Thursday 16 January 2014
A report on financial management and political decision-making within the Health and Social Services Department has been welcomed by the current Board. The report, which has been published by the Public Accounts Committee, looked at the way the Department's budget was managed throughout 2012, and how decisions were made in the run-up to the sudden stopping of services in November 2012, in light of a forecast overspend of up to £2.5 million.
The Health and Social Services Minister, Deputy Mark Dorey, said:
"PAC has reviewed the circumstances which led to the former HSSD Board predicting a significant overspend at the end of 2012, and making the decision to cancel services and close wards. This report highlights many of the issues which the new Board have also identified and have actively been working to improve throughout 2013.
"There is clearly still some way to go, as HSSD is forecasting a £1.3 million overspend for 2013. However, improving financial management remains a priority for HSSD, and we are confident that the steps we have taken during the past year are moving the Department in the right direction."
Financial management information has improved, and the PAC report acknowledges that the standard of financial reports in 2013 is higher and more consistent than those it was scrutinising for 2012. Controls on expenditure are also being strengthened, with tighter controls on off-island referrals for hospital treatment introduced during the past year.
HSSD has developed a stronger relationship with the Treasury & Resources Department, with monthly meetings between the two Ministers and senior staff focusing on HSSD's financial position and the actions being taken to manage overspends and make savings. HSSD has also focused on encouraging recruitment and retention throughout 2013, although this remains a very challenging area.
There are further improvements to be made, and the Department is pursuing the recommendations of the Finnamore report, and Internal Audit recommendations on private patient income, as well as making progress on its own Financial Management Improvement Plan.
In response to the report's recommendation that 'the overall health and social care model merits a separate review', Deputy Dorey said:
"The Board of HSSD is committed to reviewing the island's health and social care system, and we are making progress in this area. Our preferred approach is to tackle this in manageable stages. Our first priority is to look at emergency care, through the review of the Ambulance Service. But discussions have also started about reviewing the service models and clinical pathways across the whole of secondary care. Of course we will look at the way the different parts of the system link together, and how this might be altered to improve patients' experiences and outcomes.
"As suggested in the PAC report, this kind of wide-ranging review naturally has to explore the questions of what range of services we should provide, and how we can ensure that the budget, or the way services are funded and paid for, is fit for purpose and sustainable.
"The staged approach allows HSSD to make more prudent use of internal resources and minimise the cost of external consultancy in conducting the review. It enables greater clinical engagement and use of local expertise. And it ensures that, when detailed reports come to the States in 2014 and thereafter, States Members will be able to debate and decide on substantive changes to health or social care services, to the immediate benefit of islanders."