Health & Social Services
Senior Management Team Meeting
26th September 2006
Independent Inspection and Review of Health and Social Services (HSSD)
Background
The States Strategic Plan 2006-2010 states:
2.3.1 The performance of the Health and Social Services Department in meeting “Standards for Better Health” will be independently inspected by the Healthcare Commission in April 2007 and the results of that inspection will be published (HSS)
A business case for independent inspection of HSSD services and provision of second stage complaints (see appendix 1) was sent to the Healthcare Commission (HC) on the 04/07/06. This was reviewed by the HC Strategy Committee on the 13/07/06. The Chief Executive of the HC wrote to the HSSD CEO on the 01/08/06. To summarise:
· The HC declared that they were unable to provide HSSD with second stage complaints due to their own resource constraints.
· The HC was unable to provide independent inspection to the States of Jersey Health and Social Services due to a lack of management capacity.
A response from the HSSD CEO was sent on 09/08/06 and a meeting arranged in London to identify a way forward. Those attending the meeting were as follows:
Dr Richard Lane Medical Director HSSD
Richard Jouault Director CPPM HSSD
Kate Lubley Head of Operations HC
David Bawden Head of Methods HC
The outcomes of the meeting were as follows:
The Isle of Man Report (July 2006) was a “one-off intervention” and will not be repeated. The Healthcare Commission no longer has the infrastructure to deliver this type of “clinical governance review”(CGR). Its current approach to inspection is “light touch”. This involves UK Trusts declaring their compliance with the “Standards for Better Health” and the Commission collating significant amounts of information from a variety of sources such as the National Statistical Data Warehouse for Hospital Episode Statistics (HES), The Clinical Negligence Scheme for Trusts (CNST) and the National Patient Safety Agency (NPSA) etc. The intention is to inspect about 20% of Trusts. As HSSD does not contribute to these data collection points, the HC are not able to assure a declaration made by HSSD against the Standards for Better Health.
The merger of the Healthcare Commission and the Commission for Social Care Inspection (CSCI) is due to occur in 2007-2008. The 1st Bill regarding the merger goes before UK Parliament in autumn 2006. The precise outcome of this merger and its effects upon the current approaches to inspection are not known at this time.
The way forward
The HC carry out a wide range of reviews of healthcare services and it would be practicable for HSSD to be included in these reviews. This would enable HSSD to benchmark its’ services against UK provision by independent means.
Recommendation:
HSSD participate in a rolling program of independent review of healthcare services prescribed by the Healthcare Commission in 2007. The program would begin with the following reviews:
- Maternity Services
- Inpatient Mental Health Services
- Substance Misuse Services
- Race Equality.
HSSD continue to develop its governance framework with regard to compliance with the Standards for Better Health.
Resource Implications
Precise costings for inclusion within the HC’s review program are not known at this time although it has been emphasised that it is significantly less than a Clinical Governance Review (IoM estimated at between £100K-£150K). It is anticipated that the annual cost of review will be met by the revised growth bid for 2007.
Action:
The Senior Management Team is requested:
· To support this approach to independent review of HSSD.
· Nominate membership to a team to develop alternative plans for the management of second stage complaints.
· Consider the implications for Primary Care Services.
Richard Jouault Dr Richard Lane
Director CPPM Medical Director
26th September 2006
Appendix 1
Healthcare Commission Outline Business Case
Project title: Jersey - review and inspection of health and social care provision
Strategic Goals:
• To provide assessment of the assurance of the quality of healthcare services provided by the Health and Social Services Department (HSSD) Jersey, to the population of the island.
• Making information available about the performance of the HSSD, Jersey to patients and the public.
• To provide assessment of the assurance of the quality of governance arrangements between HSSD and partner agencies: specifically General Practice and Family Nursing & Home Care Inc.
• To assist the Heath and Social Services Department to improve its healthcare services by the provision of review and inspection and guidance on how to implement practices for improvement.
• To provide an independent second stage of complaints for HSSD.
• To provide the opportunity for the Healthcare Commission to implement assessment methodology in a non UK health and social care environment and to learn from this experience.
• To provide a basis on which to develop further partnership working in healthcare audit and inspection between the Health and Social Services (HSSD) Jersey and the Healthcare Commission.
Description
Background — Jersey
Jersey is the largest of the Channel Islands with an area of 118.2 sq. km. situated 14 miles off the North West coast of France and 85 miles from the English Coast. Jersey is a Crown Dependency and is not part of the United Kingdom, nor is it a colony, but it owes allegiance to the British Crown and the UK is responsible for Jersey’s Defence and international representation. It is not represented in the UK parliament, whose Acts only extend to Jersey if expressly agreed by the Island that they should do so.
Jersey is not part of the European Union, although it has a special relationship with the EU which is defined in Protocol 3 to the UK Treaty of Accession. It is divided into twelve parishes each of which is presided over by an elected Connétable, who deals with issues relating to civil matters and by a Rector who oversees issues relating to Ecclesiastical affairs.
The legislature of the Island is called “The States of Jersey”, members of which are elected by the population. In December 2005 a new system of government was established in Jersey. The old Committee system was abolished and replaced by a new Council of Ministers working alongside scrutiny panels.
The economy of Jersey has changed dramatically over the past 40 years with the decline of traditional industries such as agriculture and latterly tourism and the growth of the Financial Services sector that now employs almost a quarter of the workforce. As a result, the population of 87,186 (2001 Census) enjoys a relatively high GNI of £35,000 per head of population.
Background — Health & Social Services
HSSD is divided into the following Directorates
• Corporate Directorate– (which includes Ambulance & Estates)
• Medical Directorate — (which includes Services for Older People and Paediatrics)
• Surgical Directorate — (which includes Maternity and Procurement)
• Social Services Directorate — (which is divided into Adults, Children and Special Needs Services)
• Mental Health Directorate (which includes EMI, Drugs and Alcohol and CAMHS)
• Public Health Directorate (which includes Health Protection, Health Promotion and Health Intelligence Unit)
The overall aim of the Health & Social Services Department is to -:
Redesign the health and social care system to deliver improved health and social well being for the Island community.
Key objectives and measures of performance are -:
Objective 1: Improve health and social care outcomes by reducing the incidence of mortality, disease and injury in the population
Performance/success criteria:
By 2010:
● Increased life expectancy at birth in Jersey for men and women.(Target = for men to 78.6 AND for women to 82.5)
● Reduced mortality rates:
- From heart disease and stroke and related diseases for people under 75 (Target = 85 per 100,000 population (aged standardized mortality)
- From cancer in people under 75 (Target = 113 per 100,000 population (aged standardized mortality)
- From suicide and undetermined injury (Target = 7.4 per 100,000 population (aged standardized mortality)
● Reduced adult and children smoking rates (Target = Adults 16+ = 24% (prevalence), children aged 14 & 15 = 29 % (prevalence) by 2006)
Objective 2: Improve the consumers’ experience of Health and Social Services
Performance/success criteria:
● Secure improvements in the consumers experience of health and social services as measured by independently validated surveys (Target = Survey scores better than England average).
● Minimize elective inpatient and outpatient waiting time (Target = Maintain access to 3 months or less)
● Ambulance response times – Percentage of category A calls met within 8 minutes. (Target = 75% of calls to be responded to within 8 minutes.)
Objective 3: Manage staff and resources so as to improve performance and provide value for money
Performance/success criteria:
● Financial balance - is both a key objective and a legal requirement for States Departments. It provides the essential platform on which to manage and develop services (Target = Balanced budget (-/+ 100K).
● Minimise management costs to ensure maximum resources are directed to health and social care services (Target = Management staff to account for less than 3% of the workforce).
Objective 4: To promote the independence of adults needing social care enabling them to live as safe, full and as normal a life as possible, in their own home wherever feasible
Performance/success criteria:
● The percentage of adult social services users receiving a statement of their needs and how they will be met (Target = 100%).
● Clients receiving a review as a percentage of those receiving a service (Target = 70%).
● Intensive home care - Households receiving intensive home care per 1,000 population aged 65 or over (Target = 10% or greater by 2010).
● Delayed transfer of care - The average number of delayed transfers of care per 100,000 population aged 65 or over (Target = 30 per 100,000 population aged 65+).
Objective 5: To maximise the social development of children within the most appropriate environment to meet their needs.
● Stability of placements of children looked after - The percentage of children looked after at 31 December with three or more placements during the year (Target = 10% or less of children with 3 or more placements).
● Children in care in family placements - The proportion of children being looked after by family, friends, foster carers or placed for adoption (Target = 80% by 2010).
● Re-registrations on the Child Protection Register - The percentage of children registered during the year on the Child Protection Register who had been previously registered (Target = 10% or less re-registration).
● Duration on the child protection register - The percentage of children de-registered who had been on the Register for longer than two years (Target = 5% or less).
Evidenced based practice
Evidenced based practice is implemented by utilising-:
National Service Frameworks (NSF’s) developed for England and Wales
National Institute of Clinical Excellence guidelines
Evidence based guidance and protocols of the Royal Colleges (UK)
Scottish Intercollegiate Guidelines Network (SIGN) guidelines
And; participating in National Audits-:
National Stroke Audit
South West Cancer intelligence Service Registration Reports
National Confidential Enquiries
Healthcare Commission Project Objectives:
Following contract negotiations, the partnership between the Healthcare Commission and the HSSD, Jersey will provide:
1) A transparent, accessible and robust system of review and inspection of processes to assure the quality of health care provided to the population of Jersey.
2) A detailed summary of the evidence on which the review and inspection findings are based
3) A comprehensive action plan to address areas for improvement and further review
4) Opportunities and a basis from which to develop further partnership working between the HSSD Jersey, and the Healthcare Commission.
Phase 1: fieldwork and analysis
Fact-finding visits and interviews within Health and Social Care services and other relevant agencies in Jersey.
This will include establishing a number of stakeholder interviews with patients, carers, local groups and organisations and members of the public, staff within the HSSD and operational staff providing health and social care services.
This will include establishing interview sessions in various locations throughout the island for patients and members for the public, local partner organisations and groups.
This will also include a number of interviews with clinical, non-clinical and managerial staff providing health and social care and observation visits to clinical and non-clinical areas.
Meetings with lead personnel or specific parts of the assessment may be arranged.
Timeframe September 2006 — February 2007
Phase 2: Analyse and synthesize results
The data and information gathered from the review and inspection will be collated, coded and analysed to form the basis of the final report and evidence tables
Timeframe: March — April 2007
Phase 3: Drafting of Report
The HSSD will have the opportunity to comment on the report during the drafting stages to ensure factual accuracy. The draft report will follow the agreed processes for ensuring quality assurance of reports produced by the Healthcare Commission.
Timeframe: April 2007
Phase 4: Provision of Second Stage Complaints
Healthcare Commission will act as an independent second stage for complaints for all HSSD service users.
Timeframe: December 2006.
Appendix I
Additional review and inspection formation
Wording in reports
Every statement in the final report will link with a section in the evidence base, which is a record of the data and information gathered during the review and inspection process, and will reflect the strength of that evidence.
Stakeholder meetings
The purpose of the stakeholder meetings is to seek views, experiences and comments from patients and the public and colleagues in the local health economy and partner organisations.
The interview, note taking, reflection, requests for a copy of the notes and expenses for members of the public
The project manager will explain the Healthcare Commissions remit; that notes are taken; and that information is non attributable but will contribute to the focus of the review and inspection.
Individuals may occasionally request a copy of the notes of their interview. The interviewee should make such requests in writing to the information governance manager at the Commission. The project manager will be asked to provide the information governance manager with the transcripts who will then contact the interviewee.
Travel expenses can be paid for members of the public. The project manager will exercise judgement regarding the safety of a distressed person to travel/return home.
Timetable for meeting with health and social care staff within HSSD
Interviews will take place with a cross section of staff in scheduled interviews lasting between an hour and an hour and a half. Preparation for timetabling for health care staff includes stipulated length of session as is the need for dedicated travel time/preparation/write up/coding time between sessions.
Appendix 2 Health & Social Services – list of Contacts
Key contacts
Rose Naylor Director of Nursing & Governance
Dr Richard Lane Medical Director
Richard Jouault Director of Corporate Planning and Performance Management
gov.je