Budget Transfers to Community and Constitutional Affairs and Chief Minister's Department for Public Health Functions

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A decision made on 4 May 2017:

Decision reference: MD-HSS-2017-0049
Decision Summary Title:	Transfer of budgets in respect of Public Health Services functions from H&SS to CMD and CCA		Date of Decision Summary:	24 April 2016
Decision Summary Author:	Director of Finance and Information		Decision Summary: Public or Exempt?	Public
Type of Report: Oral or Written?	Written		Person Giving Oral Report:	N/A
Written Report Title:	Transfer of Public Health budgets from Health and Social Services Department to the Community and Constitutional Affairs Department and the Chief Minister’s Department		Date of Written Report:	31 March 2017
Written Report Author:	Director, Corporate Policy, Chief Minister’s Department		Written Report : Public or Exempt?	Public
Subject: Transfer of Public Health budgets from Health and Social Services Department to the Community and Constitutional Affairs Department and the Chief Minister’s Department
Decision(s): The Minister decided to: a) Rescind decision MD-HSS-2016-0068, relating to this proposed transfer being effective from 2016, on the basis that the same transfer is instead being enacted from 2017 through this Ministerial Decision. b) approve the transfer of a net recurring revenue budget of £896,300 from the Health and Social Services Department to the Community and Constitutional Affairs Department (in respect of strategic public health, to include the Medical Officer for Health, and professional and care regulation); and £164,200 from the Health and Social Services Department to the Statistics Unit, Chief Minister’s Department (in respect of the statistical functions for public health); both with effect from 1st January, 2017; and any restructuring amounts approved for the transferred functions.
This decision is taken for a number of reasons, but most prominently; To position strategic public health, and professional and care regulation, separate from the delivery of health care; and to enhance joint working with related policy and regulatory functions, including wider social and housing policy, so as to support the wider strategic objective of ‘tackling the wider determinates of health’. To position the production of health statistics within the independent statistics unit, helping the production of health statistics to be integrated into their schedule of releases, and to benefit from the independence and expertise of the statistics unit and the oversight of the independent statistics users group.
Resource Implications: The Health and Social Services Department’s recurring revenue head of expenditure will decrease by £1,060,500 and 15 FTE with effect from 1st January, 2017; the Community and Constitutional Affairs Department’s recurring revenue head of expenditure will increase by £896,300 and 12 FTE with effect from the 1st January, 2017; the Chief Minister’s Department recurring revenue head of expenditure will increase by £164,200 and 3 FTE with effect from the 1st January, 2017; and any restructuring amounts approved for the transferred functions will also be transferred. This decision does not result in an increase to the net revenue budget or overall FTE of the States.
Action required: Assistant Director of Finance to forward a copy of the signed MD to the Decision Support Officer, Treasury, to the Director of Finance, CCA and to the Director of Finance – Corporate Group.
Signature:		Position: Minister for Health and Social Services
Date Signed:		Date of Decision:

Budget Transfers to Community and Constitutional Affairs and Chief Minister's Department for Public Health Functions

Transfer of Public Health budgets from Health and Social Services Department to the Community and Constitutional Affairs Department and the Chief Minister’s Department

Purpose of Report

To transfer recurring revenue budgets and associated Full Time Equivalent posts (FTEs) and any related approved restructuring amounts from the Health and Social Services Department (HSS) to the Department for Community and Constitutional Affairs (CCA) and the Chief Minister’s Department (CMD) in respect of public health functions under the direction of the Medical Officer of Health (MOH), and in doing so, to outline the change in more detail.

Background

This transfer is focused on delivering operational improvements to position strategic public health functions centrally, supporting the delivery of a Strategic Plan key area of focus to ‘develop a cross-governmental approach to tackling the wider determinants of health’; and to remove any actual or perceived, future or present, conflict of interest between delivery, regulation, statistics, and the need for the independence of the MOH.

This will further enhance cross-governmental strategic work on the wider health determinants, supporting a ‘health in all policies’ ethos, as recommended by the World Health Organisation. This is driven by the rapidly increasing costs of, and need for, health care by populations with increasing proportions of elderly people – as here in Jersey - and the recognition that funding health care on current trajectories will become unsustainable without wider concerted cross-governmental effort to enable the societal conditions where people can expect healthy and productive lives, and in turn, help to prevent illness and avoidable burden on health care provision. Indeed, most aspects of government policy have a potential health impact, illustrated by the renowned Dahlgren and Whitehead diagram:

In turn, good health:

Enhances quality of life and increases healthy life expectancy
Increases workforce productivity
Increases capacity for learning
Strengthens families and communities
Contributes to security, poverty reduction and social inclusion
Reduces need for health care

In essence if avoidable ill health could be reduced the potential savings are considerable.

CCA is well placed to support this as a Department which already assists a range of Ministers developing and delivering cross-cutting policy initiatives, including in relation to social policy, and which works in close proximity with the Chief Minister’s Office, including on the Strategic Plan and Long Term Plan, where public health strategic approaches are central and critical.

Changes effected by the accompanying Ministerial Decision

3.1. The MOH and the Strategic Public Health Unit will be based in CCA – the existing budget to move to CCA

The creation of CCA aims to improve efficiency and increase flexibility by bringing together complementary community policy areas, such as housing policy, social policy, early years’ policy, justice policy, safeguarding, and emergency planning, with front line services ensuring safety for our community, such as policing, fire and prison. This provides for greater sharing and collaboration as policy develops in light of experience.

CCA also acts as the executive for a number of ministerial oversight groups dealing with cross-cutting policy, such as the Alcohol and Licensing Policy Group and the Children and Vulnerable Adults Policy Group, within which public health has a role.

The MOH and team are currently part of HSSD. The MOH sits on their senior management board and reports to the HSSD Chief Officer. This arrangement has an inherent potential conflict of interest in the independence of the MOH role although the parties involved have worked constructively to keep this to a minimum.

However, there is an increased risk of conflict, or a perception of conflict, as the scope of regulation of care extends into health care provision as set out in the new law, and in the area of statistical reporting.

In making this transfer, the MOH will become a member of the CCA senior management team, and for budgetary and other day to day management matters, report to the CCA Chief Officer, as Accounting Officer for the relevant budget.

In addition, the MOH will have reporting responsibilities to the Chief Executive as Chair of the Emergency Planning Board, and directly to the Chief Minister as Chair of the Emergency Council, in relation to matters of emergency planning and preparedness.

The MOH will also advise the Chief Minister, Chief Executive, senior officers, and Ministers, across government, on such strategic policies and operational responses which are relevant to the duties of the MOH as the government of Jersey’s lead advisor on public health matters.

In the course of these duties, the MOH is expected to provide impartial, independent advice at all times with direct access to Ministers and Chief Officers in order to deliver this legal responsibility.

Indeed, while the MOH, along with other expert advisors such as the Economic Advisor, is not a member of Corporate Management Board, whose primary collective function is the management of the public sector, the MOH does, and must, contribute fully and extensively to policy development across government.

In this way, the role of the MOH is to ensure that public health impact is routinely considered not just in health services, but in education, environment, housing, and other areas, such as economic and fiscal policies, i.e. health in all policies, as outlined earlier in this report.

The placing of the MOH and Strategic Public Health Unit within CCA in Cyril Le Marquand House is designed to enhance this collaboration, supported by arrangements to ensure that public health policy continues to support the delivery of services improving public health outcomes, such as vaccination processes.

3.2. The Regulation of Care (Jersey) Law 201- was approved in 2014 with the Chief Minister as the responsible Minister – the existing budget to move to CCA

CCA supports a range of Ministers, including the Chief Minister on the development of the Regulation of Care (Jersey) Law 201- . The Law will provide a new framework for the regulation of health and social care in Jersey, and was approved by the Assembly in 2014. It will extend the current scope of regulation beyond private residential and nursing homes to also encompass the provision of care by government, in particular, by HSSD.

The drafting of the Regulations is underway, and in the meantime, the existing arrangements are administered by HSSD, under the line management of the Chief Officer for HSSD, the MOH, and the Head of Professional Care Regulation, with the Director of Social Policy within CCA also assisting with policy development.

To facilitate the orderly transfer on adoption of the Law, the existing budget will be transferred to CCA, remaining under the line management of the MOH, pending the creation of the Health and Social Care Commission.

Note on Ministerial Responsibility:

CCA supports a number of Ministers. In particular, it supports the Chief Minister and Assistant Chief Minister, including on the development of the Regulation of Care legislation; the Minister and Assistant Minister for Home Affairs, the Minister for Housing; and the Chair of Legislative Advisory Panel. Following the transfer of the MOH and the Strategic Public Health Unit, CCA will also support the Minister for HSS on public health policy matters including the HSS Minister’s statutory responsibilities in this area. This decisions makes no changes to these ministerial responsibilities, it is confined to the transfer of budgets.

3.3. The Public Health analysts will join the Statistics Unit – the budget to move to CMD

The Statistics Unit is independent, and funded by CMD. It includes trained statisticians, and is governed by the “Code of Practice for Official Statistics”, including which statistics are produced, when, and the process for releasing statistics.

The current Health Intelligence Unit, accountable to the MOH, also includes public health analysts who have trained in statistics specialising in public health. Its current functions include producing regular profiles of population health, as well as a range of regular statistical reports, such as abortion, obesity, premature death, and ad hoc topic-based reports, e.g. Men’s Health. Its current service is, and will continue to be essential to the MOH to inform strategic public health prioritisation as well providing the necessary responsive, reactive service as regards emergent public health issues, preparing reports and briefings in relation to States business, responding, often urgently, to media requests for interviews and briefings, FOI requests and support to HSS and the medical profession in accessing and analysing public health statistical information.

In the production of regular statistical reports, there is potential to benefit from levels of independence enjoyed by the Statistics Unit, including oversight by the independent Statistics User Group.

The transfer of the Public Health analysts to the Statistics Unit will increase synergy and resilience, and may also deliver some economies of scale by bringing statistical functions closer together.

Following the transfer, the Statistics Unit will consult with the MOH on the scheduled programme of statistical releases and ensure that the MOH has continuing access to the public health intelligence analysis and support necessary for the purposes outlined above. The key link between the MOH and the Chief Statistician will be the Head of Health Intelligence whose post will transfer with, and continue to report to, the MOH in the new Strategic Public Health Unit within CCA, with appropriate arrangements put in place. The Chief Statistician will also work with the Chief Officer of CCA, with a particular view to delivering the current level of statistical outputs and resources to public health, and to enhance and expand those outputs where possible and desirable.

3.4. Note on related Public Health functions – no budget transferred by this decision, but outlined as context

The Environmental Health Team, formerly reporting directly to the MOH, has been transferred to the Environment Department to improve synergy and economies of scale across common agenda, with appropriate arrangements to ensure that there is no risk to the environmental health professional resource, including ongoing delivery of the MOH’s statutory responsibilities in the protection of the population’s health from known or emergent environmental threats. The Head of Environmental Health continues to have a direct line to the MOH, and vice versa, for expert professional public health support and advice.

The MOH’s current Preventive Programmes Team remains within HSS, though newly re-located in the Directorate of System Redesign and Delivery, positioned there to work more synergistically alongside the Primary Care Team. The Preventive Programmes Team will continue to deliver the MOH’s responsibilities to protect the population’s health and prevent diseases by maintaining the standards and coordinating the delivery of screening, immunisation, and smoking cessation programmes, as well as response to emerging disease threats (e.g. pandemic flu; more recently Ebola, Zika). Appropriate arrangements will be in place to ensure that the MOH’s responsibilities to protect the population through effective and up to date public health preventive programmes, and public health response to disease threats, remain appropriately resourced and supported. The Head of Preventive of Programmes will also continue to have a direct line to the MOH, and vice versa, for expert professional public health support and advice.

Reason for Decision

Article 18(1)(c) of the Public Finances (Jersey) 2005 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 transferred from one head of expenditure to another in order to comply with accounting standards issued for the purposes of Article 32(2).

Recommendation

The Minister is recommended to approve the Health and Social Services Department’s reoccurring revenue head of expenditure to decrease by £1,060,500 and 15 FTE with effect from 1st January, 2017; the Community and Constitutional Affairs Department’s reoccurring revenue head of expenditure to increase by £896,300 and 12 FTE with effect from the 1st January, 2017; the Chief Minister’s Department reoccurring revenue head of expenditure to increase by £164,200 and 3 FTE with effect from the 1st January, 2017; and any restructuring amounts approved for the transferred functions to also be transferred.

Resource Implications