Health and Social Services
Minister’s Decision Report
health and social services Budget Transfer from Treasury and resources for THE public sector reform PROGRAMME
- Purpose of Report
To recommend the Minister for Health and Social Services (HSSD) accepts budget transfers of £8,000, £643,000 and £469,000 in 2013, 2014 and 2015 respectively from the Treasury and Resources Department Restructuring Provision in relation to the Public Sector Reform Programme.
- Background
A Restructuring Provision was approved in the Medium Term Financial Plan 2013/15 to support the final years of the CSR process and the Public Sector Reform Programme. Under the Public Finances Law, the actual transfer of funds from the Provision can only be actioned through a Treasury and Resources Ministerial Decision.
Two key principles regarding the allocation of funds from the Restructuring Provision were endorsed by the Council of Ministers in 2011 as follows:
(a) that the request is approved on the understanding that it could not be funded from within a department’s current budget; and
(b) should a department have an unplanned underspend on its revenue budget at the end of the financial year, the allocation from the Restructuring Provision is taken back to the Provision as a first call on that underspend, in order to fund future investment.
HSSD has requested an allocation of funds from the Restructuring Provision, totalling £1,120,000 over three years. Full business cases have been submitted and challenged by the PSR Programme Office and supported by the PSR Programme Operations Board, the PSR Political Oversight Group and the Council of Ministers. These are detailed below.
HSSD: Reform Team (£970,000)
The Council of Ministers approved a Restructuring Provision request, in 2011, to provide for a CSR Programme Management Office of 9 staff for the period 2011/13 at a total cost of £1.25 million. This resource has proved invaluable to the department in managing the CSR programme by, inter alia, the provision of robust project management frameworks and skills. The Reform challenges now facing HSSD go beyond those contained within The White Paper and a lack of capacity and expertise in project programme management and transformation/improvement resource will either pose critical risk to successful management of these challenges or result in the deployment of expensive, off island resources such as interims and consultancy services.
The Reform Team Business Case describes the introduction of an integrated service improvement team in HSSD, enhancing the Department’s ability to deliver public sector reform. By creating sustainable Lean capacity and capability, and providing ongoing programme management, this will embed the Jersey Lean System (JLS) and will ensure visibility, benefits realisation and strategic alignment of operational changes.
JLS has been in place for 18 months and the experience and knowledge has started to be transferred to our colleagues within the States who are now starting their Lean Journey. HSSD has shared their experiences, lessons and benefits with the States Reform Team through:
- A half day Lean workshop held in March for Senior Managers across the States.
- A Lean Conference held in April, attended by 180 participants across the States, featuring speakers who were award winners and finalists in the recent UK Lean Healthcare Awards.
- Lean Awareness Sessions in June and July. These were run by 2 HSSD Green Belts and attended by 280 participants across the States.
- Benefits Realisation sessions with the Reform Team, including sharing template, techniques and lessons on measuring tangible projects
- Green Belt Project Meetings, Green and Yellow Belt Network Events and Open Days, which the States Reform Team attended.
The States has embarked on an ambitious reform programme; Lean is an integral part of this. HSSD has learned that, in order to support staff, secure benefits and develop a sustainable continuous improvement, a programme needs:
- Strong, visible leadership
- A real understanding of the issues, pressure and opportunities in Jersey
- Accessible, knowledgeable ‘super-users’, who have experience in delivering successful Lean projects
- Robust systems and processes
- A clear focus on benefits realisation
- Stakeholder engagement and communication
If successful in securing funding for the HSSD Reform Team, the department will continue to input to the States-wide Lean programme, through sharing our experience and knowledge. This may include participating in the delivery of future Yellow and Green Belt training, representation on the Lean Academy Steering Group and cross-Departmental networking. This will ensure that Departments are more able to support one another, reducing the reliance on external advisers in the future.
The Reform Team would comprise:
- Head of Reform Team (Lean Black Belt) working centrally as lead for LEAN and Programme Management, providing training and mentoring, running the JLS network, identifying, assessing and supporting potential projects, coordinating activity, reporting and managing performance.
- Two Reform Leads (Lean Black Belts), one working within the hospital and one within Community & Social Services, providing support to teams and LEAN projects, coaching and mentoring Yellow and Green belts and ensuring optimum benefits of operational service improvements.
- Coordination and reporting by 2 Project Managers and part time Administrator.
Not investing in continued JLS capacity and capability would seriously undermine the JLS programme in the Department. Individuals who have been trained and supported up to now would lose motivation, networks would not be continued, projects would slow down or cease and potential benefits would not be achieved. Further, any such initiatives in the future would be resisted and the States-wide JLS programme would be undermined as the ‘vanguard’ Department’s programme would be perceived as having failed.
HSSD has included an Appendix to their Business Case identifying benefits from Lean projects and has also reprofiled and reduced their initial request as some funds for 2013 have been found internally. Furthermore, the Lean Academy will ensure that, in future, benefits from Lean projects will be identified at the outset and actual benefits realised measured against those projected.
Senior Health Development Leadership (£150,000)
In order to deliver one of the key objectives in the States of Jersey Strategic Plan, HSSD is now in the process of implementing a new system of health and social care for the island. This involves the reform and modernisation of all aspects of the delivery of health and social services, including a significant remodelling of relationships and services in liaison with voluntary and community sector organisations and with primary care practitioners. The department itself also needs to evolve in the way it conducts its business both in terms of direct provision of services and in the commissioning of services provided by other organisations, both on and off island. This is a major challenge in terms of capacity, capability and culture and is fully reflective of, and congruent with, the States-wide Reform Programme.
In order to ensure that the department builds on the very real progress it has made over the last 3 years, its newly completed top team of Directors need to undergo a programme of corporate team building and leadership development to ensure that their skillsets and working arrangements are optimised to deliver their leadership role. It is intended that this programme will be team orientated and bespoke for the newly established team in health but sensitive to and aligned to the emerging work that Ashridge are developing for Chief Officer direct reports.
It is recognised in all health and social care systems in all jurisdictions that safe and sustainable services can only be devised and delivered with the full engagement of clinicians and other professionals. It was also highlighted in the Verita report of 2010, that there was an urgent need to further develop and enhance clinical governance and clinical leadership processes in the hospital. As a result, there are now much more comprehensive clinical/professional governance processes in place in the department in both the hospital and community and social services. In addition, there is a high level of commitment and interest by our senior clinicians in taking on leadership roles such a Medical Director and Clinical Director.
However, to date, only a minority of those clinicians have had some individual and de facto sporadic leadership skills development. The second part of our business case seeks to address this through the provision of a tailored medical leadership development work for them as individuals and as a leadership group. There is worldwide research evidence that demonstrates the strategic value of investing in specific medical leadership, tailored for senior doctors. The benefits of such programmes are clearly identified in outputs that include better health care outcomes for the community, superior redesign of clinical services and major advantages in hospital design and build programmes.
The delivery of the new system of health and social services is a key strategic objective for the States of Jersey, as set out in the Strategic Plan, and will take a decade to deliver. Successful delivery of such a major element of the States Reform agenda will require many things including significant resourcing. However, at the heart of successful delivery is a need for first class leadership throughout the organisation, and particularly from the senior managers and clinicians who need to model the skills and determination to deliver. These leadership programmes are critical first steps in developing and enhancing the ability to deliver our reform ambitions.
Strong, effective leadership is also critical to the delivery of Lean. Leadership development, including clinical leadership, will deliver:
- Timely decision making, with strategic and operational alignment
- Effective communication, with staff aware of the senior leadership intent and all senior leaders communicating consistent messages
- Delegation, with clear responsibility to deliver the intent
- Capacity, capability an commitment
- It is therefore a key enabler to the health and social care reform, to the delivery of Lean in HSSD and therefore to achieving the States Reform programme.
- Recommendation
It is recommended that the Minister of Health & Social Services:
- Accepts the budget transfers of £8,000, £643,000 and £469,000 in 2013, 2014 and 2015 respectively to the HSSD revenue head of expenditure from the Treasury and Resources Department Restructuring Provision.
- Reason for Decision
To accept the receipt of additional funding for the business cases detailed above.
Article 2(6) of the Public Finances (Transitional Arrangements) (Jersey) Order 2011 states that all or any part of the amount appropriated by a head of expenditure may, with the approval of the Minister for Treasury and Resources, be used for the purposes of another head of expenditure.
- Resource Implications
The HSSD revenue head of expenditure to increase by £8,000, £643,000 and £469,000 in 2013, 2014 and 2015 respectively and the Treasury & Resources Restructuring Provision to decrease by £8,000, £643,000 and £469,000 in 2013, 2014 and 2015 respectively.
Report author : Capital & Control Account Manager | Document date : 23 October 2013 |
Quality Assurance / Review :Finance Director – Corporate Group | |
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