Category Archives: HSSD

Children’s Services Report Rebuttal

On the 13th of May the Health and Social Services Department (HSSD) published a report into children’s services that contained a number of inaccuracies. As this report was published without consultation with previous members of the board of HSSD and no attempt was made to verify its assertions prior to publication, I feel that the department have lied about my time on the board and have called into question the action of civil servants who do not have the opportunity to publicly refute the claims.

Given the failings in the report I feel it appropriate to publicly publish my email sent to Deputy Luxon and the full board of HSSD seeking correction and clarification for their action.

Dear Paul,

I know that other members of the previous HSSD board have contacted you in relation to the blatant and damaging errors contained in the recently published report concerning Children’s Services, but feel that I must add my voice to the utter dismay as to the failings of this report  and my consequent skepticism and lack of confidence in the whole report. This is highly regrettable as I believe there to be a number of areas within the HSSD Children’s Service that need addressing. The service was repeatedly the highest risk item on the department’s risk register and as such, received close attention for the whole time that I served on the board, I’m please to note that the new board is also taking this area seriously, but have little faith in this report due to the fabrication and lies that I’m able to so easily identify. Questions therefore are naturally raised as to the quality and value of the remainder of the report. This only works to undermine any findings and calls into question what the department intends to do to verify the report. Were I to be completely cynical, and it’s difficult not to be, I have to question whether the report writer has undertaken a review with findings that ensures her continued employment, as is so often the case with consultants. I sincerely hope that such cynicism will be proved incorrect, but given the questions that I outline below, I’m sure you’ll understand why I come to such a position.

  1. the report states that “Using that criteria, the service would be judged inadequate, due to the inability to evidence clear governance, the lack of outcomes measures and performance data……” Indicating what I stated clearly in the SCIP debate concerning the lack of information linked to the inadequate Child Information Database. I strongly opposed the delay in implementing this replacement system proposed in an amendment laid by Deputy Soulsby and seconded by Deputy Le Clerc to the SCIP report, I am now left wondering whether the delay in implementation has happened inadvertently by the proposer of that amendment being made chair of the very committee charged with implementing this software. Could I therefore have an assurance that the swift implementation of the Child Information Database replacement remains the main priority of the Electronic Health and Social Care Record board? How is it that the system is still in the procurement phase when the SCIP report, approved by the States in July 2014, released the funding?
  2. The report states “there is no evidence that the States takes seriously its responsibilities for corporate parenting of children in care.”. Anyone taking a cursory glance at the board meeting minutes, whenever corporate parenting was discussed, will note how seriously they were dealt with by all concerned and discussed at length. I’m sure that previous boards also took this responsibility seriously, did the report writer not have access to board minutes pertaining to corporate parenting and if not, why not? If so, how can we believe that this document is evidence based when it has ignored that very evidence?
  3. The report states there is “…..low investment in training local people into social work……..”. I was advised, repeatedly, that the real difficulty in training local people in Social Work on island was due to a lack of placements. For every placement that was possible, I was advised that the position was filled. Why has the report made no mention of the lack of possible placements as an issue but has rather focused solely on cost?
  4. The report states “ A high proportion of cases in the Assessment and Intervention Team (AIT) are subject to strategy meetings as a means of ensuring that information is shared, although less than half result in a joint investigation1.” But the superscript 1 refers to the caveat “1 Data based on my own research for the diagnostic as none was available”. With no data available, how can such an assertion be made?
  5. The report states “The senior leadership team for CSC has been seriously undermined by a lack of engagement from the previous Chief Officer and the former HSSD Board.” This is complete false nonsense. Both previous boards made visits to various parts of the HSSD estate and spent considerable time discussing issues with staff on these visits. From memory I believe there was a board meeting held at Perruque House whilst Deputy Adam was minister with a visit to the services there immediately after the board meeting. Whilst Deputy Dorey was minister I remember an extended visit to both Perruque House and the Carrefour, that same day we were expected to visit Swissville, but due to the amount of discussions and time we spent at Perruque and Carrefour we had to delay the visit to Swissville. When we did visit Swissville, this was an extensive visit with plenty of opportunity for discussion between board members and staff. I also distinctly remember visiting Lukis House with Deputy James who should be able to correct the misinformation contained in this report. Both boards also held frequent meetings with senior staff of Children’s service. I have to ask what the current board were thinking when they authorised the publication of this report with this statement? It is evident that I personally arranged a presentation for all deputies prior to the States Capital Investment Programme (SCIP) debate since we were seeking funding for the replacement Child Information Database (CID) system, did the board think that I would arrange such a presentation without discussing the issues thoroughly with the staff at children’s services? Did the board think that we would seek funding without understanding the risks currently carried by Children’s services as a result of the inadequacy of that computer system? Did the board think that we would pursue an extension to the CYPP without first having an in-depth discussions as to the merits of such actions, as opposed to the alternative of implementing the draft that was presented to us? I’m aghast as to the board’s thinking on publishing such a statement, or was it the case that the board simply didn’t read the report? Was no consideration given to the quality of the work and the appropriateness of its content? Or did the board take all the content at face value? What has the current chief officer done to rectify this blatant fabrication and what role did the chief officer have in quality assurance of the report writer and the quality of the content of the report? I’m sure in time I’ll have further questions on this aspect as it’s the one part that I’m fully able to evidence to the contrary, but for the time being, a frank and honest response is urgently required and a public apology from the report writer, board and chief officer is also expected.
  6. The report states “Managers have been clear that there was a culture where problems and issues were not to be escalated and no performance data, other than the financial risks outlined in the Governance reports was to be shared with the Board”. Anecdotally I’ve noted the agenda items for the board meeting 15th October 2014 when a governance report from the Children & Maternity service was tabled. I distinctly remember questioning the lack of content of these reports and how it would be necessary to extend the content to include outcomes and quality measurements, this was whilst the current chief officer was sat at the table. Anecdotally, further to this, I distinctly remember being advised by senior staff at HSSD how reports concerning the work, quality assurance and outcomes of other parts of the HSSD were not tabled at the board meeting due to the current Chief Officer active blocking of these reports from being progressed above the Corporate Management Team (CMT). Can the board therefore state what actions they’re taking to ensure that such reports are now tabled at the board meeting and not blocked at CMT level?
  7. The report states “….. staff and managers have had to develop their own systems and approaches, drawing on what they each believe to be good practice, rather than on what the HSSD aspires to on behalf of the population that it serves.”. Could I ask whether the governance and assurance team have been consulted on the content of this report as I believed they were actively working with the Children’s Services to agree measurements that were to be reported regularly to the board.
  8. The report states “the care offered by the residential home, Le Carrefour, is positive and well-managed, with regular meetings with young residents who are able to inform the way in which the unit is run. However, there is an appalling lack of investment in the physical fabric of the building, the transport, and in the training and development of the staff who run it, and no Board member or Chief Officer, prior to the current CO and Board, has ever visited this service”. I distinctly remember two visits to Le Carrefour whilst on the board, one of which to the residential part had to be aborted as the children who were resident were in the building at the time. I’m sure you’d agree that a visit at such a time, when specifically requested by the children resident not to have a visit from the board, would be inappropriate. On that occasion we proceeded to the secure unit part of the Carrefour only. On the second occasion the visit was extensive with a thorough discussion held between deputies and the staff running Le Carrefour and a full visit to the site was possible. It was recognised that the fabric of Le Carrefour was inadequate and a decision by the board to lease two new residential homes was made to rectify the situation for future children taken into care. A visit to these new properties as well as a number of other properties used by Children’s Services was part of the board’s rolling programme of visiting all premises forming part of the HSSD estate. All visits to the properties used by children’s services included conversations and consultations with the staff working in those locations. I’d also like to highlight how the new phase 6B development includes a secure unit to replace that at Le Carrefour.
  9. The report states in its recommendations “Immediately: Agree how the findings of this review are to be shared with staff who participated, and their views reflected where there are any disagreements with the evidence base or findings.” Evidently the report has failed on the first hurdle given that those deputies mentioned have evidenced how wrong the report’s assertions are, could I ask whether there has been a peer review of the paper by all other staff members? Who else disagrees with the report’s assertions and what is the board doing to rectify these blatant and damaging failings?

I’m still working my way through the detailed findings and will no doubt have other questions on that section, but in the interim I have these further observations on the first part of the report.

Given that the report includes such blatant lies about my conduct and time on the board of HSSD, why should I believe any other part of the report? Given these inaccuracies and down right lies, may I ask how much money was spent on the production of this report as well as how much time senior staff spent in its production and an estimated cost of their time? What peer review has been done of the report? What do the board intend to do to verify what is accurate and what else is false?

A previous report looking at the Children and Young People’s Plan was conducted by another consultant who made some review and observation of the children’s services, what has the board done in relation to those findings prior to commissioning this further report? Are we to have endless reports highlighting the problems but dealing with none?

Given the public way that the report has besmirched my name and that of all other deputies that served on the board of HSSD, I’m sure you’ll understand that I’ve published these points and ensured public circulation. I expect a swift and public apology from the department for their action and an answer to the questions above if the report is to have any credibility.

I’m sure that my anger as to this unacceptable publication is evident. I fail to understand what the report writer, chief officer or board thought they would achieve in attacking former chief officers and board members. I’m fortunate that I can publicly refute the lies included in the report, such a public platform is not afforded to the civil servants that the report made such damming attacks against, therefore I would expect the department to be issuing an apology to those civil servants as well.

I’d hoped not to enter into a public discussion on HSSD for the rest of my term as I feared that I could be viewed as being bitter, but I did not expect an attack that would justify such bitterness.

Yours in disgust and annoyance,

Elis Bebb

I await their response which I expect to be public.

HSSD Minister

Today I announced my nomination for the position of Minister of the Health and Social Services Department. In making that announcement to all deputies I sent them this letter outlining what I would seek to prioritise were I to gain the position. I feel that it is appropriate for me to publish the letter here on the website in the interest of transparency of my priorities.

I’d be equally pleased to answer any questions from the public on any matter pertaining to the role of minister of HSSD.

Dear Colleagues,

Having decided to stand for the position of minister of HSSD I thought it appropriate to share with all of you some of my views concerning the immediate future of the department. Were I to be elected I would work with the board and other departments with the aim of achieving as many of the actions below as possible whilst recognising that I would need the endorsement of the rest of the board to progress these intentions.

The PEH has been the main focus of many when talking of HSSD, but this is only one part of the department’s service offering. Mental health has gained far greater interest and attention in recent years, that is to be welcomed, but there’s scant attention given to our adult disability services for instance. Children’s services receive due close scrutiny on difficult occasions but when was the last time we heard talk of the role of the Children’s Convenor?

I’m proud that my time on the board of HSSD has been spent working closely with Mental Health and the recent organisation of Elephant Week. I’ve met every other month with carers of our Disability Services and recently attended the first meeting of the extended parent carer council, an initiative that I oversaw. I’m pleased to have been closely involved with the upcoming Sexual Health strategy, the first time we will have a strategy to deal with our high rates of teenage pregnancy and our low rates of STI diagnosis. I’ve also been diligently working with our IT department, implementing what will be a great improvement in the governance of healthcare.

The Chief Executive of the States recently circulated details of the new initiative ServiceGuernsey. Whilst I share some concern over the naming of the initiative, the principles behind it are laudable and to be welcomed. Of course in healthcare, such initiatives have long been championed under the heading of “Patient Centred Care”. HSSD is much larger than just healthcare and therefore we frequently talk of Service Users rather than patients, therefore I’d like to talk of Service User Centred Care, an equally unpalatable term, but it does describe accurately what needs to be our focus on each and every occasion, people, frequently at vulnerable points in their lives.

Some amongst you will feel that the lack of mention of finances thus far is worrying, but failure to deliver Service User Centred Care will result in similar problems, such as the current crisis that has consumed our maternity service. The cost of such failures are extensive. I will outline my thoughts on Finances later in this letter.

Maternity Service

The current crisis will be the main focus of the next board. A number of recommendations will be made by the Nursing and Midwifery Council (NMC) in their report. I’m of the opinion that a large number of the recommendations will need to be implemented without question, but for some recommendations there may be a question to ask as to the appropriate solution for a small, remote location, such as Guernsey. There’s also some questions that may need to be made as a result of Guernsey’s rather unique consultant led care with no junior doctors. This model is not unfamiliar to NHS Scotland, who have similar remote locations with a different model of healthcare delivery. I would therefore propose that the findings of the coming reports be peer reviewed by colleagues in another jurisdiction to evaluate what can reasonably be justified as not being implemented.

This is not a desire to be defensive of our services. We must recognise the failings that have occurred over a number of years and resolve to swiftly implement the findings where appropriate, but where we feel there are questions over the NMC findings we must not only act in the best interests of our population, we must also be seen to act in such a manner. A peer review allows us such an opportunity.

Part of the reason for the failings in my opinion, has been as a result of a closed environment within one of our services. This must never again be allowed to happen. I look at the partnership approach within mental health, where a number of service users call in to Albecq Ward for a discussion with service users to ensure that they receive the care that would be expected. Such visits keep our services open and transparent to the very people who’ve experienced them in the past and on occasion may need to call on the services again in the future. Specifically on Loveridge Ward, I believe there to be an association known as friends of Loveridge and I’d like to discuss a similar approach with them. We cannot rely on the medical profession alone to resolve the issues, as some of the issues are of their making.

Governance

It is evident that we cannot rely solely on the governance arrangements midwives have in place and need to improve on our internal governance arrangements. Following the incidents on Loveridge ward, the language used by the NMC and the Local Supervisory Authority (LSA) has been that of a culture. A culture of straying from procedures as being acceptable, a culture of poor relations between nurses and doctors, a culture of secrecy as a result of frequent leaks to the media. As a result of the Financial Transformation Program (FTP) two posts in the governance team were removed. We need to shore up our governance team and extend their remit, as such I would be talking about our staffing level and scope of the governance team, should they feel that an increase in staffing is necessary I would be seeking to review the staffing and skills at our disposal.

In the interim, the governance team is now looking at the individual failings in Loveridge ward and reviewing the policies across the hospital. This will give us a matrix of services areas against practice, developing a picture of where the failings lie and what actions will be necessary to tackle them.

MSG

The MSG contract will terminate in 2017 as I’m sure you’re all aware. Notice must be given in 2015 of whether the States will continue with the contract. This is an incredibly tight timeline, but given the previous reports commissioned by the department and the current crisis, I don’t believe the current contract to be a viable option. The culture of poor practice is partly borne of the current contract and the problem could be reasonably summed up in the following statement:

The Interests of the MSG are not always aligned with the interests of the PEH.

The variance of interest has already led to a culture of poor practice and the friction between senior consultants and junior nurses is detrimental to our service users.

There are different means of delivering secondary healthcare, States employed consultants, the current MSG model which could be thought of as similar to barristers in chambers, privately employed visiting consultants or a State owned company employment of all health workers. There’s also a combination of all the above that could be considered. I would seek to have a policy letter outlining the options to the States as soon as practicable, this would require a conversation with both the Social Security Department (SSD) and the Treasury and Resources Department (TRD) as the means of conducting such a review must be complementary to the benchmarking exercise that the TRD have identified in the coming budget.

Departmental Finance

The departmental budget for this year and the past two years has not been met. The proposed 2016 budget is once again lower than originally requested by the department. But whether there is an overspend or an underspend (as happened in 2011, where the significant underspend was masked by the decision of the department to undertake expenditure that should rightfully have been from TRD) the discourse is poor with only a comparison made between budget and expenditure. The context for the expenditure is simply lost and the resulting public discourse is ill informed and damaging to a department that strives to provide excellent healthcare and social care outcomes for its service users. I therefore would seek to publish quarterly financial results along with quarterly governance reporting. The number of procedures carried out in the PEH, the average length of stay, the number of hospital acquired infections, the number of service users with psychosis that we have, the number of service users with affective disorders, the number of off island complex placements and the number of off island acute placements, the number of children in our children services. When presented in that light the discourse will be greatly improved. I would therefore seek the endorsement of the States to publish such a report from the first quarter of 2015.

Capita have placed what I understand to be one of their most senior advisors to work with the HSSD for many months and have not identified any significant savings within the immediate term, even the longer term savings come with extensive caveats. This is no reason not to strive for greater savings, but the options are unpalatable. There is a fairly easy way of bringing the department back into budget and to meet a proportion of the outstanding FTP target, this would be through charging for certain services, blood tests, x-rays, parking being three obvious candidates. Jersey already employ this model in certain areas and I would seek to have a policy letter brought to the assembly as soon as practicable outlining the various charging options, but I must also state that the department may well lay the report and seek the States to reject such charging mechanisms. Neither of the previous boards this term have supported, by majority, the introduction of charging and such an outcome is conceivable of the next board.

IT

Part of the solution to the current crisis is the implementation of the EHSCR e-Prescribing module. This would tighten regulation surrounding the prescribing practices that is now overdue.

Children’s Services

The greatest risk item on the HSSD risk register remains in children’s services relating to the outdated computer system. If we are to avert another crisis we must reform the IT system and revisit working practices. This work has started, but progress is hampered by the delay in reviewing EHSCR as requested by the TRD. I know that the TRD are equally frustrated by this delay, but we must now work to release the funding and see the implementation happen as a matter of urgency.

Mental Health

Last week marked Elephant Week, an initiative to start a uniquely Guernsey week for raising awareness and tackling stigma surrounding mental health. I was the organiser of the week and brought various government departments, charitable organisations and the private sector together to deal with one of the biggest health issues we have.

The States are now working with Guernsey Mind to implement a mental health policy that should see a substantial reduction in the number of sickness days that are taken. When the Guernsey Post implemented this policy they saw a reduction of sickness days from 1,200 to 400 with 60% of that improvement seen in the first year. This is now estimated to save Guernsey Post £100,000 per annum. The opportunities for savings within the States are substantial and I believe HSSD should be at the forefront in implementing this policy.

Sexual Health

As I stated in an email to all of you recently, we need to introduce the ability to charge for contraceptive services in the Orchard Clinic. The current position of treating a Sexually Transmitted Infection (STI) and then advise service users of the need to go elsewhere for contraceptive services flies in the face of the ServiceGuernsey initiative. I believe the policy letter is written and I would therefore seek to present it to the assembly as soon as the timescales allow.

Resourcing

There are a number of promises made above, I must caveat all of them by stating that the HSSD will be tied in to a number of reviews concerning the immediate crisis in midwifery care. Throwing money at the problem won’t be a solution. The experience and knowledge of senior members will be torn between the immediate crises and the needs of benchmarking, review of healthcare and review of the MSG contract. I believe it would therefore be foolish to promise delivery of all of the above within short timescales, but I would seek to prioritise these demands with the new board and deliver to all States members a summary of the priorities and expected timescales by the end of the year.

I’d like to close by stating clearly that HSSD is facing a crisis in one part of its services. I’d suggest that what we need is experience and knowledge, when the Local Supervising Authority (LSA) described the failings as a systemic organisational failure, what the States need is someone who knows the system, understand the organisation and has a clear vision of how it needs reforming as well as the means of getting there. We also shouldn’t allow this one area to consume the board to the detriment of the rest of the department. I believe that I have the knowledge, the experience and the ability to deliver on the above and to keep all of you informed. This is not the time for us to look to an individual or a small group of five to resolve the problems, this is a time when each and every one of us need to take responsibility to the extent we can.

Thank you for your time in reading the above, should you wish to discuss any of the above or any other matter pertaining to the minister’s position on HSSD, please feel free to contact me.

Yours sincerely,

Elis Bebb.