of finance and operational performance relating to the provision of HCS in support of getting the best clinical outcomes and experience for patients, within the resources set out in the annual plan.

5. Advise the board on discharging its functions and meeting its responsibilities with regard to Information Management and Technology (IM&T) and Information Governance (IG). Such advice relates to:

1. Information management and digital strategies including clinical systems2. Data protection, confidentiality and privacy3. Information security including information sharing protocols4. Data quality and integrity5. Records management

6. Provide assurance to the Board that arrangements are in place to assess and deliver benefits of innovative technology and information for use in decision making, and

7. Provide assurance to the Board that IM&T services are safe and sustainable, and that risks are being assessed and managed effectively.


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The Committee will:

Finance strategy and business planning

1. Ensure delivery of the financial aspects of the Operational Plan.2. Ensure delivery of the annual and medium-term financial plans: income and expenditure

plans/budgets, revenue investment, capital investment, working capital, statement of financial position and cash flow, and associated targets for savings to ensure sustainability going forward. The Committee shall assess the assumptions therein and the alignment with overall objectives.

3. Review in-year performance against financial plan, particularly gaining an understanding of key assumptions and risks within HCS projections.

4. Review levels on contingency with the HCS financial plans and the phasing of key developments and efficiency schemes, ensuring that the full impact of any developments (including depreciation and cost of capital) have been appropriately included.

5. Review and develop reporting arrangements.6. Ensure the availability and quality of financial management information (to ensure a consistent

approach to financial management)7. Review and maintain an overview of financial and service delivery agreements and key contractual

arrangements.8. Review business cases and either:

i. Approve as appropriate on behalf of the Board, if within the committees delegated authority; or

ii. Endorse prior to Board approval; if above the Committees delegated authority.

9. Consider key financial policies, issues and developments to ensure they are shaped, developed and implemented in HCS appropriately.

Quality and Performance Committee

The purpose of the committee is to enable the Board to obtain assurance that high standards of care are provided by Health and Community Services (HCS) and in particular, that adequate and appropriate governance structures are in place throughout HCS to:

1. Deliver Excellence in patient care (Experience, Safety and Effectiveness)2. Deliver operational performance 3. Obtain assurance that risks arising from clinical care are adequately controlled or mitigated4. Provide assurance to the Board that risk management arrangements for safety, quality and patient

experience are in place and operate effectively.5. Ensure statutory and regulatory compliance

The Committee will:

1. Provide assurance and evidence to the board that care groups are meeting quality and performance standards across the full range of HCS services and activities.

2. Where performance is below standards, the Committee will ensure that robust recovery plans are developed and implemented.

3. Ensure that there is a process in place to monitor and promote compliance across HCS with clinical standards and guidelines.

4. Identify and monitor any gaps in the delivery of effective clinical care ensuring progress is made to improve these areas.

5. Obtain assurance that where practice is of high quality, that practice is recognised and propagated across HCS.

6. Obtain assurance that HCS is outward looking and incorporates the recommendations of external bodies into practice with mechanisms to monitor their delivery.

7. Ensure that all elements of governance are adhered to across HCS.


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8. Agree the annual quality priorities, monitor progress and ensure that HCS has real time, up to date information about what it is like to experience care across HCS to identify areas for improvement (and ensuring that the improvements are effected).

9. Review and approve the HCS annual Quality Account before submission to the Board.10. Approve the terms of reference and membership of its sub-committees, overseeing their work and

receiving reports for consideration and action as necessary. 11. Consider matters referred to the Committee by the Board12. Consider matters referred to the Committee by its sub-committees. 13. Receive internal audit reports relevant to the remit of the Committee and obtain assurance that

findings and recommendations are acted upon. 14. Support HCS objectives by striving for continuous quality improvement.15. Promote the HCS honest and open reporting culture.16. Obtain assurance that robust arrangements are in place for the review of patient safety incidents

and ensure that actions for improvement are completed. 17. Obtain assurance that risks to patients are minimised through:18. Considering areas of significant risk, setting priorities and agreeing actions.19. Ensuring that areas of risk are regularly monitored and that effective disaster recovery plans are in

place.20. Obtain assurance that there are processes in place that safeguard children and adults.21. Escalate to the Board any identified unresolved risks arising (within the scope of these terms of

reference) that pose significant threats to the operation, resources of reputation of HCS and/or the Government or Jersey.

22. In liaison with the Finance and Digital Committee, obtain assurance the Quality Impact Assessments are completed for proposals for cost improvement programmes and other significant service changes and that the assessment of their impact on the HCS quality of care determines whether to proceed with implementation.

23. Working with the Finance and Modernisation Committee to ensure that the availability of resources does not adversely impact upon the quality of services and/or quality of care.

24. Working with the People and Organisational Development Committee to obtain assurance on safer and optimal staffing and that education, learning and development is aligned with the HCS quality priorities.

People and Organisational Development Committee

The purpose of the committee is to assure the Board that the People and Organisational development function is delivering upon its strategic objectives.

The Committee will:

1. Obtain assurance that there are practices in place, which ensure the sustainability and affordability of workforce supply on a short, medium and long-term basis including workforce planning, development, redesign, recruitment and retention.

2. Obtain assurance that Health and Community Services (HCS) implements effective and equitable reward packages that positively influence performance.

3. Obtain assurance that HCS attract and retain high performing workfare capable of delivering HCS operational and clinical strategies.

4. Obtain assurance that HCS delivers services, which are fair and equitable promoting diversity and equality of opportunity.

5. Obtain assurance that strategic education issues and external relationships which impact upon supply and engagement are included in HCS planning.

6. Obtain assurance that HCS is driving improved employee engagement, ensuring appropriate mechanisms for the employee voice to ensure that rapid action is taken to improve staff experience.

7. Agree the HCS workforce strategy and establish, monitor and report to the Board on an annual programme of work to implement the strategy.

8. Agree (where necessary) POD reports prior to publication and review implications of local/national reports that have been published.


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9. Identify risks associated with POD ensuring ownership with mitigating actions, escalating to Board as appropriate.

10. Approve the terms of reference and membership of its sub-committees, overseeing their work, receiving reports for consideration and action as necessary.

11. Consider and approve action plans, programmes of work and strategic objectives providing assurance to the Board on progress.

12. Work with the Quality and Performance Committee to obtain assurance on safer and optimal staffing and that education, learning and development is aligned with HCS quality priorities.




Health and Community Services Board

Board Meeting 08 July 2019

New Risks Reported to the Board

Introduction

Recommendation 22 of the Comptroller and Auditor General Report Governance Arrangements for Health and Social Care R120/2018 (R120/2018) set out the need to

“Establish robust arrangements for the preparation, maintenance, review and challenge of risk registers relating to health and social care, including arrangements for escalation.”

The HCS Executive response was

“Developing a Board Assurance Framework will be the prime responsibility of our new risk and oversight committee. A programme of work detailing milestones to accomplish this will be presented to the board at the first meeting.”

Discussion

The Board has overall responsibility for ensuring that systems and controls are in place which are sufficiently robust to mitigate risks which may threaten the achievement of the Health and Community Services (HCS) strategic objectives. The Board will achieve this primarily through the work of its assurance committees, external scrutiny and the systematic scrutiny and collection of performance data to evidence the achievement of HCS objectives.

A Board Assurance Framework is designed to provide the Board with a straightforward but comprehensive method for oversight of the principal risks to the HCS objectives. With the establishment of the HCS Board the absence of such a Board Assurance Framework constitutes a new risk reported to the Board today.

RAGREF ref.July 19

Exec Lead

Assurance Committee

Objective 31 Dec 2019

Comments

1.0 Group Medical Director

Risk Amber rating. BAF functioning but with improvements to be made as Care Groups, Board and Board Committees mature

The absence of a BAF presents a principal risk to the achievement of a strategic objective described in the HCS Target Operating Model and One HCS Consultation document “To provide safe, affordable, high quality care that is accessible when and where our service users need it.”

The Board has already gone some way to implement and maintain new systems of Corporate Governance to mitigate this risk by establishing a corporate governance structure with appropriate Board Committees all having clear terms of reference (for approval by the respective committees 15 and 17 July 2019) with committee schemes of delegation approved through the approval of the Boards terms of reference. The HCS Target Operating Model Consultation is in the final phase of establishing a clinically led operational management structure. Finally the Executive team is clear in the work to be done to address the shortcomings in governance arrangements for health and social care set out in the in Auditor General’s Report R120/2018.

There is, however, more work to be done to;

1 Identify HCS Strategic Objectives This is the first step. These objectives can be clinical, financial, workforce and other objectives critical to the achievement of the Board overall aims and values.

Agenda Item 11 New Risks Reported to Board BAF Issued 20190701.docxOverall Page 31 of 56

https://statesassembly.gov.je/assemblyreports/2018/r.120-2018res.pdf


2 Identify Principal Risks to the achievement of these Strategic Objectives

These are significant risk that threaten the achievement of HCS strategic objectives. These will be described in the HCS Corporate Risk Register. Most will in time be risks escalated when Care Group risk management has matured. Care Group Associate Medical Directors start their lead responsibility July 01 2019.

3 Identify Key Controls to mitigate and manage these risks

These are the management systems and processes HCS already has and will have in place to manage its principal risks.

4 Gain Assurance Over Controls The Board must gain assurance about the effectiveness of the controls in place to mitigate and manage the principal risks.

A programme of work to accomplish the BAF is set out for the Board

Deliverable Action Timescale

Identify HCS Strategic Objectives

Strategy and Risk Workshop

29 July 2019 (TBC)

Identify Principal Risks Strategy and Risk Workshop 29 July 2019 (TBC)

29 July 2019 (TBC)

Identify Key Controls Performance Framework to inform Executive Care Group Reviews

Executive Care Group Performance Reviews start Aug 2019 (TBC)

Gain Assurance over Controls Monthly Executive Care Group Performance Reviews

Monthly Management Executive Meeting

Care Group personnel (Associate Medical Director, Lead Nurse/Allied Health Professional/Lead Manager in place by end July 2019). Executive Care Group Performance Reviews start Aug 2019 (TBC)

July 17 2019 (first meeting)

Board Committees established and programme of work relating to Board Assurance Framework agreed

Committee meeting schedule set out to Dec 2019

July 15 2019 (first meeting)

Draft Board Assurance Framework provided for Board

Board Report September 31 2019

Working BAF with schedule of updates and reporting for remainder 2019 and 2020

Board Report October 28 2019

Internal review of degree to degree to which the BAF is providing an effective means for HSC Board oversight of the principal risks to the HCS objectives and describes the

Fully functioning and effective Care Groups, Board Committees and Board

December 2019 (initial review of first 6 month HCD Board and new corporate governance arrangement)

January 2020 revised arrangements in response to Board



necessary extent of risk control and assurance

review and reflection of first 6 months functioning

Internal review of degree to degree to which the BAF is providing an effective means for HSC the Board oversight of the principal risks to the HCS objectives and describes the necessary extent of risk control and assurance

Fully functioning, effective and mature Care Groups, Board Committees and Board

June 2020 in response to January 2020 revised arrangements in response to Board review and reflection of first 6 months functioning

Conclusion

The establishment of a Health and Community Services Board requires, as a principle of sound corporate governance, the establishment of a Board Assurance Framework. The absence of such a framework presents a risk to what is likely to be an HCS strategic objective. The reporting of this new risk to the Board forms one part of the HCS response to Recommendation 22 of the Comptroller and Auditor General Report Governance Arrangements for Health and Social Care R120/2018.

Professor John McInerneyGroup Medical Director Lead Executive Risk Committee01 July 2019



Health and Community Services Board 08 July 2019 Agenda Item 13a

Page 1 of 3


REPORT TO MAIN BOARD – 8th July 2019

From Q&P Vice Chair – Rose Naylor, Chief Nurse

This report describes the business conducted at the Q&P Committee held on 5TH June 2019 , indicating the challenges made, assurances received, residual concerns and/or gaps in assurance.

Item Report/Key Points Challenges Assurance Residual Issues / Gaps in Controls or Assurance

Q+S Assurance Committee changes to the Committee and Governance Structure from July 2019

Presentation of key changes as part of the revised governance arrangements under the HCS TOM including changes that move from a Quality and Safety Assurance Committee to Quality and Performance Chaired by Assistant Minister Steve Pallot

Management of transition from current Assurance Committees, to new structure and changes to the Chair and membership from 15th July 2019

No gap between closing of Quality and Safety Assurance Committee, last meeting in June and the establishment of the Quality and Performance Committee first meeting July 15th.

Implementation timeline of HCS new Target Operating Model (TOM) means that not all leadership roles appointed to at tier 3 level at the time of the first meeting July 15th, and that the care groups not yet fully operational.

Key Performance Indicator draft report (KPI Report)

Discussed new format of the Quality and Performance Committee KPI report which will be populated and discussed at future Q+P Assurance Committees. Aligned with the Care Groups

Not all data fields populated yet There exists a current line of sight on activity relating to patient safety through the quarterly reports, Mental Health Improvement Plan, Maternity Action Plan and the JNAAS framework on all nursing care areas within HCS

Need to agree benchmark thresholds for KPIs involving Associate Medical Directors (AMDs)/Care Group Leads

Litigation Quarter 1 2019 Report

Update on clinical and non clinical claims and new claims position

For future Q+P Committees need to theme claims and present a plan to address some of the issues driving claim activity

Current line of sight and connectivity to GMC Revalidation on all claims.

For Q+P need to theme claims and plan to address some of the issues driving claim activity

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Central Alert System and current risks

Report presented alerted the Committee to a risk in relation to our Central Alert System specifically our ability to consistently evidence the action taken in respect of all Alerts

Further work needed on mapping all possible entry points

Gap in ability to consistently evidence actions taken

Being managed manually at the moment, further work needed to improve the process

Jersey Nursing Assessment and Accreditation System ( JNAAS) Quarter 1 2019 Report

Unannounced assessments started in 2019 .

The physical environment presents some challenges to meeting all standards.

JNAAS based on the CQC standards.Golden thread from bed to Board for assurance in relation to practice.Wards are supported through the Chief Nurse Office Quality Assurance Nursing Team and this is through a full rolling programme of unannounced assessments against the standards

Diabetic Retinal Screening Verbal update on the plans for screening

Will remain as a standing agenda

Formal written update to come to next Assurance Committee on progress

Maternity Services Learning Action Plan

Presented to Q+P for information and assurance on progress against actions

Remains as a standing agenda item until completed.

Executive oversight of the plan on a fortnightly basis with Exec Tri and Maternity Tri.

Mental health improvement update

Verbal update on mental health and particularly the recruitment of new staff In relation to the work of the Improvement Board discussed what papers to come to Q+P

Timeline for recruitment into posts

Vacancies covered at present by agency staff Mental Health Improvement Board in place

Papers will be shared with Committee in future



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Island wide Do not attempt cardio pulmonary resuscitation policy ( DNACPR)

Policy developed pan island – ratified by relevant organisations HCS – including Ambulance Primary Care. FNHC, Hospice

Agreement needed on timeline for implementation

Group Medical Director Sponsor and the Operational Lead for delivery will be Medical Director and Care Group Lead for Primary Care .Meeting ref launch 11 June



Health and Community Services Board 08 July 2019 Agenda Item 13b

Page 1 of 2

Report Title

Quality and Performance Report

Author(s) and Sponsor

Author(s): Rose Naylor, Chief Nurse

Sponsor Steve Pallett

Executive Summary

PurposeThe purpose of this report is to provide an overview of the Quality and Performance Committee to the HCS Board to enable the Board to obtain assurance that high standards of care are provided by Health and Community Services and in particular that adequate and appropriate governance structures are in place throughout HCS to :

Deliver excellence in patient care ( experience, safety and effectiveness ) Deliver operational performance Obtain assurance that risks arising from clinical care are adequately controlled or mitigated Provide assurance to the Board that risk management arrangements for safety, quality and patient

experience are in place and operate effectively Ensure compliance with legal, regulatory and other obligations

As part of HCS new Target Operating Model (TOM) the governance arrangements have been strengthened to ensure that there is a golden thread from the point of care delivery to the Board. The Quality and Performance Committee meets under its revised terms of reference and new membership on July 15th.

Key Issues to Note The new Target operating model for HCS reflects a new style of organisation, moving from a model

of a management led organisation to Clinical and Professional leadership. Associate Medical Directors/Care Group leads have been appointed and take up post from July 1st. These Associate Medical Directors/Care Group leads will be supported by Senior Nurses, Allied Health Professionals and General Managers working together to deliver excellent patient care and provide assurance to the Board on performance and delivery

The experience of those who access services is key and we have prioritised investment to create a Patient Advice and Liaison Service, the Manager of which will be appointed as part of the implementation of the TOM. It is anticipated that this post will be filled over the summer and will have a key focus on early identification and addressing concerns, developing the patient voice, and ensuring that patient experience becomes a regular feature in everything we do, whether in business as usual or developing new services.

In the process of developing an Accountable Care Framework as part of the HCS TOM which will strengthen clinical governance arrangements. This will place the responsibility within the Care Groups to demonstrate assurance in relation to care delivery, operational performance and the identification of any clinical risks. This work will be implemented during the summer as the TOM is implemented and the Care Groups become more established.

Identification of risks is an important feature of our Assurance Framework, this is being developed to ensure there is an accountable risk management system in place. That risks are treated, mitigated or managed and reduced, with a clear line of sight to the Board.

Current assurance mechanisms in place, a number of reporting mechanisms are already in place which provide assurance in relation to practice these include : the Mental Health Improvement Board, executive oversight in maternity services, Jersey Nursing Assessment and Accreditation undertaken in all inpatient areas, transparency boards in all of the ward areas, quarterly reporting on litigation and claims, infection prevention and control, serious incidents review process, Health and Safety, complaints and feedback. This information will be transitioned into the accountable care framework over the course of the summer.

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A key performance report is being developed for each of the Care Groups and will provide oversight to the Q+P Committee and identify any risks in relation to Quality and Performance.

In relation to clinical services that have transferred to other parts of OneGov as part of the OneGov TOM, a clinical governance framework has been put in place which confirms that the responsibility and oversight for health professionals and clinical governance remains with the island’s Group Medical Director and island’s Chief Nurse.

A care group with a focus on Quality and Safety has been established under the TOM and they will work across all services. This care group sits under the leadership responsibility of the Group Medical Director and has a Clinical Lead – an Associate Medical Director and a Quality and Safety Manager, this team have drafted a Quality and Safety Strategy which sets out the priorities for improving patient outcomes and experience and will be signed off by MEX before it returns to Q+P.

Conclusions, Implications and Future Actions RequiredThis report reflects an organisation undergoing change in relation to leadership and care delivery. The work identified above will be implemented over the coming months and will continue to develop over that time as the Care Groups start to become formed and the new leadership model is established. It is important that the Board remains sighted and assurance is provided during the time of change as well as when the new model is fully implemented, it is the responsibility of the Q+P Committee to do this.

Recommendations

The Board is asked to NOTE the Report FOR INFORMATION

Impact upon Strategic Objectives

Q+P will be developing these as part of a programme of work for the Committee

Impact Upon Corporate RisksThe development of the accountable care framework will provide the Board with assurance and provide the Board with a line of sight on all risks affecting patient care.

Regulatory and/or Legal Implications

There are no specific regulatory or legal implications arising from this report

Equality and Patient ImpactTimely implementation of the HCS TOM is fundamental to the progression of the Accountable Care Framework

Resource Implications

Finance Human Resources IM&T Estates

Action / Decision Required

For Decision For Assurance For Approval For Information

Date the paper was presented to previous Committees

Audit and Risk Finance and Modernisation

People and OrganisationalDevelopment

Quality and Performance

Management Executive Team

NA

Outcome of discussion when presented to previous Committees/MExNA Committee under new TOR and membership meets 15th July 2019

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Page 1 of 2

Report Title

Finance and Modernisation Report – Assistant Minister Hugh Raymond


Author(s): Steven Mair

Sponsor Hugh Raymond

Executive SummaryPurposeTo Provide assurance to the Board with regard to the budgets and financial management of Health and Community Services

Key Issues to Note The Department has for 2019 a revenue budget of £199.7m and a capital programme of £11.1m

(£5.4m new funding for 2019, £5.7m brought forward from prior years). Both budgets are under control and the Department anticipates that it will be in a balanced position

by the year end Inevitably in an organisation of the size and complexity of HCS there are budgets where the actual

expenditure/income varies during the year but overall we are confident with resepct to the end of year position

The departmental management team reviews detailed monthly reports on progress against the budget and takes action as necessary and individual budget holders meet regularly with financial managers

Ministers are fully briefed and it is my intention to bring forward to future meetings papers covering:

o Budget monitoringo The Department’s efficiency programmeo At the year end the Department’s outturn

So that the Board can be assured:

o we are financially soundo it can track changes and progress across the yearo it can challenge variations and be provided with explanations

Conclusions, Implications and Future Actions RequiredThe Department has robust financial management and if issues arise they are pro actively tackled. It is also leading the way in identifying efficiency programmes that ensure it provides value for money for islanders and modern and effective services

Recommendations

The Board is asked to NOTE the Report FOR DISCUSSION

Impact upon Strategic ObjectivesThe department’s finances and financial management support are integral to and fully support the ambition of the Department

Impact Upon Corporate RisksPotential risks are identified as part of the monthly monitoring report and the management team and Ministers assess and consider them


This report allows the Department to comply with the Public Finance Law and professional standards

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Equality and Patient ImpactBy maximising the resources available within the constraints of public expenditure limits and ensuring that they are used in a cost effective manner the Department’s finances support patient care. In addition any changes to the finances such as through the efficiency programme are assessed and signed off by the Medical Director and Chief Nurse to ensure a full quality impact assessment is undertaken


Finance # Human Resources IM&T Estates


For Decision For Assurance # For Approval For Information #






Outcome of discussion when presented to previous Committees/MexRelevant Board Committees, which considered the report, should be identified as should their decision (E.G endorsement/recommendation to the Board, assurance received etc.)

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Page 1 of 2

Report Title

Assurance Report of the Chair of the Finance and Modernisation Committee


Author(s): Steven Mair

Sponsor Hugh Raymond

Executive SummaryThe Executive Summary should be the purpose written for the Board and cover the assurance perspective.

Purpose

To provide assurance to the Board with regards to finance and modernisation.

Key Issues to Note

The Board has previously not operated with a Finance and Modernisation Committee, although financial matters have been reported to the Resources and Performance Committee which has focussed on budget monitoring. It is intended going forward that to provide more assurance to the Board the following will be reported

Budget monitoring The Department’s efficiency programme At the year end the Department’s outturn Internal audit reports Anything pertinent to the Department from the External Auditor’s GoJ annual audit

The first meeting of the Finance and Modernisation Committee is scheduled for 15 July 2019. This follows the HCS Board 08 July 2019. This sequence results from the intention to establish the Board at the earliest date. The more appropriate order of ‘Committee’ and then Board is established thereafter. Future Boards will receive assurance reports from the newly established Finance and Modernisation Committee. The Chair of the Finance and Modernisation Committee is Deputy Hugh Raymond. The Lead Executive is Group Director, Steven Mair

The purpose of this report is to alert the Board to key financial and modernisation risks as currently understood by the HCS Department. In order to satisfactorily deal with this the Department will be receiving monthly monitoring reports on the budget and the efficiency programme which are well established programme of work

Other reports will follow a regular timeline but will be less frequent than monthly as their product requires for example the outturn report will self-evidently be on an annual basis etc

Recommendations


Impact upon Strategic Objectives Regular monitoring and management of finances and modernisation facilitates implementing

transformational objectives to Improve Islanders’ wellbeing and mental and physical health Effective financial management underpins all that the Department does. Any mis management of modernisation or budgets that would prevent HCS from achieving core

business objectives.

Impact Upon Corporate Risks

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HCS budget monitoring forms part of a suite of budget reports that are brought together by the Group Director on behalf of the GoJ to provide corporate wide assurance


None that the Department is aware of

Equality and Patient ImpactNone that the Department is aware of


Finance X Human Resources X IM&T X Estates


For Decision For Assurance X For Approval For Information






No No No No No

Outcome of discussion when presented to previous Committees/MEx

Agenda Item 14b Finance and Modernisation 8.7.19.docxOverall Page 44 of 56


Page 1 of 2

Report Title

People and Organisational Development ReportAuthor(s) and Sponsor

Author(s): Darren Skinner

Sponsor Deputy Jeremy Maçon

Executive Summary

PurposeThe purpose of this paper is to provide an overview of the programme of work to be undertaken by the Health and Community Services (HCS) People and Organisational Development Committee (POD) and the key performance indicators.

The POD Committee has been tasked with an ambitious agenda of deliverables over the coming months, with the first POD Committee taking place on Monday 15 July 2019. The POD Committee will be working on the following key priorities;

o Workforce Strategyo Workforce Planningo Education, Learning and Developmento Health and Wellbeingo Job Planningo Revalidation; ando HR Metrics

Future reports will be designed to provide the Board with assurance that sufficient controls are in place to monitor performance against the key workforce priorities set out above. Where any improvements are required, the actions will be apportioned to the appropriate work streams and monitored by the POD Committee.

Key Issues to Note

Currently there is a lack of HR metrics and data in order to report any detail in relation to attrition rates, staff headcount and vacancies, sickness absence management etc. This is due to the Government of Jersey moving from the previous HRIS to a new system ‘Peoplelink’ where there have been a number of transition issues preventing reporting across the whole of Government on people metrics. It is anticipated that this data will be available shortly, however no specific timeframe has been provided.

The first POD Committee meeting is due to be held on Monday 15 July 2019 where we will be setting the agenda and programme of work to be undertaken, after which we will be able to report to the HCS Board on timelines for each work stream.

Conclusions, Implications and Future Actions Required

The People and Organisational Development Committee and associated work streams have been given an ambitious agenda and a lot of work will be required in order to establish systems and processes to monitor and report detail associated with our people and performance along with appropriate and relevant benchmarking. The work stream will need to lead a number of initiatives in relation to our people and development in order to deliver the best service to our patients and service users across the Health and Community Services portfolio. There will be additional challenges with the implementation of our new model of care and the Target Operating Model which will be reported through the POD Committee.

Recommendations

The Board is asked to NOTE the Report and planned work of the POD Committee

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Impact upon Strategic ObjectivesFuture reports will provide the necessary information pertinent to people and organisational development and the impact on our strategic objectives.

Impact Upon Corporate RisksFuture reports will provide the necessary information pertinent to people and organisational development and the impact on our corporate risks.


There are no specific regulatory or legal implications arising from this report.

Equality and Patient ImpactThere is currently little or no available information to identify the impact on patient care. However, staffing levels are regularly reviewed and managed by clinical leads, with necessary cover being arranged where necessary in order to ensure that staff to patient ratios are minimised as the result of sickness or vacancies.


Finance Human Resources IM&T Estates


For Decision For Assurance For Approval For Information






N/A

Outcome of discussion when presented to previous Committees/MExThe People and Organisational Development Committee will meet for the first time on 15 July 2019.

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Page 1 of 3


REPORT TO MAIN BOARD – [08 July 2019]

From Existing Risk and Oversight Committee

Chair – Steve Mair, HCS Finance Lead

This report from Professor John McInerney Group Medical Director and Executive Lead for the Risk Committee

This report describes the business conducted at the Existing Risk and Oversight Committee held on 05 June 2019 indicating the challenges made, assurances received, residual concerns and/or gaps in assurance.

Item Report/Key Points Challenges Assurance Residual Issues / Gaps in Controls or Assurance

Risk Register The Risk Report was carried over from the May 2019 Risk and Oversight Committee

A number of divisional risk are scoring more than 15 but don’t appear on the corporate risk register.

The corporate risk register does not build from the operational risk register as it arises from a different non-Datix derived process

The management of the risk register and appropriate escalation of corporate risk is in transition as the organisation moves into the Target Operating Model.

The existing corporate risk register has been populated through a process different to that by which the operational risk register is populated – response to central government request not built up through risks recorded on Datix

The governance and processes to consolidate and prioritise operational risks into an overarching corporate risk

Shortcomings in risk management structures and processes have been recognised

Short term expert resource is being procured to review risk management in HCS to align to the target operating model and improve effectiveness.

Work has been commissioned to align Datix with the Target Operating Model and to produce a Corporate Risk Register.

New governance arrangements including risk management framework and updates to the Datix software tool which is

Outputs of the remedial work not completed until October 2019. OF concern to the Board is the current absence of a reliable corporate risk register setting out assured Top 10 corporate risk

Need to improve risk escalation framework in tension period to establishment of new target operating model structures, poor compliance with application of existing risk register

Infrastructure risk will endure through the transitional period until projects completion

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register are under review as part of the wider reorganisation of governance in HCS within the OneGov context.

A number of significant risks require cross-cutting support from government to manage effectively.

Work is underway to review the risks < 12 which have not been reviewed.

Care groups once established will be asked to provide assurance that risks are still applicable, that assessments accurately reflect the current position and that they are being actively managed.

used to record, track, and report risks, incidents, feedback & claims

The most significant risks on the existing corporate risk register are being managed e.g. general hospital and mental health hospital infrastructure risk and assurance evidence is available for Mental Health Improvement and General Hospital refurbishment

Clinical Risk/Benefits to Children from the Transition of Children’s Community Health Services from Health and Community Services (HCS) to Children’s, Young People & Education Services (CYPES)

The transition of services provides opportunities and risks. Its new ground for joint HCS/CYPES to develop the organisational structures and processes to be able to provide the necessary degree of assurance to both Ministerial department boards. These are established in early form.

The transition of services is wide-ranging and touches on the work of all HCS Assurance Committees in the new corporate governance structure.

The agenda item contains a number of recommendation for the HCS Management Executive to consider in support effective cross department governance capable of providing the necessary assurance to both CYPES and HCS Departments

Services transferred June 02 2019. Not enough time has passed yet for practical experience of the transfer



Page 3 of 3

HCS response to review of status of CAG and Scrutiny recommendations

HCS has provided an update on all CAG and Scrutiny Report recommendations 2015-2019

The action tracker was completed. Further work is required.

The submitted tracked actions were assured by HCS Exec Team with final sign off by DG with message that further quality assured submission would be needed when required

The ‘compliance officer’ in the central finance team who populate ‘tracker’ does not form part of the Finance TOM from Aug 2019.

Compliance function will need to be locally resourced.

Progress against CAG/Scrutiny recommendations is part of Risk Committee ToR

Report back from Public Accounts Committee

Corporate Risk Lead (MT) updated on recent PAC report identifying shortcomings in cross government learning and actions from PAC recommendations

HSC appetite to contribute to such learning needs a mechanism to be initiated and coordinated

No HCS response as yet to the report

Not yet clear what such coordinated learning might involve and who or which department might lead on it

Approval of Finance Policies 6 policies were on the agenda for approval

No policies were approved Policies are being produced but improvement needed in ratification process

A process and approval forum needs to be identified for policy approval




Page 1 of 3

Report Title

Existing Risk and Oversight transitioning to Risk Committee


Author(s): John McInerney

Sponsor Steve Pallett

Executive SummaryThe Executive Summary should be the purpose written for the Board and cover the assurance perspective.

Purpose

To provide assurance to the Board with regards to risk.

Key Issues to Note

Matters considered at the Risk and Oversight Committee included:

Risk Register Transition of children services from Health and Community Services (HCS) to Children, Young People

and Education Services (CYPES) HCS response to review of status of CAG and Scrutiny Recommendations Report back from Pubic Accounts Committee Approval of Finance Policies

The first meeting of the Health and Community Services (HCS) Board Risk Committee is scheduled for 15 July 2019. This follows the HCS Board 08 July 2019. This sequence results from the intention to establish the Board at the earliest date. The more appropriate order of ‘Committee’ and then Board is established thereafter. Future Boards will receive assurance reports from the newly established Risk Committee. The Chair of the Risk Committee is Senator Steve Pallet. The Lead Executive is Group Medical Director Professor John McInerney

The purpose of this report is to alert the Board to key corporate risks as currently understood by the HCS Department. The HCS executive recognises there needs to be an improvement in the identification, assessment, escalation and management of risk in the way envisaged in the new corporate governance arrangements and set out by the HCS Board in response to Recommendation 22 of the Comptroller and Auditor General Report ‘Governance Arrangements for Health and Social Care (Sep 2018)

“Establish robust arrangements for the preparation, maintenance, review and challenge of risk registers relating to health and social care, including arrangements for escalation.”

Developing a Board Assurance Framework will be a key output of the Risk Committee. A programme of work detailing milestones to accomplish this will be presented to the Board in September 2019. This is later than the date reported to the CAG (“early 2019”). The Corporate Risk Register currently sets out the following risks

1. Staffing pressures in front line and support services 2. Failure to deliver services with budget3. Estates infrastructure 4. Unexpected loss of access to essential information 5. Major incident impacting health and / or social care services6. Delivery of Future Hospital7. Avoidable harm 8. Fire prevention & management9. Failure to transform services 10. Uninsured litigation

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11. Grievance from Workforce relating to equal pay for work of equal value (Nurses, Midwives & AHPs)12. Brexit relationship with UK & EU

There is a shortcoming in assurance that this list reflects all the risks the Board would want to consider – risks to the achievement of its strategic objectives.

There has been a delay in establishing and populating Care Group leadership groups (Associate Medical Director, Lead Nurse [and Lead Allied Health Professional where indicated] and Lead Manager as part of the HCS Target Operating Model. Associate Medical Director appointments started July 1 2019 and appointments to Lead Nurse/Allied Health Professional and Lead Manager posts will follow. Implementation of Care Group clinical governance structures and processes, including risk management will follow. Reviewing current Care Group clinical governance structures and processes and informing a new approach consistent with the One HCS Target Operating Model forms part of the deliverable agreed by the Chief Nurse for October 2019. A ‘gap analysis’ is being undertaken on current clinical governance functions and associated policies is indicating

1. Risks populating the corporate risk register have been derived through a different process to risks on the operational risk register

2. There is a shortcoming in the assured risk score validation process 3. There are variations in escalation processes of risk from operational to executive oversight4. There are risks on Care Group registers that warrant executive/board oversight but do not appear

on corporate register 5. Training gaps

Shortcomings, all of which will be remediated through the new corporate governance processes, as

1. Care Groups will have standardised processes to populate operational risk registers and escalation of risks scoring more than 16

2. Monthly Executive Care Group Reviews will provide for a consistent means of validation and either support for Care Groups to manage the risk down to an acceptable residual score or escalation of the risks to the relevant Board Committee

3. Monthly Board Committees will provide further means to seek assurance that risks are being managed and if this is not possible are then escalated to the HCS Board

4. Work to develop the Board Assurance Framework will continue through 2019 with a progress report for the Board in October 2019.

Recommendations


Impact upon Strategic Objectives Improved monitoring and management of risk removes barriers to implementing transformational

objectives to Improve Islanders’ wellbeing and mental and physical health Effective risk management reduces the likelihood that a risk will materialise and adversely affect

quality and safety. Failure to identify and mitigate risk will prevent HCS from achieving core business objectives.

Impact Upon Corporate RisksHCS significant operational risks are scored and prioritised to populate the Corporate Risk Register. There is insufficient assurance as yet on the completeness of assessment of Corporate Risks that have the potential to adversely affect HCS strategic objectives




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There is no evidence that HCS is currently in breach of any statutory or regulatory compliance. No such breaches are recorded on the Risk Register. The current absence of a Board Assurance Framework means however that positive assurance cannot yet be provided.

Equality and Patient ImpactCorporate Risks 5 and 7 ‘Risks Staffing pressures in front line and support services’ and ‘Avoidable Harm’ could impact on patient care where staff patient ratios are adversely impacted by vacancies or sickness


Finance X Human Resources X IM&T Estates


For Decision For Assurance X For Approval For Information






No No No No No

Outcome of discussion when presented to previous Committees/MEx

There has been no previous Risk Committee established as part of the new HCS Board corporate governance structure

Previous meetings of the current Risk and Oversight Committee have recognised the need to revise the risk register to updated and harmonised with Government of Jersey corporate risk policy.

Key risks requiring action include:

Address gaps in service to Mental Health Clients. Work is underway to recruit to key vacant roles and remodel care pathways within existing resources as far as possible in 2019. Further investment in Mental Health Services is the first priority for additional resources in the Department’s revenue submission to the Government Plan process from 2020.

Address the defects in the buildings used by Mental Health Services and Learning Disability clients – resources are being sought to reprioritise existing capital allocations in 2019 and secure additional capital allocation through the Government Plan from 2020.

Manage the risks to patients at the General Hospital from the ageing facilities in the context of extending the timelines for rebuilding the hospital. An additional capital allocation is being sought in the Government plan process from 2020 and the Department is working with Treasury and Exchequer to bring forward the most urgent works in 2019.

Manage risks of medical malpractice litigation with the support of Treasury and Exchequer Risk Management Colleagues.



Health and Community Services Board 08 July 2019 Agenda Item 16c

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Board Briefing Paper

States of Jersey Community and Social Services for Adults and Older Adults – Follow-Up (R.42/2019) – Executive Response with the Comments of the Public Accounts Committee

Presented to the States 24 June 2019 (2019 R.42.Res)

Background

The Public Accounts Committee (PAC) has presented the HCS Executive response to the Comptroller and Auditor General’s follow up report on Community and Social Services for Adults and Older Adults (R.42/2019). The PAC comments also reference the C&AGs original report Review of Community and Social Services R.131/2015) . The table below provides partial assurance to the Board that the corporate governance structure being established in response to the C&AG Report Governance Arrangements for Health and Social Care R120/2018 (R120/2018) will go some way to address the concerns set out in R.42 Res/2019 (R.42).

Response

PAC Comment Executive Response

1 C&AG recommendation in original report Review of Community and Social Services (R.131/2015) was not only to establish clear milestones for the implementation of a governance framework but also to monitor delivery against these milestones …. and that there are few mentions of how these initiatives will be monitored by the Executive to measure their success or failure

The delivery programme for each of the C&AG recommendations from both R.42/2019 and R.131/2015 will be revisited by HSC Group Managing Director and where no delivery dates or mechanisms for monitoring the process against delivery are evidenced these will be set out. A delivery programme will then be set out for HCS Board approval

Assurance for specific elements of the delivery will be allocated to the relevant Board Committee. The Risk Committee will be responsible for receiving assurance about delivery of the complete programme and where elements of the programme are not delivered the population of the HCS Risk Register accordingly

2 Recommendation 2 of the C&AGs 2015 report is to ‘identify specific measures to reduce reliance on interim staff’. PAC would welcome more specific information about the role of the People and Organisational Development HSC Bard Committee in addressing staffing levels throughout the Governments community and social services

The delivery of the POD Annual Work Plan will provide assurance to the HCS Board about the degree to which specific measures are leading to a reduction in the reliance on interim staff.

Care Groups will include ‘identify specific measures to reduce reliance on interim staff’ as an operational deliverable. This will be monitored through the Executive Monthly Care Group Review and monthly HCS Management Executive meeting

3 Recommendation 3 in the 2015 report emphasises the need to measure and evaluate the effectiveness of steps taken to improve engagement with staff

‘Hard’ data (staff turnover, sickness, Our Conversation metrics etc. and ‘soft’ data exit interviews, staff surveys etc.) forms part of the monthly Executive Care Group Review process

4&5 In response to Recommendation 7 PAC would welcome clarity on how the performance indicators already established e.g. for the Safeguarding Board would be developed to better understand performance, drive action

This will be addressed by the Executive in its written progress report in relation to the first recommendation of the C&AGs follow up report of April 2019 to be presented to PAC by 7 October in readiness for the meeting scheduled 21 October 2019

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https://statesassembly.gov.je/assemblyreports/2015/r.131-2015.pdf



Health and Community Services Board 08 July 2019 Agenda Item 16c

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and enhance governance through the rest of the services

5 PAC welcomes the Executive response to the first recommendation of the C&AGs follow up rest “Establish clear milestones for the completion and implementation of the C&SSD-wide governance framework, covering all C&SSD services, ‘business as usual’ and change initiatives, and measure delivery against these milestones”

The corporate and clinical governance structures with a central role for the Management Executive the monthly Executive Care Group review and the HSC Target Operating Model implementation provides early evidence that this work is in progress. More clarity can be provided on key milestone for the delivery of the recommendations

6 PAC would welcome more clarity on the proposed timelines for completion action set out in the Executive reasons to the recommendation in the C&AGs reports

An overarching delivery programme will be drafted by the HCS Group Managing Director with clear deliverables, timescales and named executive leads responsible for delivery of component parts of the programme. This programme will be received by the Quality and Performance Committee for assurance

Rob SainsburyHCS Group Managing DirectorJune 28 2019

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Documents

StatesofJersey-HealthandSocialServices ... and wellbeing/R... · Health and Community Services Board 08 July 2019 Agenda Item 08 to account by seeking assurance about HCS activities