Health and Social Services Department
Operational Plan 2012 - 2013
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Contents
1. Foreword .................................................................................................... 3
2. What is an operational plan? ....................................................................... 5
3. Responsibilities and Roles within HSSD........................................................ 6
4. The 2020 Vision ......................................................................................... 12
5. Where we are now ..................................................................................... 13
6. What we need to consider ......................................................................... 19
7. Our Work for 2012 and beyond ................................................................. 22
8. Balancing the books ................................................................................... 23
9. How do we measure outcomes?................................................................ 26
10. How we keep you informed ....................................................................... 26
Annex 1 – HSSD Mandate ................................................................................ 27
Annex 2 - 2020 Vision: 18 Key points ............................................................... 29
Annex 3a: Central and States Wide Priorities ................................................... 31
Annex 3b: HSSD only Priorities ......................................................................... 32
Annex 4 - Revenue Budget 2012 ...................................................................... 34
Glossary ........................................................................................................... 35
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1. Foreword by Mark Cooke, Chief Officer
I am delighted to present to you our operational plan for 2012 - 2013. This is
the first operational plan to be published following the approval of the HSSD
2020 Vision for the States of Guernsey.
The 2020 Vision sets out an ambitious programme for how we can work
together to ensure the future sustainability and affordability of Health and
Social Care services. It is the Department’s intention to deliver high quality
health and social care services across Guernsey and Alderney. We strive to
continually improve what we do and how we do it, in the most effective and
efficient way.
The causes of poor health and increasing social care needs are many and
varied. However, there is clear evidence that common themes such as better
housing, better education, better job prospects and an effective welfare
system reduces the ultimate demand on health and social care services. We
are collaborating closely with other States Departments, community
organisations and the business sector to reduce reliance on our services by
supporting people’s physical, mental and social well-being. With a backdrop of
a very tight financial budget this sets out a real challenge for the coming years.
This one year operational plan provides a guide to what we hope to achieve in
the coming 12 months as part of the next steps in achieving the 2020 vision.
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In summary these are:
- To continue to deliver high quality, safe and effective services
- To balance our books for 2012 and develop plans to deliver the 2013
budget
- To work with other States Departments on the Social Policy agenda
- To continue to plan for the future
o Develop strategies for Mental Wellbeing, Disability, Supported
Living and Ageing Well
o Seek permission to replace the Castel Hospital by 2015
o Improve the Island’s Health and Social Care governance and
assurance processes
o Review and revise the 2020 Vision
Significant challenges and great opportunities lie ahead for Health and Social
Care in the Bailiwick. I hope this provides you with some insight into the work
planned for this year, and gives you some assurance that the Health and Social
Services Department is working hard on your behalf.
June, 2012
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2. What is an operational plan?
An operational plan explains the things that the Health and Social Services
Department need to do to work towards its strategic goals.
You can find out more about the Department’s strategic goals by reading the
2020 Vision.
a) What does this operational plan tell you?
This operational plan looks at the work and priorities of the Health and Social
Services Department in 2012.
It explains how these fit in with the Department’s long-term goals. It also
describes the major issues that will affect the way we work.
b) How can you find out more?
You should contact Martin Gavet, Change and Performance Manager, Tel:
725241 Ext: 4879.
You can also read about the work of the Health and Social Services Department
on http://www.gov.gg/healthandwellbeing.
c) How often is the operational plan updated?
This is the first operational plan for the Health and Social Services Department.
It covers 2012 to 2013 (one financial year).
The next operational plan will be written in 2013, and will cover the period
from 2013 to 2016. All future operational plans will last three years.
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3. Responsibilities and Roles within HSSD
a) What do we do?
Our broad responsibilities are defined as 'Promoting, protecting and
improving the health of all, through the provision of hospital, community,
social and public health services.' A copy of HSSD’s full mandate is included
under Annex 1 (see pages 27 & 28).
HSSD’s service users have varying and often complex needs and our role is
to provide the range of services to meet those needs. The pictogram below
highlights the diversity of our service users and our mission statement for
all the work we do.
HSSD’s Mission Statement
To promote, improve
and protect the
health and social
wellbeing of all
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b) Delivering high quality services
The Health and Social Services Department’s
responsibilities are extensive, ranging from the
provision of hospital-based services to health
promotion and social care.
The following chart shows the range of services provided by HSSD and the
number of dedicated staff that work in each of the services:
HSSD Staff by Service Area
(Whole Time Equivalent)
Finance &
Procurement
Public Health
Diagnostic &
Support Services
37
IM&T
40
97
18
Community &
Disability
Acute Hospital
Services
279
290
Human Resources
28
Estates and
Facilities
264
Specialist Services
355
Central
Administration
Services
19
Institute of Health
& Social Care
Studies
Children &
Maternity Services
203
63
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c) Staff by Profession
To enable HSSD to deliver the large number of services it is responsible for, we
have a varied, diverse and dedicated workforce. Many of our staff work closely
with other services within HSSD and with other States Departments. They are
often part of a Multi-Disciplinary Team who are working together to provide
the best outcomes for our service users.
The chart below gives an overview of HSSD’s diverse workforce by showing the
number of staff employed by profession:
HSSD Staff by Profession
(Whole Time Equivalent)
Medical Technicians
26
HSSD Support Staff
Carers
258
104
Registered Nurses
529
Estates,
Housekeeping &
Catering Staff
294
Unregistered
Nurses
324
Medical & Allied
Health Professionals
Midwives
115
25
Social Workers
61
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d) Our Partners and how we work together
Primary Care
There are three primary care practices in Guernsey and two in Alderney. The
GPs are usually the first point of contact for an individual when they require
support or help. Most practices have other services including physiotherapy,
chiropody and osteopathy. If a GP feels that a problem requires further
investigation or intervention, they may refer to a consultant at the Medical
Specialist Group or to one of HSSD’s community teams, for example.
Secondary Care
Secondary care includes anything that needs further intervention after going
through the primary care system. This largely involves accommodation-based
services, such as hospital, residential or nursing home care, which are provided
by HSSD, the private sector and the charitable sector.
Medical Specialist Group
The Medical Specialist Group (MSG) provides the emergency and elective
specialist medical services for the Bailiwick of Guernsey within the secondary
health care framework of Guernsey and under the Health Insurance Scheme.
This is in partnership with the Health and Social Services Department and the
Social Security Department.
Primary Care Company Limited
The Primary Care Company Limited (PCCL) provides doctors for patients
attending the emergency care facility at the Princess Elizabeth Hospital (PEH).
It also provides the medical cover to ensure there is always a doctor available
in the PEH.
Guernsey Physiotherapy Group
The Guernsey Physiotherapy Group (GPG) is contracted to provide
physiotherapy to patients who are under the care of a specialist
consultant/doctor. They provide a wide range of services, both in the Princess
Elizabeth Hospital and to outpatients, in areas such as musculoskeletal,
neurological, stroke, and respiratory.
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St John Ambulance and Rescue Service
The St John Ambulance and Rescue Service provides emergency ambulance
services and routine patient transport through a mixture of Paramedics,
Emergency Medical Technicians and Ambulance Care Assstants. A wide range
of other services are also provided through their charitible arm including
inshore rescue, cliff rescue, marine ambulance and decompression chamber.
Tertiary services
Tertiary services tend to be more specialised and complex, and include such
things as cardiac surgery, organ transplants, radiotherapy and spinal surgery.
These services are not able to be delivered in Guernsey and a referral to a UK
hospital would be required.
Other States Departments
HSSD works closely with other departments of the States of Guernsey.
In particular, it works with the Social Security Department (SSD) which funds
the medical specialist contract and the physiotherapy contract. HSSD, jointly
with SSD, reviews the performance of our key strategic partners against the
agreed contract terms. Together the departments review services, prioritise
services, plan and agree funding for new medical or physiotherapy services.
HSSD and SSD also work together to manage the demand for new medicines so
that the people of Guernsey and Alderney have the medicines they need at a
reasonable cost to the States of Guernsey.
The Policy Council is a key enabler of HSSD’s work. It supports the prioritisation
of legislation to enable HSSD to better deliver its core responsibilities. This
enables us to manage risk in health and social care wherever it is delivered and
whoever is funding it, so the people of Guernsey and Alderney can be
confident of the quality of the services they buy and receive.
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e) Putting our work into the wider context
Guernsey's Government has developed an approach to improve its planning
and performance that makes government more accountable to the public. It
has done this by introducing the States Strategic Plan (SSP) which enables the
co-ordination of long-term government planning with shorter term
departmental planning.
The States Strategic Plan (SSP) is the overarching strategy for the whole of the
States. HSSD’s long term strategic plan and yearly operational plan must
therefore align with the SSP. The pictogram below shows how the key States
plans, Fiscal and Economic Policy, Social Policy and Environmental Policy,
interrelate:
HSSD
Operational
Plan 2012
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4. The 2020 Vision
The 2020 Vision sets the strategic framework for the future of the health and
social care system. It is about all States Departments working together towards
common goals to provide a sustainable health and social care system for
Guernsey and Alderney.
The 2020 vision has three key objectives which underpin what we need to
do. These are:
• Promote healthy lifestyle choices and social wellbeing
Promote
Improve
• Improve services, continuously striving for safety, quality,
efficiency and effectiveness
• Protect and support the community
Protect
Central to the 2020 Vision theme is the aim to support people, wherever
possible, to live independently in their own homes. This will be achieved by
working with many other States departments to provide appropriate
interventions at the most effective point in time.
It will mean a significant improvement in the integration of services, so that
people can access the right service at the right time, through public, private or
voluntary sector providers. This will ultimately result in more effective
outcomes for the service user, and a more efficient system for the taxpayer.
For details of the aims of the 2020 Vision see Annex 2 on pages 29 & 30.
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5. Where we are now
We aim to offer services that meet islanders’ needs, and to continually
improve the work that we do.
In order to make sure that we are doing the right thing, we have regular
independent reviews of the services we provide. Our most recent reviews
included:
Occupational Therapy
Midwifery
Physiotherapy
Radiology
Emergency Care
Ear/Nose/Throat
Orthopaedics
Urology
Obstetrics
Gynaecology
From time to time, we also commission reviews of the wider health and social
care system. Most recently, the King’s Fund reported on the future costs of the
system (more in Section 5) and Sector produced a report, commissioned by the
Public Accounts Committee, on the value for money of the services delivered
by the Medical Specialist Group and the Guernsey Physiotherapy Group.
We use these reports, together with internal information about our services,
to shape our long-term plans and to make important changes.
a) What have we already achieved?
In 2011, we made improvements in many different areas of our work:
We have streamlined our management structure and employed new
clinical staff.
We have improved our governance and audit frameworks, to make sure
we are delivering good quality services.
We have bought new equipment: including 7 new beds that will help to
reduce falls, and a mass spectrometer for analysing drug samples.
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We have been involved in joint work with other departments and other
islands, and have helped to launch and develop some important
strategies for Guernsey and Alderney.
We have significantly reduced our costs and improved our efficiency.
If you want to find out more, you can read about the different things we have
done in the following boxes:
Service Improvements
We have bought a Gas Chromatograph Mass Spectrometer for drug
analysis. This means we can now deal with urgent drug samples within
one hour. We can also detect Emerging Drugs of Concern (EDOCs) which
have not been reported in the UK.
We have bought 7 new falls beds to reduce the number of falls in
hospital.
We have added Radiology Order Communications, Mental Health Clinical
Notes and Electronic Patient Record tools to the Electronic Health and
Social Care Records System (EHSCR). This has improved the patient
journey by making the ordering process for tests more efficient and
providing quicker access to diagnostic services.
We have launched a Mental Health and Wellbeing Service in Primary
Care and created an Intensive Outreach Team for Child and Adolescent
Mental Health.
Children and Young People’s Plan 2011-13 – this cross-departmental
programme of work resulted in a number of service improvements,
including the appointment of 4 new social workers.
Bowel Cancer Screening commenced in 2011 helping to achieve earlier
diagnosis and reducing the number of future cancers.
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Good Governance and Clinical Audit
We have completed and implemented an Integrated Risk Management
Policy, which includes procedures for dealing with Serious Untoward
Incidents (SUI) and for Reporting of Injuries, Diseases and Dangerous
Occurrences (RIDDOR).
The quality assurance system for the States Analyst’s Laboratory has
been audited and reaccredited by the United Kingdom Accreditation
Service (UKAS).
We have completed 4 Reporting of Incidents, Diseases and Dangerous
Occurrences Regulations (RIDDOR) investigations and 18 Serious
Untoward Incidents (SUI) investigations, and we have taken part in
national audits on falls and bone health. This has resulted in changes
and improvements in clinical practice.
We have developed a Clinical and Social Care Audit Strategy and we are
drafting a new Clinical and Social Care Governance Strategy.
We have developed an audit tool for the Bowel Cancer Screening study
and an audit feedback form for operational clinical governance
committees.
HSSD has introduced an Ethical Framework to support and underpin the
decision-making process. It seeks to ensure that decision-making will be
undertaken fairly, reasonably, impartially and transparently.
The Institute of Health and Social Care Studies has been validated by
the University of East Anglia.
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Savings, Cost Avoidance and New Revenue
We have
reviewed
strategic contracts
and made
significant
procurement and efficiency savings.
We have made major reductions in the cost and number of off-island
placements for those with acute and complex needs.
We have reduced our expenditure on temporary staff.
We have transferred cardiology services from London to Southampton
in response to patient experience.
Strategic Developments
We have established a Projects, Programmes and Portfolio Office (P3O)
to coordinate and prioritise our strategies and long-term plans.
Mental Health legislation for Guernsey has been given Royal Assent
through the Privy Council.
We have taken a lead role in developing the new cross-Departmental
Supported Living and Ageing Well Strategy.
We have appointed a Disability and Equalities Officer to develop the
cross-Departmental Disability and Inclusion Strategy.
We have completed the first three-year cycle of the Children and Young
People’s Plan.
We are formulating new strategy to support the mental wellbeing of
islanders.
Joint Working
We have taken part in the Small Islands Conference.
We have worked with the Financial Transformation Programme to
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Joint Working
improve efficiency and make savings across the Department.
We have started a dialogue with Jersey about closer joint working.
We have been involved jointly with the Housing Department in the
development of extra-care housing.
We have actively contributed to other States departments, policies, and
the States Social Policy Agenda.
Internal Changes
We have completed the restructure of the Health and Social Care
Services Directorate and the Corporate Services Directorate, and
reduced the number of managers in the department.
We have re-aligned budgets following the restructure of the HSSD
directorates.
Staff in many different areas have completed a range of qualifications,
including NVQs, Masters, diplomas, certificates and PhDs.
In addition to the above, there are many other achievements by our staff and
the examples given are just a flavour of recent success stories.
New Buildings
We have received planning permission for new Mental Health facilities.
We have agreed the design of the new extra-care housing with the
Guernsey Housing Association and the Housing Department.
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b) What is not working so well?
We have identified a number of areas where our services are not meeting
expectations, or where we will need to make changes to keep up with best
practice elsewhere.
As part of the 2020 Vision we will be looking at:
The organisation and funding of health and social care services in
Guernsey and Alderney.
Appropriate community and care home-based support for working age
and older adults.
Demand for HSSD-run services in education, such as speech and
language therapy and occupational therapy.
Developing the way we work with Primary Care and secondary
healthcare services, to deliver high quality, “seamless” health care to
islanders.
Improving the way we provide services to Alderney.
We are constantly working to improve our services in areas where they do not
meet expectations. You can find out more about some of our major plans in
the latest update of the 2020 Vision.
Link
For further details of HSSD’s 2020 Vision please go to the document
downloads section at the following States of Guernsey webpage:
http://www.gov.gg/healthandwellbeing
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6. What we need to consider
Good quality social care and health care services depend on good quality staff,
sufficient and predictable funding, and the ability to understand and to meet
need.
This section looks at the constraints that will affect each of these three areas
now and in the coming decades. We will have to take these constraints into
account, and find new ways of operating, if we want to continue delivering the
kind of services that Guernsey and Alderney expect.
Two recent reports have given us useful information on the future demand for,
and cost of, social care and health care in Guernsey. These are:
Public Sector Expenditure. Andy Sloan, PhD (States Economist). Policy
and Research Unit, States of Guernsey.
Report from The King’s Fund.
a) Health care and social care staff
The States has decided to limit the total population of Guernsey to its level in
2007. This means that more and more members of the working population will
reach retirement over the next few years and they will not be replaced with
new workers.
This will limit the total number of staff available to deliver health and social
care.
As more of the population reach older age, the demand for social care and
health care services is likely to increase. Older adults tend to use the whole
range of services, from acute care to support with daily life, because of specific
health conditions or general frailty.
Health and social care services tend to involve a lot of one-to-one support. If
the number of people needing services increases, then even more staff will be
required to provide them.
Finally, conditions linked to older age, such as dementia, are becoming more
common. These will require more staff to have a greater range of specialist
skills and training.
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It is worth noting that these factors affect the services provided by the Health
and Social Services Department, but they also impact on private-sector service
providers – particularly local nursing and residential care homes.
b) Funding
The cost of health care, in particular, is expected to increase over the coming
decades. There are several reasons for this increase:
The ageing population: As explained above, older adults tend to be
bigger users of health services. This will increase the demand for services
which, in many cases, have already reached their current capacity.
Healthcare inflation: The cost of providing health services tends to
increase by at least 3% per annum above inflation. This is largely driven
by the adoption of new technologies.
We do not expect the economy to keep pace with the cost of providing health
and social care, particularly as the proportion of working age people will get
smaller and smaller if the population cap takes effect.
In the immediate future, States Departments will also be required to make
significant “efficiency savings” through the Financial Transformation
Programme, which is expected to save £31 million.
The King’s Fund report estimated that Guernsey could reduce its overall
healthcare spending by 3% per annum by investing in preventive measures.
This would counterbalance the effects of healthcare inflation, but would do
nothing to reduce the impact of growing demand for services or a shrinking tax
take (the result of a smaller working population and low economic growth).
In addition, as the number of older adults increases, and the number of
working age people supporting them gets smaller, families may not be able to
fund care home “top-ups” or private care for older relatives.
If this happens, the States will need to step in to meet those needs – either by
providing its own services, or by meeting costs through the benefits system.
Whatever happens, it is very likely that HSSD will have to do “more with less”
over the coming years.
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c) Predicting and meeting need
Population projections clearly show that the number of older and very old
people will increase over the next thirty years. We know this tends to be linked
to significant increases in demand for health care and social care services.
However, we lack clear and consistent data on people’s current needs, which
would allow us to plan effectively for the future. In particular, we do not collect
data on primary care visits, and data for other services is still recorded on a
variety of different systems.
We have even less information on older patients accessing non-States-funded
services in primary care. We currently have no information (except anecdotal)
about whether current arrangements meet needs, what barriers to access
exist, or the quality of the service provided. We do have evidence on a lack of
alignment of services, and the difficulties of creating best-practice care
pathways in such a fragmented environment.
Successful service delivery often depends on integrating a number of services
which makes data collection and analysis a particular challenge. Although
some data is collected and monitored, providers of health and social care
services are not currently required to produce any Key Performance Indicator
(KPI) data on outcomes.
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7. Our Work for 2012 and beyond
The work that HSSD is undertaking for 2012 and beyond fits within the
strategic framework of the 2020 Vision. This includes the following key areas
of work, which reflect the key challenges ahead:
Promote healthy lifestyle choices and social wellbeing
• Develop a Mental Health and Wellbeing Strategy.
• Develop a Health Improvement Strategic Framework.
• Develop a Health Protection Strategic Framework.
Improve services, continuously striving for safety, quality,
efficiency and effectiveness
• Develop a Disability and Inclusion Strategy.
• Continue the EHSCR programme.
• Undertake the Phase 6B Development replacing the Castel
Hospital (Mental Health).
Protect and support the community
• Develop a Vulnerable Adults policy.
• Contribute to the Criminal Justice strategy.
• Develop a Supported Living and Ageing Well Strategy.
Key Enabling Plans
• Develop governance and assurance processes and structures.
• Develop a communication and engagement plan.
• Improve regulation of healthcare professionals and organisations.
Key Client Strategies
• Undertake a Review of Acute Services.
• Develop the Childrens and Young People's Plan 2013-2017.
All of these will be included in the 2020 Vision Refresh which is being
undertaken in 2012.
For further information please see the key points in Annex 2 (pages 29 &
30). These are the aims for HSSD and other States departments and Annex
3a and 3b (pages 31-33) outline how these aims are going to be met.
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8. Balancing the books
a) Revenue budget
In 2012, the annual revenue budget for HSSD has been set at £106.9 million.
This is summarised below. Further details, broken down by service area, are
provided in Annex 4 (page 34). The following figures are taken from the 2012
Budget report (Billet d'État XXII of 2011 refers).
2010
Actual
£000
72,632
42,243
114,875
-7,190
107,685
2011
Original
Budget
£000
71,506
44,663
116,169
-8,669
107,500
Net Expenditure by Category
2012
Budget
£000
Staff costs
Non pay costs
Gross expenditure
Operating Income
FTP General Efficiency Target
Total net expenditure
74,305
43,624
117,929
-8,679
-2,350
106,900
b) Capital expenditure
The routine capital allocation for 2012 is £2 million. In addition the department
has carried forward £1.4 million from 2011, as well as £0.5 million set aside for
a replacement MRI scanner. Furthermore there are residual sums for major
schemes including the new clinical block at the Princess Elizabeth Hospital.
Planning is under way on a new mental health block, known as Phase 6B,
which is anticipated to be some £26 million.
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2010
Actual
£000
298
230
630
1,158
1,158
2011
Original
Budget
£000
1,830
225
1,170
3,225
(1,225)
2,000
2012
Budget
£000
Routine Capital Expenditure
Miscellaneous Capital Works
IT projects and Equipment
Equipment, Machinery and Vehicles
Routine Capital Expenditure
Use of Accumulated Capital Allocation
Funded from Routine Capital
Allocation
2,430
250
715
3,395
(1,395)
2,000
c) Efficiency targets
In setting the budget for 2012, HSSD was issued an efficiency target of £2.3
million. Significant progress has already been made in delivering this target.
Some £455,000 is expected to be saved due to existing FTP projects, £984,000
from ongoing savings and £494,000 from one-off savings through a budget
review, following an under-spend in 2011. A further £417,000 has been saved
by deferring two States Strategic Plan projects until 2013. This means that
£911,000 of savings have been achieved through non-repeatable measures.
Further ongoing savings of this amount will need to be found by 2013.
The additional savings target of £2.35 million needs to be seen in the context
of a wider efficiency and budget reduction plan that has already been largely
delivered by the Department. During 2011, £5.1 million of savings were
delivered comprising £3.8 million to bring the budget back into balance and
£1.3 million towards the Financial Transformation Programme. If the £2.35
million is achieved in 2012, this will take total savings delivered to £7.4 million,
or over 50% of the total target of £14.4 million.
The residual balance of £7 million will form two new targets: £4.7 million in
2013 and £2.35 million in 2014. Whilst some of these will be delivered through
emerging HSSD specific FTP savings projects, a significant proportion can only
be delivered through wider cross-cutting corporate efficiency projects.
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The Department has made significant savings by keeping its level of
expenditure the same during the last 4 years. It is committed to continuing
financial restraint but it recognises that making any further savings will be
extremely difficult and will potentially impact heavily on the level of service
that can be provided.
In considering future funding arrangements, the Department will have to
consider the following remaining options that are available to it:
Increase levels of income;
Reconfigure existing services to allow for any new essential service
provision; and/or
Reduce service level provision in areas which are less essential.
There will be some very challenging decisions to be made within this political
term of office to meet budgetary requirements and long-term challenges
facing the Island, such as demographic change towards an ageing population.
The Department is committed to making these decisions within its ethical
framework to ensure equity and transparency in the decision-making process.
The revenue budget for 2012 can be found on page 34 (Annex 4).
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9. How do we measure outcomes?
We need to monitor and measure the work we are doing, so that we can
answer two questions:
1. Are we doing what we promised, when we promised?
2. Is it working?
During 2012, we will be developing a Performance Management Framework,
which sets out the measures we will need, to prove that the changes we are
putting into practice are actually useful, and are achieving our goals.
We will then have a number of Key Performance Indicators (KPIs) which we will
use to measure the work we have done. The results will be published in our
Annual Report.
We are currently doing some research to find out whether we can measure the
Social Return on Investment (SROI) of our work. SROI is a measure that tells
you whether the projects you are doing have had a positive or negative impact
on the community, and if they have made savings in other areas – for example,
social security, justice or emergency service costs.
10. How we keep you informed
There is an increasing demand for information and knowledge about the
strategic direction of organisations. Effective communication is an essential
requirement for organisational management and efficient service delivery at
every level. It is also an important factor in achieving successful change.
Communication and engagement form part of the 2020 Vision for the future
development of the health and social care system in Guernsey and Alderney.
In order to ensure that stakeholders are informed and engaged in the changes
that will be taking place under the 2020 Vision a Communications and
Engagement Strategy will be developed and used in partnership with all
relevant parties.
More information will be made available to States members and the public by
the Health and Social Services Department during 2012.
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Annex 1 – HSSD Mandate
HEALTH AND SOCIAL SERVICES DEPARTMENT
MANDATE
(a)
To advise the States on matters relating to:
The mental, physical and social well being of the people of Guernsey and
Alderney;
And to be responsible for: -
(b)
(i)
Promoting, protecting and improving personal, environmental and
public health;
(ii)
Preventing or diagnosing and treating illness, disease and
disability;
(iii)
Caring for the sick, old, infirm and those with disabilities;
(iv)
Providing a range of social services to all age groups including
ensuring the welfare and protection of children, young people and
their families and ensuring that the best interests of the child shall
be a primary consideration.
To contribute to the achievement of strategic and corporate objectives,
both departmentally and as part of the wider States organization, by:
(i)
Developing and implementing policies and legislation, as approved
by the States, for the provision of services in accordance with this
mandate; and
(ii)
Actively supporting and participating in cross-departmental
working as part of the States Strategic Plan process and ensuring
that public resources are used to best advantage, through cooperative and flexible working practices.
27 | P a g e
(c)
To exercise the powers and duties conferred on it by extant legislation.
(d)
To exercise the powers and duties conferred on it by extant States
resolutions, including all those resolutions, or parts of resolutions, which
relate to matters for the time being within the mandate of the Health
and Social Services Department and which conferred functions upon the
former:
Board of Health
Children Board
Public Assistance Authority.
(e)
To be accountable to the States for the management and safeguarding
of public funds and other resources entrusted to the Department.
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Annex 2 - 2020 Vision: 18 Key points
Key Point 1 - Funding
Further work to understand the costs of the current
health and social care system
Key Point 2 - Transition
Smooth transition for people moving from services
through the ages
Provision and funding for those services
Key Point 3 - Balance of
Investment
Balance of investment between primary, secondary
and tertiary services and the effects of this
Key Point 4 - Inclusion
Ensure that clinicians from primary and secondary
care are able to contribute to the shape of services
Key Point 5 – Contracts
Contract negotiations with the Medical Specialist
Group, Guernsey Physiotherapy Group, Accident &
Emergency
Key Point 6 – Partnership
Strengthened joint working with charities and Not for
profit organisations (NPOs) and Non government
organisations (NGOs)
Key Point 7 - Regulation
System of regulation for all parts of the health and
social care system
Key Point 8 – Research
Research and modelling undertaken on the impact of
preventative measures
Key Point 9 – Strategies
Strategies to be developed for disability and mental
health to improve service provision and enable
people to live productive and independent lives
Key Point 10 – Alignment
Alignment of future strategy with the States’
objectives
Key Point 11 - Prioritisation
Prioritisation by the States of Guernsey to decide how
much should be invested in determinants of good
health and social wellbeing (e.g. education,
employment, housing etc)
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Key Point 12 – Promotion
Promotion of self care and independence with the
support of a social care and prevention model rather
than a health care model
Key Point 13 – Review
Review of the direction taken in health and social care
to ensure that impending demographic demand can
be met without financial overburden
Key Point 14 – Movement
Movement towards models of care more suited to
responding to chronic long term conditions and
disability
Key Point 15 – Knowledge
Knowledge about what interventions are most
effective and what level of quality of service is being
provided and what outcomes we are getting for the
investment made by the public
Key Point 16 – Prevention
Careful decision making regarding areas of
investment
Key Point 17 – Increase
Increase in potential for commercial aspects of health
care provision to be explored
Key Point 18 – Process
A process for reviewing and establishing appropriate
funding options to support the development and
implementation of the 2020 Vision in conjunction
with Policy Council, Treasury and Resources
Department, Social Security Department and other
stakeholder agencies and departments
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Annex 3a: Central and States Wide Priorities
Initiative Title
Who we are working with
SAP / Shared Service Centre
Treasury and Resources Department
Procurement
Treasury and Resources Department
Wider Area Network
Treasury and Resources Department
ICT Model
Treasury and Resources Department
Estates Rationalisation
Treasury and Resources Department
Criminal Justice Strategy
Home Department
Disability and Inclusion Strategy
Cross Departmental
Supported Living and Ageing Well
Strategy
Extra-care Housing
Housing Department
Drug and Alcohol Strategy
Home Department
Vulnerable Adults
Cross Departmental
Key Worker Housing
Housing Department
Children and Young People’s Plan 2014
Cross Departmental
Mental Health and Wellbeing Strategy
Cross Departmental
Health Improvement Strategic
Framework
Health Protection Strategic Framework
Cross Departmental
Housing Department
Cross Departmental
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Annex 3b: HSSD only Priorities
Initiative Title
Lead Directorate
Sponsoring
Director
Lead HSSD
Manager
2020 Strategic Framework
2020 Vision (Phase 2
Refresh)
2020 Organisational
Modelling
Communications and
Engagement Strategy
Funding of Health and
Social Care System
Corporate Governance
Corporate Services
Mark Cooke
Ed Freestone
Corporate Services
Mark Cooke
Ed Freestone
Corporate Services
Richard Evans
Amanda Fasola
Finance and
Performance
Corporate Services
Mark Cooke
Tom Niedrum
Richard Evans
Sonia Martin
Mental Health Legislation
Health and Social
Care Services
Finance and
Performance
Jacqui Gallienne Adrian Datta
Performance Management
Framework
Public Health Agenda
Tom Niedrum
Alan Chapman
Clinical Governance and
Public Health
Quality Strategic
Framework
Financial Transformation Programme
Stephen
Bridgman
Andrew
Harrington
Acute Review
Jacqui Gallienne Nanette Jones
Pharmacy Review
Health and Social
Care Services
Corporate Services
A & E Review
Corporate Services
Jacqui Gallienne Nanette Jones
Diagnostic Charging
Corporate Services
Richard Evans
Jan Coleman
Phase 6B (Mental Health)
Corporate Services
Richard Evans
Phil Johns
De Sausmarez Ward
Corporate Services
Richard Evans
Phil Johns
PEH Site Development
Corporate Services
(planning phase)
King Edward VII Hospital
Corporate Services
Site Development (planning
Richard Evans
Phil Johns
Richard Evans
Phil Johns
Richard Evans
Jan Coleman
Corporate Development
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phase)
The Oaks (planning phase)
EHSCR Programme
Telephony
Corporate Services
Finance and
Performance
Finance and
Performance
Richard Evans
Mark Cooke
Phil Johns
Alan Chapman
Tom Niedrum
Mark
Huntington
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Annex 4 - Revenue Budget 2012
2010
Actual
£000
24,295
4,040
4,848
33,183
11,817
12,007
11,558
2,996
12,968
2,295
53,641
7,793
8,461
16,254
342
197
915
1,187
2,299
105,719
105,719
1,966
107,685
2011 Net Expenditure by Service Area
Original
Budget
£000
Non-Formula-Led
Administration and Corporate Services
25,939 Corporate Services
4,488 Finance and Performance
5,194 Human Resources
35,621 Sub-total
Health and Social Care
10,100 Acute Hospital Services
12,060 Children’s and Maternity Services
11,620 Community and Disability Services
1,815 Health and Social Care Management
13,365 Specialist Services
1,489 States Employed Consultants
50,449 Sub-total
Off-Island Services
7,650 Acute Off Island Treatments
8,637 Out of Island Placements
16,287 Sub-total
423 Office of Children’s Covernor
Public Health Strategy
292 Clinical Governance and Chief Nurse
1,103 Community Health and Wellbeing
1,275 Public Health
2,670 Sub-total
105,450 Sub-total
- FTP General Efficiency Target
105,450
2,050 St. John Ambulance and Rescue Service
Grant
107,500 Net Expenditure by Service Area
2012
Budget
£000
25,580
5,142
5,290
36,012
10,420
11,922
12,048
1,698
13,892
1,543
51,523
7,396
8,597
15,993
532
553
1,255
1,282
3,090
107,150
(2,350)
104,800
2,100
106,900
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Glossary
Term
Explanation
Acute
In medicine, an acute disease is a disease with either or
both of:
1.
a rapid onset, as in acute infection;
2.
a short course (as opposed to a chronic course).
This adjective is part of the definition of several diseases
and is, therefore, incorporated in their name, for
instance, severe acute respiratory syndrome, acute
leukaemia.
The term acute may often be confused by the general
public to mean 'severe'. This however, is a different
characteristic and something can be acute but not
severe.
Acute hospitals are those intended for short-term
medical and/or surgical treatment and care. The related
medical speciality is called acute medicine.
Cardiology
Cardiology is a medical specialty dealing with disorders
of the heart (specifically the human heart). The field
includes medical diagnosis and treatment of congenital
heart defects, coronary artery disease, heart failure,
valvular heart disease and electrophysiology. Physicians
who specialize in this field of medicine are called
cardiologists. Physicians who specialize in cardiac surgery
are called cardiac surgeons.
Capital Expenditure Capital expenditure is spending on things which have a
useful life in excess of 1 year and which have a value of
over £5000. It includes major projects such as new
buildings or site improvements, general refurbishment
of premises, and the purchase of vehicles, plant and
equipment. Capital expenditure is funded from two
sources. Major projects are funded from the Capital
Reserve once approved by the States of Deliberation. All
other capital expenditure must be funded from the
Routine Capital Allocation.
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Children and Young The Children and Young People’s Plan is the key
People’s Plan
document for all departments delivering services to
children, young people and their families in Guernsey
and Alderney. It sets out:
the vision that we have for our children and young
people;
the key priorities and actions we commit to
undertaking in partnership;
the improved outcomes we want to achieve for
children and young people.
The Plan is produced every three years.
Children’s
Convenor
The Child, Youth and Community Tribunal (CYCT) offers
children and young people in need or in trouble the
opportunity to have their case heard outside of a court
environment.
As part of the Children (Guernsey and Alderney) Law,
2008, a Children’s Convenor was appointed. The
Convenor is responsible for considering cases where
there is concern about a child or young person. If the
Convenor decides that grounds set out in the law may be
met, the case can be referred to the CYCT.
Based on factual reports and information presented,
Tribunal members will then decide what action is
required in the best interests of the child. They will be
required to make an informed and unbiased decision on
whether the child needs to be protected, guided or
controlled.
See http://www.cyct.org.gg/
Clinical Governance Clinical Governance is the term used to describe a
systematic approach to maintaining and improving the
quality of patient care within a health system.
Corporate
Governance
Corporate Governance is the system by which
organisations are directed and controlled. It involves
regulatory and market mechanisms, and the roles and
relationships between an organisation’s management,
its board, its shareholders and other stakeholders.
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Criminal Justice
Strategy
In conjunction with key stakeholders, the Home
Department is presently leading on the development of
an overarching Criminal Justice Strategy. Ultimately the
Strategy will work to:
enhance the coordination of services and
initiatives
develop services and initiatives in areas of
proven need;
ensure that requests for investment in specific
initiatives arise from a clear strategic context
and are evidence-based.
Disability and
Inclusion Strategy
A Disability and Inclusion Strategy has been running
since 2010.
The main aim of the Strategy is to reduce or eliminate
the social exclusion experienced by people with
impairments and by informal carers. It will ensure that:
People have equal access to opportunities to take
part in island life.
People's needs are met in a thorough, appropriate
and coordinated way.
People are treated as individuals with a right to
make choices about their own lives.
The Strategy is multi-agency led and is coordinated by
the Disability and Equality Officer.
Drug and Alcohol
Strategy
A combined Bailiwick Drug and Alcohol Strategy has
been running from 2007. The primary aim of this
Strategy is to minimise the harm caused by drug and
alcohol misuse by Bailiwick residents of all ages.
The Strategy is multi-agency led and this significant piece
of work is coordinated by the Drug and Alcohol Strategy
Coordinator.
Estates
Rationalisation
HSSD is currently in the process of assessing the number
of properties under its administration and relocating
services to ensure the most efficient use of its
properties.
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Extra Care Housing
Extra care housing has been viewed increasingly as a
community-based alternative to institutional residential
care. However, extra care housing can also provide more
multidimensional solutions ranging from providing an
alternative to residential care to enabling individuals to
age in place.
There are two major underlying themes that define extra
care housing:
it is a type of housing;
there is access to on-site 24-hour, 7 day a week care
and support services which are flexibly delivered
according to need.
Gynaecology
Gynaecology is the medical practice dealing with the
health of the female reproductive system (uterus,
vagina, and ovaries). Literally, outside medicine, it means
"the science of women". Its counterpart is andrology,
which deals with medical issues specific to the male
reproductive system.
Key Performance
Indicators
A key performance indicator is a measure of how an
organisation is meeting its objectives.
Key Worker
Housing
Social housing projects for key workers (e.g. nurses,
police, etc.)
Mandate
Written authorization and/or command by a person,
group, or organisation (the ‘mandator’) to another (the
‘mandatory’) to take a certain course of action. The
States of Guernsey gives each of its departments a
‘mandate’ to follow.
Medical Specialist
Group
The Medical Specialist Group (MSG) provides the
emergency and elective specialist medical services for
the Bailiwick of Guernsey within the secondary health
care framework of Guernsey. This is in partnership with
the Health and Social Services Department.
Multi Disciplinary
Team (MDT)
A Multi Disciplinary Team is when professionals from a
range of disciplines work together to deliver
comprehensive care that addresses as many of the
service users needs as possible.
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Mental Health and
Wellbeing Strategy
The Mental Health and Wellbeing Strategy will provide
the vision for the future of mental health services. It will:
promote good mental health and wellbeing;
provide accessible and acceptable support for
people as they live their lives;
provide timely, respectful and effective intervention,
in partnership with other agencies, when needed.
Midwifery
Midwifery is a health care profession in which providers
offer care to childbearing women during pregnancy,
labour and birth, and during the period after childbirth.
They also help care for the newborn and assist the
mother with breastfeeding.
Obstetrics
Obstetrics is the medical specialty dealing with the care
of all women's reproductive tracts and their children
during pregnancy (prenatal period), childbirth and the
postnatal period.
Occupational
Therapy
According to the World Federation of Occupational
Therapy, “occupational therapy is a profession concerned
with promoting health and well being through
engagement in occupation." Occupational therapy (also
abbreviated as OT) is a holistic health care profession
that aims to promote health by enabling individuals to
perform meaningful and purposeful activities across the
lifespan. Occupational therapists use treatments to
develop, recover, or maintain the daily living and work
skills of their patients with a physical, mental or
developmental condition.
Oncology
Oncology is a branch of medicine that deals with cancer.
A medical professional who practices oncology is an
oncologist.
PCCL
The Primary Care Company Limited (PCCL) provides
medical care services for patients attending the
emergency care facility at the Princess Elizabeth
Hospital. It also provides the medical cover to ensure
there is always a doctor available in the PEH.
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Performance
Management
Performance management consists of a set of
management and analytic processes, supported by
technology, that enable organisations to define strategic
goals and then measure and manage performance
against those goals.
HSSD is developing a performance management
framework which will use tools to measure its
performance against its strategic and wider States
corporate objectives.
Physiotherapy
Physiotherapy is a health care profession primarily
concerned with the remediation of impairments and
disabilities and the promotion of mobility, functional
ability, quality of life and movement potential through
examination, evaluation, diagnosis and physical
intervention. In addition to clinical practice, other
activities encompassed in the physical therapy
profession include research, education, consultation and
administration.
Primary Care
There are three primary care practices in Guernsey and
two in Alderney. The GPs are usually the first point of
contact for an individual when they require support or
help. Most practices have other services including
physiotherapy, chiropody and osteopathy. If a GP feels
that a problem requires further investigation or
intervention, they may refer to a consultant at the
Medical Specialist Group or to one of HSSD’s community
teams, for example.
Radiology
Radiology is a medical specialty that employs the use of
imaging to both diagnose and treat disease visualised
within the human body. Radiologists use a variety of
imaging technologies (such as x-ray radiography,
ultrasound, computed tomography (CT), nuclear
medicine, and magnetic resonance imaging (MRI) to
diagnose or treat diseases.
Revenue
Revenue expenditure is everything that is not deemed
capital expenditure, and covers all day to day activity,
including staffing costs and running expenses, less any
income that is received such as for the provision of
private health care. Revenue expenditure is funded from
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general taxation through the allocation of cash limited
budgets to Departments.
Secondary Care
Secondary care includes anything that needs further
intervention after going through the primary care
system. This largely involves accommodation-based
services, such as hospital, residential or nursing home
care, which are provided by HSSD, the private sector and
the charitable sector.
Stakeholder
All those who have an interest in the services delivered
by the Health and Social Services Department (e.g.
Patients, Staff, Politicians, Business Partners, Insurance
Companies, States of Guernsey, States of Alderney,
other States departments, NHS, Suppliers, etc.)
Strategic Goals
The planned objectives that an organization strives to
achieve.
Supported Living
and Ageing Well
Strategy
The Supported Living and Ageing Well Strategy is in the
process of being developed and will address the housing,
care and support needs of the ageing population and
those people with supported living needs.
Tertiary Care
Tertiary services tend to be more specialised and
complex, and include such things as cardiac surgery,
organ transplants and spinal surgery. These services are
not able to be delivered on Guernsey and an off-Island
referral is required.
Urology
Urology is the medical and surgical specialty that focuses
on the urinary tracts of males and females, and on the
reproductive system of males. Medical professionals
specializing in the field of urology are called urologists
and are trained to diagnose, treat, and manage patients
with urological disorders.
Vulnerable Adults
Policy
Safeguarding Adults can include any work or activity
which aims to support vulnerable adults to retain
independence, well-being and choice and to be able to
live a life that is free from abuse and neglect.
It is about both preventing abuse and neglect, and
promoting good practice when responding to specific
concerns.
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A cross departmental group is working on developing a
Vulnerable Adults Policy for Guernsey and Alderney.
2020 Vision
The 2020 Vision provides a framework for future
development of the health and social care system in
Guernsey and Alderney.
The purpose of the framework is to:
describe the current health and social care system in
Guernsey and Alderney and the estimated costs;
establish the key principles within which States
Departments can plan,
develop and deliver health and social care services
and other related activities in Guernsey and
Alderney.
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